Rx Pay Card Brochure - IHC Health Solutions 2026

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  1. Click ‘Get Form’ to open the Rx Pay Card Brochure in the editor.
  2. Begin by filling out Section A, 'Tell Us About Yourself.' Enter your name, date of birth, age, sex, social security number, phone number, occupation, and addresses. Ensure all information is accurate for processing.
  3. In Section B, 'Choose Your Desired Coverage,' select your coverage option by checking the appropriate box for Member or Member + Dependents.
  4. Proceed to calculate your monthly cost based on your selected coverage. Input the total amount in the designated field.
  5. Complete Section C by selecting your payment options. Choose between automatic bank withdrawal or credit card payment and provide necessary details.
  6. Finally, review all entered information for accuracy before signing and dating the application at the bottom of the form.

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