12-2023_LTD_Invoice_(03).pdf

This document is a United HealthCare eAdministration invoice for Payroll BCC and CCC, located at 14 S. Ft. Harrison Ave., 3rd Fl., Clearwater, FL 33756. The invoice covers the 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 document details a Long Term Disability plan with a Group ID of 306594, Subgroup ID 1003, and Invoice Number 240030000137.

The invoice shows a current period amount of $40,604.06, with no retroactive amount. The reconciled invoice indicates 1,926 current period count and a current period volume of $10,411,297, with a rate of $0.3900. The total premium due matches the current period amount of $40,604.06. The document provides options to make a payment, download to Excel, or return to the list, and is copyrighted by United HealthCare Services, Inc. for the year 2024.