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Health care authority electronic debit service agreement form

Health care authority electronic debit service agreement form 2025

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The document outlines the Electronic Debit Service (EDS) available for self-pay PEBB subscribers, detailing the process to authorize monthly premium withdrawals from a bank account. It includes instructions for completing the EDS agreement, necessary information required, and guidelines for changes or cancellations. Subscribers must continue paying premiums until notified of their EDS start date.

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Versions	Form popularity	Fillable & printable
2018	4.7 Satisfied (46 Votes)
2012	4.9 Satisfied (42 Votes)

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