{{ __('Make Self-Payment') }}

Complete Your Self-Payment

You're about to pay ${{ $eligibility['data']['amount_dollars'] }} for your own subscription coverage.

Payment Summary

Company: {{ $employee->business->name }}
Employee: {{ $employee->full_name }}
Plan Duration: {{ $eligibility['data']['business_plan']['duration_months'] }} month(s)
${{ $eligibility['data']['amount_dollars'] }}
Total Amount

Credit Card Information

@for($i = 1; $i <= 12; $i++) @endfor
@for($i = date('Y'); $i <= date('Y') + 10; $i++) @endfor

Billing Address (Optional)

Terms and Conditions

By proceeding with this payment, you acknowledge and agree to the following:

  • You are paying ${{ $eligibility['data']['amount_dollars'] }} for your own telemedicine subscription coverage.
  • This payment will reduce your company's business plan quantity by 1 and total cost by ${{ $eligibility['data']['amount_dollars'] }}.
  • You will maintain full access to all telemedicine services for the plan duration.
  • This payment is non-refundable once processed successfully.
  • You can only make one self-payment per business plan period.
Cancel Process Payment (${{ $eligibility['data']['amount_dollars'] }})