LRFA

Latvian Relief Fund of America


LRFA is a professionally managed, non-profit, mutual assistance organization, designed to provide our members with affordable health care plans and financial assistance in emergencies. We support other Latvian-American organizations and education in the U.S. and abroad.
Membership Benefit Plans About Us Forms Contact Us
Information Request Form
Membership
Change of Address
Benefit Plan Enrollment
Travel Plan Enrollment
Benefit Claims
Make a Payment

LRFA Members - Make Your Monthly Benefit Plan Payments Online!

All LRFA members may pay by check, money order, or simply use the online form below to submit a payment for their current Benefit Plans. Confirmation email will be sent to you once we receive payment.

Please provide the following information: (Red indicates a required field)

Your Information
First Name
Last Name
Middle Initial
Membership #
Telephone
E-Mail Address

Make a Payment
Please enter the applicable fees from your invoice. You may pay for one or more months in the current year (please note how many months you are paying for on each plan and multiply fees accordingly).
Medicare Supplemental Plan Months Amount Due
  M-Basic   M-1   M-2   M-3   M-4   M-5   M-6
$
Health Supplemental Plan    
  H1-20   H1-50   H1-80
  H2-20   H2-50   H2-80
  H3-20   H3-50   H3-80
$
Prescription Drug Plan    
  Age 1-17   Age 18-50   Age 51+
$
Hospital Supplemental Plan    
  Group I   Group II   Group III   Spec. A   Spec. B
$
Emergency Plan for Visitors from Abroad    
  Plan A   Plan B
$
Mortuary Plan    
  Basic   A   B   C   D   E   F   G   H   I   J
$
  Benefit Plan Fees: $
  Online payment fee: $
  Donation (optional): $
  Annual Membership Fee $30: $
  Total Payment: $

Questions and Comments:

By submitting this form, I agree to all the terms of the LRFA Benefit Plans.

 

© 2017 LRFA   -   P.O. Box 8857, Elkins Park, PA 19027-0857   -   info @ lrfa.org

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