Pre-Paid Plan Payment

Upload your payment receipt so we can confirm your pre-paid plan enrollment. Please provide complete and accurate details to help us match your payment quickly.

Your Information

Full Name *

Please enter your full name.

Email Address *

Please enter a valid email address.

Mobile Number

Please enter a valid mobile number.

Insurance Details

Insurance Provider *

Please enter the insurance provider.

Plan Name

Person to be Insured

Birthdate

Age

Payment Receipt Attachment *

Please attach a copy of your payment receipt.

Personal ID Attachment *

Please attach a copy of your personal ID.

Remarks:

By submitting this form, you agree that Health Connect may review your receipt and contact you regarding your pre-paid plan enrollment.

What happens next?

Your receipt will be sent securely to Health Connect.
We will validate your payment and match it to your plan.
A representative may contact you for additional details.
You’ll receive confirmation once your payment is verified.

Tips for faster processing

Upload a clear photo or scanned copy of the receipt.
Include the plan name and provider if available.
Double-check your email address and mobile number.