Premium Payment Terms and Conditions

For information on how prescription drug plan premiums are billed and how you can pay your premiums please review the Part D Member Premium Billing Fact Sheet (PDF).

For questions regarding payment of your prescription drug plan premium, please call Member Services at 866-643-6924.  TTY users should call 711.

Hours of operation:

• October 1 – March 31: 8:00 a.m. to 8:00 p.m., seven (7) days a week.
• April 1 – September 30: 8:00 a.m. to 8:00 p.m., Monday-Friday.

Premium Payment Forms

• Credit Card Authorization (PDF)
• Bank Withdrawal Pre-Authorization Form (PDF)
• Part D Member Premium Billing Fact Sheet (PDF)