Atlanta Plumbers and Steamfitters Fringe Benefit Funds

Self-Pay Dependent Coverage Contribution

Welcome to Online Payment Services. You are entitled to continue coverage for your dependent(s) by making a timely self-contribution using the form below.

Please note that contributions must be made based upon the coverage type you elected during the most recent enrollment period. In order for your payment to be processed as quickly as possible, please complete the below information in its entirety.

Member Information

Member First Name *

Member Last Name *

Member UA ID *

Coverage

Spouse Only — $25 per week

Calculate Payment *

Please select how you'd like your payment amount to be calculated.

By Selected Dates By Number of Weeks Custom Amount

Coverage Period *

From *

To *

Number of Weeks *

Custom Amount (USD) *

Your card stays with the processor

When you continue, your card details are entered on our card processor's secure hosted page; NEBA never sees or stores your card number.

Questions or assistance?

For questions or assistance, please contact the Enrollment Department.

72enrollment@nebainc.com
(888) 365-0072

Monday – Friday: 8:00 a.m. – 5:00 p.m.
Saturday & Sunday: Closed