Welcome to QualChoice Online Payment

Pay your premiums quickly, accurately and securely from your bank account. Just fill in the fields below, review and submit your payment. Your payment should be processed within two business days.

If you have received notice that your account is on pharmacy or medical hold: It may be up to two business days after your payment has been processed before those benefits are available.

This is a one-time payment only. To set up recurring payments, please complete the correct form below:

For Group Policies:
Authorization Agreement for Automatic Payments

For Individual Policies:
Billing and Payment Authorization Form - IQChoice

For MediQ65 Medicare Supplement Policies:
Billing and Payment Authorization Form

Mail to:

QualChoice Finance Department
P.O. Box 25610
Little Rock AR 72221

For questions or help, contact:
800.235.7111, ext. 7023

QualChoice Account Information (required fields marked *)

Bank Information (required fields marked *)