Electronic Funds Transfer

The Electronic Funds Transfer (EFT) form is designed to gather the employer’s banking information in order to electronically transfer subsidy payments to the employer. The employer must attach a VOIDED CHECK, or letter on bank letter head providing the account number and routing number, to this form. This form may also be used to make any future banking changes while enrolled in Insure Oklahoma.

An EFT payment is designed to electronically deposit subsidy payments to the employers’ bank account.

The first premium subsidy payment may be paper. After that all Insure Oklahoma premium subsidy payments will be deposited into the employer’s bank account electronically.

EFT payments are deposit only.  Funds will not be withdrawn from this account.


Process for the Electronic Funds Transfer Form:

Box 1 

Insure Oklahoma Employer ID is not needed for new applicants. The ID number is only needed for those applying for an Insure Oklahoma renewal or making changes to an existing account.

Types of Authorization:

  • New – applying for the first time;
  • Change – making changes to an account while enrolled in Insure Oklahoma;
  • No Change to EFT account – for renewal applicants only, whose banking information has not changed.

Box 2 

Please submit all information about your banking account and financial institution.

Box 3 

Employers need to sign and date the form before submitting. 

Box 4 

A business’s agent may conduct certain payroll functions. If this is the case, the agent must submit and sign all the information detailed in this box.

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