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Get Health Care Authority Electronic Debit Service Agreement Form
Ement The Health Care Authority (HCA) is pleased to offer electronic debit service (EDS) to subscribers of PEBB health benefits who self-pay their monthly premium. With EDS, you can have your monthly premium taken from your checking or savings account. To get started, please fill out the information below. New EDS account? q Yes q No Bank account change? q Yes q No Subscriber s Information Subscriber s name (please print) Subscriber s social security number (If you are the spouse/qualifie.
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