P.A.Y.S. RD 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 1-855-302-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. RD Initial Payment Activation Forms: (required to activate a benefit)
Automotive Expense
Birth of Child/Grandchild
Critical Illness
Death of Spouse
Hospitalization
Move to New Residence
Veterinary Expense


P.A.Y.S. RD Continuing Payment Activation Form: (required verification for subsequent benefits to be issued)
Hospitalization