If I choose to receive claim payment(s) to my designated deposit account, I authorize the insurer and/or its affiliates (the "Companies") to make electronic fund transfer deposits into my designated deposit account as an optional method of payment of my eligible claim payments. I understand that any deposit made to an inactive account will be returned and reissued to me as a prepaid debit card. In addition, if any overpayment of claim benefits are credited to my account in error, I authorize withdrawal of any payments necessary in order to assure the accuracy of my eligible claim payments. I can cancel this authorization at any time by giving written notice. Any notice hereunder will not be deemed effective until the Companies have received my written notice.

If I choose to receive claim payment(s) by a prepaid card, I authorize the use of a preloaded Claim Card Mastercard Prepaid Card ("Claim Card ") by the insurer and/or its affiliates as an optional method of payment for my eligible claim payments. I agree that additional claim payments may also be loaded onto the Claim Card. I understand that there may be restrictions that prevent the use of the Claim Card in certain circumstances and that some payments may involve combinations of the Claim Card and payment by check. I understand there are specific terms and conditions and fees associated with the use of the Claim Card. I understand the Cardholder Agreement which I will receive with the Claim Card will set forth the terms and conditions of use and any applicable fees.