Premiums


Click here to download the Premium Submission Form

Due Date: Premiums are due on the first day of the month of coverage. If payments are not made within the coverage month, An Intent to Cancel letter will be sent out. If the premium is not made within 45 days of the due date, the account is subject to termination without further notice. Please note that non-payment notices are not required by the policy, and if issued, are to be construed as a courtesy extended by Montgomery Management.
Premium Payment Forms: All premium payments or adjustments must be accompanied by a Premium Accounting worksheet.

Customized worksheets are acceptable if they include the following data:

  • Coverage period of payment
  • Census by coverage type (single/family)
  • Rates by coverage type
  • Commission rate and amount being deducted (if applicable)
  • Name and phone number of the person preparing the premium worksheet

Any adjustments must be made within three months of the original payment. The adjustment should be itemized on a separate premium worksheet containing all the information required for a regular premium payment.

Contact Information
For more information, contact Donna Dickinson, at (800) 883-1500 X115, or via e-mail at ddickinson@montmgmt.com

W-9 Forms
Any broker or TPA receiving or withholding commissions, must submit a completed W-9 form to MMC. To download a copy of the form, please click here, or contact Donna Dickinson at the above number. These forms are also available at www.irs.gov.
Click here to download a blank W-9 form.

Send Premiums to:
For Stop Loss or Life/AD&D payments
Wachovia Bank
Montgomery Management Lockbox #931833
3585 Atlanta Avenue
Hapeville, GA 30354

For Aggregate Only Premium payments
Wachovia Bank
Montgomery Management Lockbox #935130
3585 Atlanta Avenue
Hapeville, GA 30354

If you are interested in making payments by wire/ACH, please feel free to contact us and we will provide you with all necessary banking information.

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