ERRORS GO HERE × HP Retiree Medical Benefits PaymentPlease fill in the name of the Stetson College of Law retiree and the name of the insured if different from the retiree (e.g., spouse of retiree).Once you have completed all the required information for the credit card payment and click Submit, you will receive a payment confirmation on the next screen.If you have further questions, please contact Human Resources at 727-562-7345. Retiree Information Retiree First Name Retiree Middle Name Retiree Last Name Retiree Email Address Retiree's Address Retiree's Street 1 Retiree's Street 2 Retiree's City Retiree's State/Province Retiree's ZIP/Postal Code Retiree's Country Insuree Information Insuree First Name Insuree Middle Name Insuree Last Name Insuree Email Address Insuree's Address Insuree's Address Different Than the Retiree's Address? Yes No Insuree's Street 1 Insuree's City Insuree's State/Province Insuree's ZIP/Postal Code Insuree's Country Payment Information Payment Type : Annually Quarterly Monthly Amount $ For assistance, contact Human Resources at [email protected] or 727-562-7345. Submit
