With Clearpay, timely payments are never a concern. There is no check to write, no postage to pay. And this service is offered at no extra charge.

Here’s All You Do: Complete the Clearpay authorization form and send it with your premium payment.  In addition to your check for one month’s premiums, please enclose a blank check marked “Void”, or a deposit slip showing your preprinted bank account number. This will be used as a record of your account number, your bank’s code, and other information that we’ll need.

Federal HIPAA Privacy regulations require that an authorization form be completed and signed by any Subscriber requesting the JACL Health Benefits Administrators to assist them in any issues regarding protected health information.  After you have completed and signed the authorization form, it may be faxed to our office at 415.391.6611.

Should you ever wish to revoke your authorization at any time, you may download this "revocation of release of personal information" form and fax it to our office.