2021-12_LTD_Invoice_(01).pdf

This document is a UnitedHealthcare eAdministration invoice for Payroll BCC and CCC, specifically for Long Term Disability coverage. The invoice covers the period from 12/01/2021 to 12/31/2021, with an invoice date of 11/15/2021 and a due date of 12/01/2021. The invoice is associated with Group ID 306594, Subgroup ID 1003, and was issued for the Pinellas County location at 14 S. FL Harrison Ave, 3rd FL, Clearwater, FL 33756.

The total billed amount is $39,201.77, with no retro amount and a total premium due of $38,477.16. The reconciled invoice shows a current period count of 1954 for Long Term Disability, with a current period volume of $100,051,736 and a rate of $0.3900. There are options to make a payment or download the invoice to Excel, indicating this is a routine billing document for employee benefits coverage.