12-2023_LTD_Invoice_(03).pdf

This document is a UnitedHealthCare eAdministration invoice for Payroll BCC and CCC, located at 14 S. Ft. Harrison Ave., 3rd Fl. in Clearwater, FL 33756. The invoice covers Long Term Disability insurance for Group ID 306594, Subgroup ID 1003, for the coverage period from 12/01/2023 to 12/31/2023, with an invoice date of 11/15/2023 and a due date of 12/01/2023.

The invoice details show a current period count of 1,926 participants, with a current period volume of $10,411,297 and a rate of $0.3900, resulting in a total premium due of $40,604.06. There is no retroactive amount listed, and the invoice provides a breakdown of the Long Term Disability plan. The document is from UnitedHealthCare Services, Inc. and includes options to make payment or download the invoice to Excel.