Get Flextoday

This comprehensive guide will provide you with step-by-step instructions on how to accurately fill out the Flextoday online, ensuring that you complete the COBRA Premium Payment Authorization Form correctly. By following these guidelines, you will be better prepared to manage your COBRA premium payments efficiently.

Follow the steps to complete the Flextoday form online.

1. Click ‘Get Form’ button to obtain the Flextoday form and open it in the editor.
2. Fill out the name and address of the payee (credit card holder). Provide the name and address details of the person making the payment, along with their phone number and email address.
3. Enter the COBRA information of the participant. Provide the name, participant ID number (SSN), address, city, state, and zip code associated with the COBRA coverage.
4. Specify the group health plan sponsor (employer) to ensure accurate processing of the premium payment.
5. Indicate the monthly COBRA premium amount due by inputting the specific dollar amount.
6. Select the payment method by checking either 'Check' or 'Card'. If you choose to pay by card, enter the card number, select the card type (Visa or MasterCard), and fill in the CSS and CVV codes.
7. Provide the expiration date of the credit card in the format MM/YYYY.
8. Review the general provisions regarding timely payments and the credit card convenience fee. Ensure you understand and agree to the terms outlined in the form.
9. Sign and date the form in the designated area to authorize the payment.
10. Once all fields are completed, save your changes, then download, print, or share the form as needed. You can fax it to FlexToday or mail it to the provided address.

Take control of your COBRA premium payments by completing the Flextoday form online today.