Employee Benefit Premium Payments

PMC Employees needing to make a payment for their Health, Life Insurance and other premiums may do so using the secure form below.

FULL Name: *
Date of Birth: *
Last 4 digits of your Social Security Number: *
Phone: *
Email: *
Health Insurance Amount: Do not enter a dollar sign.	$
Dental Insurance Amount: Do not enter a dollar sign.	$
Supplemental Life Amount Do not enter a dollar sign.	$
Long Term Disability Buy-up: Do not enter a dollar sign.	$

Please double check the amounts entered above. Overpayments may cause funds to become reserved on your card and it could take several business days for a refund to go through.

Accepted Cards

Credit card number:

Exp Month/Year /

CVV (3 digit verification number on card):