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COBRA/Direct Bill
Administration  >  Online Payment

Make a payment  
* Required Fields

To make a monthly payment from your checking or savings account, Please complete the information below and select submit.

Please Note:  This is not a recurring payment, You will need to log in each month and complete this form.

 OR

To sign up for recurring monthly withdrawals from your checking or savings account complete the Authorization for Automatic withdrawal of insurance premiums form and submit to UnitedHealthcare (Fax 262-797-0719)

Make a Payment

Total Balance: $0.00

* Step 1 - Select Payment Amount
      
       - $

Step 2 - Enter your Account Information


The Routing number is on the bottom of the check the left set of numbers.
* Enter your routing number:
* Re-enter your routing number:

The Account number is on the bottom of the check and is the second set of numbers. The Check number is not to be included in the information provided but is the last set of number.
* Enter your account number:
* Re-enter your account number:
* Account Type
      
      
* Name on check:
* Address on check:
* City:
* State:
* Zip:
* Email address:

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