If you are enrolling in the Traditional PPO/Copay Plan, please select your payment method (payroll, credit/debit card, or bank account) for automatic minimum payments with this form: 

COPAY PLAN ONLY - Payment Account Selection Form for Payment Protection Program

 

If you are enrolling in the High Deductible Health Plan but do not want your Vive HSA automatically used to pay your out-of-pocket costs, you may authorize another form of payment for your SimplePay Health monthly statements through this HSA Payment Opt-Out Form:

HIGH DEDUCTIBLE PLAN ONLY - HSA Payment Opt-Out Form (Optional)

 

Please reach out your SimplePay Health Pro at 1-800-606-3564 or HealthValet@simplepayhealth.com with any questions or concerns.

Q&A – How to access your member portal on app

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