Billing and payment authorization agreements

For your security, we process payments through a secure third-party vendor, ACI Payments, Inc. (ACI Payments). Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is not responsible for ACI Payments processes including, for example the privacy policies that govern ACI Payments. Please see ACI Payments Terms and Conditions⁠ for more information. By submitting your payment, you accept the ACI Payments Terms and Conditions.

By submitting this payment, I certify that I am an authorized user of this bank account and / or credit or debit card. I understand that the bank account and / or credit or debit card listed cannot be my employer's account. If I have chosen the one-time or recurring Bank Draft option, as a convenience to me, I hereby request and authorize Blue Cross NC to initiate the debit to my bank account payable to the order of Blue Cross NC for my premium. I also authorize my financial institution to reduce the balance of my bank account by the amount of each draft. I understand the bank draft may take 1-3 days to settle with my bank.

I understand that Blue Cross NC may attempt to debit my bank account up to two times for each month's premium to ensure no lapse in coverage. Blue Cross NC does not charge a fee for this service; however, I am aware that my bank may charge a fee if there are insufficient funds to cover the payment. I agree that Blue Cross NC’s rights with respect to the bank draft shall be the same as if it were a check drawn on my bank account and signed by me personally.

If I have chosen the one-time or recurring Credit or Debit Card, as a convenience to me, I hereby request and authorize Blue Cross NC to charge my credit or debit card for my premium. I also authorize my financial institution to charge my credit or debit card account for the credit or debit card charge.

If I have chosen to save my payment method, I authorize Blue Cross NC and ACI Payments to securely store my payment information and use it for future transactions. I understand that I can update or remove the saved payment methods at any time.

To the extent that I have chosen another payment method, I agree that I have reviewed and approved the payment terms on their website. I understand that by choosing the method of payment above it will default to my preferences regarding those payments. I hereby authorize Blue Cross NC to make the payment using the payment method listed above.

I agree that if such charges be dishonored, whether with or without cause and whether intentionally or inadvertently, Blue Cross NC shall have no liability whatsoever even though dishonor results in forfeiture of insurance.

If I have chosen to enroll in paperless billing, I accept the agreement below and I am affirmatively consenting to receiving my premium and billing information electronically and understand that by doing so I will not receive paper billing. As a convenience to me, I hereby request and authorize Blue Cross NC to send all current and future premium and billing notices electronically and to discontinue sending me any paper premium notices. I acknowledge and agree that the date of receipt of my electronic premium notice shall be the date and time on which Blue Cross NC sends the electronic premium notice regardless of the date and time I receive such notice.