Find the corresponding description for each section at the bottom of this page.

1. Primary Billing Number and Member Number
   Please have both numbers available when calling customer care.
2. Due Date
   Your bill must be paid in full on or before this date to avoid possible late fees.
3. Payment Account/Credit Card/Bank Deduct
   Please indicate the payment amount included with your remittance. If Credit Card or Bank Deduct, your payment will be made automatically on the 5th of each month and there is no need to send a payment.
4. Change of Address/Payment Options
   Check this box and complete form on reverse to change your mailing address or set up automatic payments.
5. Previous Balance
   Balance from the previous month(s) bill.
6. Payments
   Total of all payments applied during previous month.
7. Balance Forward/Past Due Balance
   This amount, if any, is due immediately on your account.
8. Total Current Charges
   Total of this month’s current activity.
9. Total Amount Due
   Current Charges plus Past Due Balance. You will need to pay this amount.