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PMC Employees needing to make a payment for their Health, Life Insurance and other premiums may do so using the secure form below.

 

FULL Name: *
Date of Birth: *
Last 4 digits of your Social Security Number: *
Phone: *
Email: *
Health Insurance Amount:
Do not enter a dollar sign.
$
Dental Insurance Amount:
Do not enter a dollar sign.
$
Supplemental Life Amount
Do not enter a dollar sign.
$
Long Term Disability Buy-up:
Do not enter a dollar sign.
$

Please double check the amounts entered above. Overpayments may cause funds to become reserved on your card and it could take several business days for a refund to go through.

Payment




Credit card number:

Exp Month/Year /

CVV (3 digit verification number on card):

 

 

WARNING

Please only press the payment link/button below *ONCE* and allow time to process!!!
Pressing a second time will likely cause a double charge!