PSEA | Essential Family

Step 1: Billing Information

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First Name

Last Name

Phone

PSEA Member ID

If you do not know your ID, please call PSEA Member Benefits at 1-800-944-7732 ext. 7127

or enter 111111 as a temporary ID. Membership will be verified.

PSEA Members and their parents, siblings and children are eligible for the PSEA plan discount. Relatives please use members PSEA ID above.

Address

City

Zip Code

Step 2: Payment Information

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Name On Card:

Card Number

CVC

Step 3: Plan Information (check one box)

I would like to pay for my plan monthly (check box).

Automatic renewal monthly at $5.00

I would like to pay for my plan annually (check box).

Automatic renewal annually at $60.00

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After payment submission, you will receive activation instructions via email. Your account will not be active until this step has been completed.

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