Electronic funds transfer (EFT) enrollment form

Set up auto pay with electronic funds transfer (EFT)

It's secure, easy and convenient. Set up your EFT by logging in to your member account and clicking Pay My Premium.

Important things to know:

• On the first day of the month, we will automatically debit the account that you name on the form.
• You will no longer get a bill by mail each month.
• If your bank account does not have sufficient funds to cover your plan’s premium payment, Priority Health reserves the right to charge a non-sufficient funds (NSF) fee up to the amount allowed by the state of Michigan, which is $25.

Change your EFT information

Send us an EFT request form by the 25th day of the month. Automatic premium payments will start on the first of the upcoming month.

Cancel EFT payments

We need 30 days' advance notice. Send your notice to:
Priority Health, MS 1190
1231 East Beltline NE
Grand Rapids, MI 49525

Or, call the Customer Service phone number on the back of your member ID card.