HomeMy WebLinkAboutInv# 20210501 - LIFE INSURANCE COMPANY OF NORTH AMERICA - 04/26/2021Group Billing & Administration Bill Details
Current Coverage Period
05/01/2021 - 05/31/2021
Active - City of Dania Beach Group Subtotal
$4,063.19
Product
Voluntary Term Life
Plan Ref
SGM-610429
Benefit Type
Voluntary $2,860.00
Subtotal
Product
Basic Term Life
Plan Ref
SGM-610429
Benefit Type
Basic $1,076.88
Subtotal
Product
Basic AD&D
Plan Ref
SOK-607690
Benefit Type
Basic $126.31
Subtotal
Retiree - City of Dania Beach Group Subtotal
$95.80
Product
Voluntary Term Life
Plan Ref
SGM-610429
Benefit Type
Voluntary $14.35
Subtotal
Product
Basic Term Life
Plan Ref
SGM-610429
Benefit Type
Basic $73.20
Subtotal
Product
Basic AD&D
Plan Ref
SOK-607690
Benefit Type
Basic $8.25
Subtotal
PROCESSING
Payment status
Offline Payment Selected
View Premium
Remittance Support
SUMMARY
Due Date
05/31/2021
Bill total
$4,158.99
Applied total
$0.00
Published date
04/27/2021 22:04
Current coverage period
05/01/2021 - 05/31/2021
REFERENCES
Billing account name
City of Dania Beach
Billing account ID
1234
Bill ref
1234_050121
PAYMENT
Payment date
04/29/2021
Bank account
-
Submitted by
Bendra Caseneuve
Online payment amount
-
Total for Current Coverage Period
$4,158.99
Page 1 of 2Billing Home
4/29/2021https://live.group-billing-solutions.com/viewpoint/billing/employerbilldetailspage.jsp?plist=p23&vsid=106268
Current Coverage Period $4,158.99
Adjustments for Prior Coverage Periods $0.00
Bill Total $4,158.99
Product Policy Ref Benefit Type
Adjust
To
Zero
Amount
Before
Adjustment
Amount
Amount
After Reason Comment Adjustment
Amount
Voluntary
Term Life SGM-610429 Voluntary No $2,874.35 $0.00 $2,874.35 - - $0.00
Basic Term
Life SGM-610429 Basic No $1,150.08 $0.00 $1,150.08 - - $0.00
Basic AD&D SOK-607690 Basic No $134.56 $0.00 $134.56 - - $0.00
Adjustments Page 2 of 2Billing Home
4/29/2021https://live.group-billing-solutions.com/viewpoint/billing/employerbilldetailspage.jsp?plist=p23&vsid=106268