KelseyCare Advantage offers three convenient methods to pay your monthly premium. Simply download the form below that best suits your needs, then send the completed form to us by mail, email, or fax. You will receive a confirmation by phone or email each time your payment is received.
To pay your plan premium by Electronic Funds Transfer (EFT) each month, download, complete, and return the form below. Your monthly plan premium will be automatically withdrawn from your bank account.
To pay your plan premium by deduction from your Social Security Benefit, download, complete, and return the form below. Once the form is received, KelseyCare Advantage will submit the premium withhold request on your behalf to your selected Benefit Administrator for the next available effective date.
To pay your plan premium by deduction from your Railroad Retirement Benefit, download, complete, and return the form below. Once the form is received, KelseyCare Advantage will submit the premium withhold request on your behalf to your selected Benefit Administrator for the next available effective date.
MAIL:
KelseyCare Advantage
ATTN: Enrollment
P.O. Box 841569
Pearland, TX 77584
FAX: 713-442-9536
Email: KCAPA@kelsey-seybold.com
Reach out to a KelseyCare Advantage Member Services specialist by calling 713-442-CARE (2273), option 2, or toll-free at 1-866-535-8343 (TTY:711).
October 1 - March 31, 8 a.m. to 8 p.m., seven days a week
April 1 - September 30, 8 a.m. to 8 p.m., Monday through Friday
Always at Your Service
Call Member Services at 713-442-CARE (2273)
or toll-free at 1-866-535-8343 (TTY: 711)
8 a.m.– 8 p.m. | 7 days a week | From October 1 to March 31
8 a.m.– 8 p.m. | Monday – Friday | From April 1 to September 30
