Premium Payment Terms & 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 855-540-4744.  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)