P.A.Y.S. Payment Protection Plan



Note: Activation Number must be included on your form in order to be processed by our Plan Administrator. If you do not have this number, please contact the Plan Administrator toll-free at 1-877-940-PAYS (7297) to get an Activation Number. Forms received without an Activation Number cannot be processed.

Also, please ensure you complete and submit the correct form. Initial Payment Activation Form is required to activate a benefit. Continuing Payment Activation Form is required verification for subsequent benefits to be issued.


P.A.Y.S. Initial Payment Activation Forms: (required to activate a benefit)
Automotive Expense
Birth of Child
Disability
Divorce/Legal Separation
Family Leave of Absence
Hospitalization
Identity Theft
Involuntary Unemployment
Marriage
Purchase of New Residence
Veterinary Expense


P.A.Y.S. Continuing Payment Activation Forms: (required verification for any subsequent benefits to be issued)
Disability
Family Leave of Absence
Hospitalization
Involuntary Unemployment