Policyholder Services

Premium Payment — Credit Card

General Payment Information

• Policy No. *
  
• Invoice Number
  
• Payment Amount * Example: 1234.56
  
  
• Phone *
  

Credit Card Billing Address

• First Name
  Must Match
  Credit Card
  
  
• Last Name *
  (or Organization)
  Must Match
  Credit Card
  
  
• Street *
  
• City *
  
• State * Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
  
• Zip Code *
  

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Credit Card Information

• Card Type* Mastercard Visa American Express
  

• Credit Card Number: *
  Card Expiration: *
  Card CVV: *

  
  

 

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• Billing/Premium Q&A

  •   -- Discounts (7)

            What risk management courses have I completed?

            Did I receive my risk management discount?

            Does OMIC offer a risk management discount to physicians who use electronic medical records (EMR)?

            How do I sign up for a risk management course?

            What other discounts are available?

            What risk management seminars qualify me for a discount?

            Does OMIC offer a part-time discount?

  •   -- Dividends (1)

            Does OMIC pay dividends?

  •   -- Payment (12)

            When will I receive my refund?

            Can I get a refund if I overpaid my premium or if my premium is reduced because of discounts or practice changes?

            I’m having financial difficulties. Can I have an extension or make arrangements for a special payment schedule?

            Did you receive my payment?

            Will I be charged a fee if I pay quarterly?

            Can I pay monthly instead of quarterly?

            Can I have automatic deductions made from my credit card?

            How long is my credit card authorization good for?

            Does OMIC have a grace period?

            What is the amount due?

            When is my payment due?

            Do I have to pay my annual premium in full when I join?

  •   -- Premium (11)

            Will my OMIC premium decrease if I discontinue performing refractive surgery?

            How are premiums determined?

            What if I practice in more than one state or territory?

            Will I pay a lower premium if I limit my practice to refractions, low vision screening, or other non-surgical activities?

            Are refractive surgeons charged a higher premium than physicians who do not perform refractive surgery?

            Will my premium be based on the types of procedures I perform?

            My hospital has agreed to cover me for ROP services I render. How will this affect my coverage with OMIC and my premium?

            I will be taking 8 weeks of maternity leave. Can I place my policy on inactive status during this time to reduce my premium?

            If I have a claim, will it increase my premium or allow you to cancel my coverage?

            What will my premium be if I perform liposuction, facelifts, and rhinoplasty?

            Can OMIC ever assess me for additional premium?