Automatic bill payment enrollment form

You can set up an automatic monthly electronic fund transfer (EFT) to pay your monthly premiums by filling out a form, below. Here's how it works.

How EFT works

When your payment is transferred:

  • On the 1st or 10th day of the month, we will automatically debit the checking or savings account that you name on the form.
  • You will no longer get a bill by mail each month.

If your bank account does not have sufficient funds to cover your plan’s premium payment, Priority Health reserves the right to charge a non-sufficient funds (NSF) fee up to the amount allowed by the state of Michigan, which is $25.

To set up EFT premium payments

Send us an EFT request form by the 25th day of the month. Automatic premium payments will start on the first of the upcoming month.

To cancel EFT premium payments

We need 30 days' advance notice. Send your notice to: Priority Health, MS 1190, 1231 East Beltline NE, Grand Rapids, MI 49525.


Sign up now