Cobra Payment

Please complete the form below to submit your COBRA Payment. Please note: A convenience fee of 3.5% applies to all online COBRA payments.

To avoid this fee, a check can be mailed to:
PO Box 1226
Brick N.J. 08723

Personal Information
(in addition to the receipt I will receive via email).
Payment Details
This is the 3 digit number printed on the back signature panel.
By proceeding with your COBRA payment, you acknowledge and agree that this transaction is final and non-refundable. Once the payment is submitted, it cannot be disputed, reversed, or charged back under any circumstances. Please ensure that you have reviewed all payment details carefully before submitting your payment. If this payment is received after the 30-day grace period for your premium payment, Flex Facts will return the payment.