Retiree Request for Bank Draft

Many University retirees have found monthly automated bank draft procedures a simple and efficient way to pay their monthly insurance premiums. With your authorization, The Accounts Receivable Department will draft your bank account each month for the premium amount. A notice of the amount to be deducted is sent to each retiree prior to the premium due date. Deductions occur on the 5th day of the month the premium is due or the next business day after that date. Download the Request for Bank Draft for Insurance Premiums form, and please attach a voided check to the completed, printed form and return it to the Accounts Receivable Department.