Electronic Premium Notice Authorization Agreement
By accepting the agreement below, I am affirmatively consenting to receiving my premium notices via email and understand that by doing so I will not receive paper premium notices or premium notices in some other non-electronic form. As a convenience to me, I hereby request and authorize Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to send all current and future premium notices electronically and to discontinue sending me any paper premium notices. I acknowledge and agree that the date of receipt of my electronic premium notice shall be the date and time on which Blue Cross NC sends the electronic premium notice regardless of the date and time I receive such notice.
I understand that I may request a copy of my premium notice in paper by contacting Blue Cross NC’s Customer Service Department at 1-888-206-4697. I understand that I may withdraw my consent to have my premium notices sent to me electronically by logging into My Member Services and utilizing the 'Manage Billing & Payments' tool.
I understand that it is my responsibility to ensure Blue Cross NC has been given my up-to-date email address and that it is in fact correct and accurate. I further understand that I am solely responsible for ensuring my email address is functioning properly at all times and that Blue Cross NC has no liability for errors in transmission of the electronic premium notices other than addressing the electronic premium notices to the email address I provide.
By electing to have my premium notices sent to me electronically, I am certifying that I am aware of the hardware and software requirements for access to and retention of the electronic premium notices and my email system is compatible with the required hardware and software systems. To receive electronic premium notices, subscribers must have a computer with Internet access and an email client capable of receiving SMTP emails. Please check your software documentation or contact your software manufacturer if you need assistance in setting up your email configuration.
I understand that Blue Cross NC’s policy on the use of electronic premium notices is subject to change by Blue Cross NC at any time in its discretion by updating this Authorization. I understand that my continued use of the electronic premium notices process after such changes are implemented constitutes my acceptance of the changes and continued authorization. Please consult this Authorization in the Billing and Payments FAQ section regularly for any changes.
Payment Authorization Agreement
By accepting the agreement below, I am an authorized user of this bank account. As a convenience to me, I hereby request and authorize Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to initiate the charge to my bank account payable to the order of Blue Cross NC. I agree that Blue Cross NC’s rights in respect to each bank draft shall be the same as if it were a check drawn on my bank account, and signed by me personally. I also authorize the financial institution to reduce the balance of my bank account by the amount of the bank draft.
If this authorization is for recurring monthly back drafts it will remain in effect until I revoke it through the facilities of this web site or in writing at least 10 days prior to the date the account is scheduled to be charged. I agree that if such charges be dishonored, whether with or without cause and whether intentionally or inadvertently, Blue Cross NC shall have no liability whatsoever even though dishonor results in forfeiture of insurance. The amount accepted for payment by Blue Cross NC systems will be charged upon this authorization.