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Use this form to allow your plan to withdraw your monthly plan premium payment from your checking account on the 15th of each month.
Please return the EFT form to the following address:
University of Maryland Health Advantage Attention: Premium Billing 1966 Greenspring Drive, Suite 100 Timonium, MD 21093
Use this form to sign-up to have your monthly plan premium automatically deducted from your Social Security or Railroad Retirement Board check.
Please return the Social Security & Railroad Retirement Board Premium Deduction Authorization Form to the following address:
University of Maryland Health Advantage Attention: Enrollment 1966 Greenspring Drive, Suite 100 Timonium, MD 21093