DIRECT PAYMENT PLAN - South Dakota State Employee Health Plan - benefits sd 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information, including your name, address, and daytime phone number. Ensure accuracy for seamless communication.
3. Next, provide the name of your financial institution along with its city, state, and zip code. This is crucial for setting up the direct payment.
4. Indicate whether you are using a checking or savings account by circling the appropriate option. Then, enter your routing number and account number.
5. Select which premiums you wish to deduct by circling all applicable options: Health, Life, Dental, Vision, or Medical Reimbursement Account.
6. Attach a voided check to authorize payments from your account. This step is essential for verification purposes.
7. Finally, sign and date the form at the bottom. If someone else is signing on behalf of the account holder, ensure they also provide their signature.

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