HomeMy WebLinkAboutInv# 1654444815 - Fidelity Security Life Insurance Company - 10/20/2022 (2)FULL MONTH LIST
EM Subscriber ID Last Name First Name Billing Tier Plan Rate Division Code Location Code Company Code
26265795300 Morrell Paula Employee + 1 Benefit Level 1 $8.33
Location Total: $8.33
Full Month Total: $8.33
INVOICE NUMBER:165444815 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:October, 2022