New EFT/PAC Form

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New EFT/PAC Form

We are pleased to announce that we have an improved Electronic Funds Transfer/Pre-Authorized Check (EFT/PAC) form designed to help get policies placed and delivered faster and easier than before!

The new form will be available for each state starting May 19, 2023. It will be available through the E-APP and in the Application and Forms option under the New Business dropdown on the Agent Resource Center. It will replace the existing Pre-Authorized Check form in all states.

About the process:
The Pre-Authorized Check (PAC) Premium Payment Premium Payment Service Form can be obtained at time of application or during the application process to obtain applicant approval for either or both of the following to occur:

  1. Request that a one-time electronic funds transfer occur to pay for premium due as a delivery requirement should a policy be issued.
  2. Request ongoing PAC premium payments on active cases for premiums as they become due.

This one form can be utilized to request either or both activities. If requesting both a one-time EFT and PAC from separate (different) accounts, separate forms must be submitted for each.

Important Note: the one-time electronic funds transfer (EFT) will only be processed once all other delivery requirements relating to the policy are received. Processing of the one-time electronic funds transfer (EFT) may take one to five business days.

For agent inquires contact your dedicated NGL Agent Services Team at 888.505.2332 or For sales questions contact the Long Term Care Sales Team at

New EFT/PAC Form

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