HomeMy WebLinkAboutInv# 2022-00001024 - FLORIDA MUNICIPAL INSURANCE TRUST - 12/28/2022STATUS COVERAGE TYPEPLAN NAME TIER PREMIUM ADJUSTMENTTOTAL
ACOSTA RAFAEL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58 $178,918.63 $48,538.13 $227,456.76
ADAMS LORI A Medical Plan 2 Employee Only $785.10 $0.00 $785.10 ACTIVE RET
ALPHONSE LOU A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
ANAYA ALEXANDRA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
AZCANO ALEJANDRO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BALDIE TOMMY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BATISTA CLAUDIA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BORDY KATIA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BORGOS LUIS A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BOUTSIS EVE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BROWN ERIC A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
BROWN LOUIS A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BROWN RODRICK A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
BROWNE JOHNATHAN A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
CANGIALOSI JOSEPH A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
CASERTA CHRISTINA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
CHEN MICHAEL A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
CLAYTON ERIKA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
COLLINS ROGER A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
COOK RONALD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
COSTA NATHAN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
CRAWFORD RUPERT A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
CROSS JERRYLYN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DAMIS WINDY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DAVILA EDDA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DAVIS JOYCE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DE JESUS GABRIEL A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
DIPAOLO FRANK A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DONNELLY COLIN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DOTSON RICKEY A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
DRUMMOND TAMARA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
EDGE CHARLES A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
EKLE ROBERT A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GAINES TANEISHA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GARDNER KALA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GRANT MITCHELL A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
GREENE DARIUS A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
GREENE DARREN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
HARRIS WILLIAM A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
HENLEY ALICE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HENLEY MOKIETA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HIRSCH STACY A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
DANIA BEACH Due Date: 12-01-2022
Gen Date: 11-18-2022
EMPLOYEE NAME
Printed Date: 12/29/2022
HOGGINS ERNEST A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HUCK MICHAEL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
HUGHES ANASTACIA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
ICENHOUR RACHEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
IFEDI ANTHONY A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
IGLESIAS GUTIERREZCLAUDIO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JACKSON JOHNATHAN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JAMES TAMARA A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JAMES TAMMIE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JELASO MEGAN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
JOHNSON ANTOINE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JOHNSON BRANDON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JOHNSON JR KENNITH A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
JOLLY CORY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
JOSEPH PATRICK A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
KALLICHARAN CARL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LAJOIE CORINNE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
LARIOS IBARGUENIBEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LAWSON RACHELLE A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
LIMA MARILANE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LOBO YAMIL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
LOTTIER CHRISTINE A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MARTIN RALPH A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MARTINEZ GABRIEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MCDONALD MARVIN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCDOWELL KEITH A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
MCFARLANE DARRYL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MCHELLON DONIAL A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCLAREN KRISTEN A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
MCNABB KENNETH A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
MCNEAL GREGORY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MCPHEE JOYCE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MERCADO KARLA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MIEREZ ANN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MILES FELICIA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
MYKOO SHANESA A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
NORENA ELEANOR A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
OZAYDIN DINCER A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
PECORARO SHERRY A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
PEGUERO ULYSSES A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PEIRCE LOGAN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PEREZ FRANK A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
PERRY LEONARD A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PETERSON TERRY A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
POLLARD ALBERLEAN A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
Printed Date: 12/29/2022
QUINTERO JOHN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
REYES EDDIE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RODRIGUEZ FERNANDO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RODRIGUEZ HAROLD A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
RODRIGUEZ MICHAEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RODRIGUEZ RICHARD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SABINO DEBORAH A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SALGADO JOSE A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SALVINO MARCO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SANTANA JULIO A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SAUNDERS JANICE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SCHNEIDER THOMAS A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SEGAL ADAM A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SHAHRYAR MICHELLE A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SHELEY CHERIE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SINGH KEVIN A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SINGH MAXINE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SPEAR MITZIE A Medical Plan 5 Employee Only $678.35 $0.00 $678.35
SPENCER WILLIE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
STEVENS TANIA A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
TAYLOR CORRY A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
TERRAZAS MONICA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
THOMAS AHMAD A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
UROW BARBARA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
VASTA MICHAEL A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WALTON ERIC A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WASHINGTON WILLIS A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WEEKES KATHLEEN A Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
WEST COKENYA A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WESTBERRY ANSON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WHITE DEON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WHITE GEORGE A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WILLIAMS DARIUS A Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
WRITER CYRUS A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
ZAPATA MARLON A Medical Plan 2 Employee Only $785.10 $0.00 $785.10
ANSBRO NOAH R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BAKER ERIC R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
BERTUCCIO JOSEPH R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
BROWN KENNETH R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
CARUSO BRUCE R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
CHANDLER CHRISTOPHERR Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
DARA MICHAEL R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
FELICETTY MARK R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
GARCIA GONZALO R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
HANSEN DONALD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
Printed Date: 12/29/2022
HENG PETER R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
HUSOSKY JOSEPH R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
JOHNSON ANTHONY R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
JOHNSON STANLEY R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
KENON FLOYD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LEXA JOHN R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
LIEM BRUCE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
LORBER RICHARD R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MACE ANGELINA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MARIANI JENNIFER R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MCDONALD MARY R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
MUSTELIER ENRIQUE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PATELLARO LOUANN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PATTERSON DIANNA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PELLECER SERGIO R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
PHIPPS BRIAN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RIVIERE JOSEPH R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
RODRIGUEZ JOSE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
ROSE MARY R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
ROSS LUISA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RUDBECK BENJAMIN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
RUETH PATRICIA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SATTERFIELD NICKI R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SIEB RICHARD R Medical Plan 5 Employee Only $678.35 $0.00 $678.35
SLADE CURTIS R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SMITH MICHAEL R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
SNELL ARNOLD R Medical Plan 2 Employee + Family $2,375.58 $0.00 $2,375.58
SOMERS PATRICIA R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
STUBBS DANIEL R Medical Plan 2 Employee + 1 $1,548.08 $0.00 $1,548.08
SULLIVAN DARIN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
TARMEY LORI R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
TRAVAGLIO-WILLIAMSCHER R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
URTECHO JOSE R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WALTERS IRISH R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WENTWORTH JEAN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
WILLIAMSON JOHN R Medical Plan 2 Employee Only $785.10 $0.00 $785.10
$227,456.76
227456.76
Printed Date: 12/29/2022