HomeMy WebLinkAboutInv# 165241158 - Fidelity Security Life Insurance Company - 05/02/2022 (2)FULL MONTH LIST
EM Subscriber ID Last Name First Name
26265795300 Morrell Paula
INVOICE NUMBER:165241158 To view dependent members, please see the Enrollment Report at
eyemed.com/eyemanage
ROSTER REPORT
FULL ROSTER
ROSTER LISTING FOR:The City of Dania Beach COBRA
BILLING PERIOD:May, 2022
Billing Tier Plan Rate Division Code
Employee + 1 Benefit Level 1 $8.33
Location Total:$8.33
Full Month Total: $8.33
To view dependent members, please see the Enrollment Report at
eyemed.com/eyemanage
ROSTER REPORT
FULL ROSTER
The City of Dania Beach COBRA
May, 2022
Location Code Company Code
To view dependent members, please see the Enrollment Report at
eyemed.com/eyemanage
ROSTER REPORT
FULL ROSTER
The City of Dania Beach COBRA
May, 2022