All LRFA members may pay by check, money order, or simply use the online form below to submit a payment for your current Benefit Plans.

Confirmation email will be sent to you once we receive payment.

Please provide the following information: (Red indicates a required field)

Your Information

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Please enter the applicable fees from your invoice.

You may pay for one or more months in the current year (please note how many months you are paying for on each plan and multiply fees accordingly).

Medicare Supplemental Plan Months Amount Due
  M-Basic   M-1   M-2   M-3   M-4   M-5   M-6   M-7
$
Health Supplemental Plan    
  H1-20   H1-50   H1-80
  H2-20   H2-50   H2-80
  H3-20   H3-50   H3-80
$
Hospital Supplemental Plan    
  Group I   Group II   Group III   Spec. A   Spec. B
$
Medical Plan for Visitors from Abroad    
  Plan A   Plan B
$
Mortuary Plan    
Plans       B   C   D   E   F   G   H   I   J
$
  Benefit Plan Fees:
$
  Online payment fee: 
$
  Donation (optional): 
$
  Annual Membership Fee $30: 
$
  Total Payment: 
$

By submitting this form, I agree to all the terms of the LRFA Benefit Plans.