Attachment 5 - Technical Exhibit OCC Life Claims-Jan 2016 thru May 2021.xlsx
XLSX spreadsheet 23 KB Posted
- Attached to
- Group Life Insurance
- Solicitation number
- 2031JW21Q00092
About this file
This document includes an attachment summarizing life insurance claims paid by the Office of the Comptroller of the Currency from 2016 through May 2021, as well as a related federal contract opportunity notice.
The solicitation seeks an experienced contractor to underwrite and administer the group life insurance program for active and retired employees of the OCC and Office of Financial Research through June 2026. Services include amending an existing policy to provide benefits for approximately 2,580 OCC employees, 2,510 OCC retirees including 688 in a frozen group, and employees and dependents of the OFR. Coverage includes basic, optional supplemental, and dependent life insurance. The incumbent contractor is Metropolitan Life whose 5-year contract expires June 30, 2021. The attachment provides claim details by year, type of coverage, and totals paid from 2016 through the first five months of 2021.
View the file
Other files
Show all 19
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Claim Detail 2021
| Attachment 5 - Technical Exhibit OCC Life Claims - Jan 2016 thru May 2021 | |||||
| RFQ: 2031JW21Q00092 | |||||
| Amendment 1 | |||||
| Gender | Date Incurred | Date Paid | Employee Age | Claim Amount (Including Interested) | Claim Type |
| M | 12/15/2015 | 01/19/2016 | 68 | 75,000.00 | Basic Life - OTS Retiree |
| F | 09/11/2015 | 02/10/2016 | 61 | 10,000.00 | Dependent Life Family |
| M | 11/01/2015 | 02/17/2016 | 72 | 29,250.00 | Basic Life - OCC Retiree |
| M | 11/01/2015 | 02/17/2016 | 72 | 884.72 | Basic Life - OCC Retiree |
| M | 02/15/2016 | 03/18/2016 | 51 | 210,000.00 | Basic Life - Active |
| M | 02/05/2016 | 03/24/2016 | 63 | 144,000.00 | Basic Life - OTS Retiree |
| F | 04/03/2016 | 04/26/2016 | 82 | 9,500.00 | Basic Life - OTS Retiree |
| F | 04/03/2016 | 05/12/2016 | 80 | 63,000.00 | Dependent Life Spouse - OTS Retiree |
| M | 03/26/2016 | 05/16/2016 | 56 | 300,000.00 | Optional Life EE |
| M | 03/26/2016 | 05/16/2016 | 56 | 1,294.52 | Optional Life EE |
| M | 03/26/2016 | 05/16/2016 | 56 | 720.62 | Basic Life - Active |
| M | 03/26/2016 | 05/16/2016 | 56 | 167,000.00 | Basic Life - Active |
| M | 04/13/2016 | 05/20/2016 | 74 | 75,000.00 | Basic Life - OCC Retiree |
| M | 05/30/2016 | 06/29/2016 | 74 | 268,000.00 | Basic Life - OTS Retiree |
| M | 06/09/2016 | 08/05/2016 | 85 | 166,000.00 | Basic Life - OTS Retiree |
| M | 07/10/2016 | 08/08/2016 | 71 | 142,000.00 | Basic Life - OTS Retiree |
| F | 07/10/2016 | 08/19/2016 | 81 | 20,250.00 | Basic Life - OTS Retiree |
| F | 07/10/2016 | 08/19/2016 | 81 | 53.26 | Basic Life - OTS Retiree |
| M | 08/12/2016 | 09/08/2016 | 84 | 300,000.00 | Basic Life - OTS Retiree |
| M | 08/05/2016 | 09/30/2016 | 68 | 115,000.00 | Basic Life - OTS Retiree |
| M | 08/05/2016 | 10/12/2016 | 62 | 98,000.00 | Basic Life - OCC Retiree |
| F | 09/01/2016 | 10/20/2016 | 60 | 128,000.00 | Dependent Life Spouse |
| F | 09/01/2016 | 10/20/2016 | 60 | 85.92 | Dependent Life Spouse |
| F | 09/01/2016 | 10/20/2016 | 60 | 25,000.00 | Dependent Life Family |
| F | 09/01/2016 | 10/20/2016 | 60 | 16.78 | Dependent Life Family |
| M | 05/25/2016 | 10/21/2016 | 84 | 22,000.00 | Basic Life - OCC Retiree |
| F | 09/07/2016 | 11/07/2016 | 88 | 5,250.00 | Basic Life - OCC Retiree |
| M | 11/02/2016 | 12/02/2016 | 81 | 110,000.00 | Basic Life - OTS Retiree |
| F | 10/17/2016 | 12/27/2016 | 88 | 7,250.00 | Basic Life - OCC Retiree |
| M | 10/27/2016 | 01/13/2017 | 72 | 23,250.00 | Basic Life - OCC Retiree |
| M | 10/27/2016 | 01/13/2017 | 72 | 32.79 | Basic Life - OCC Retiree |
| M | 09/16/2016 | 01/17/2017 | 68 | 75,000.00 | Basic Life - OTS Retiree |
| M | 09/15/2016 | 01/30/2017 | 85 | 43,000.00 | Basic Life - OTS Retiree |
| M | 01/03/2017 | 02/16/2017 | 71 | 48,500.00 | Basic Life - OTS Retiree |
| M | 02/01/2017 | 02/22/2017 | 80 | 20,750.00 | Basic Life - OCC Retiree |
| M | 01/25/2017 | 02/23/2017 | 76 | 72,500.00 | Basic Life - OTS Retiree |
| M | 02/14/2017 | 04/10/2017 | 72 | 50,000.00 | Basic Life - OCC Retiree |
| M | 04/09/2017 | 05/03/2017 | 67 | 237,000.00 | Basic Life - OTS Retiree |
| M | 05/07/2017 | 06/02/2017 | 72 | 123,000.00 | Basic Life - OTS Retiree |
| M | 05/07/2017 | 06/02/2017 | 72 | 43.80 | Basic Life - OTS Retiree |
| M | 11/06/2016 | 06/05/2017 | 84 | 33,000.00 | Basic Life - OTS Retiree |
| M | 06/07/2017 | 07/17/2017 | 68 | 775,000.00 | Basic Life - OTS Retiree |
| F | 07/23/2017 | 08/09/2017 | 74 | 19,000.00 | Basic Life - OTS Retiree |
| M | 05/10/2017 | 09/06/2017 | 79 | 21,166.66 | Basic Life - OCC Retiree |
| F | 08/19/2017 | 09/19/2017 | 55 | 177,000.00 | Dependent Life Spouse |
| F | 08/19/2017 | 09/19/2017 | 55 | 25,000.00 | Dependent Life Family |
| M | 08/03/2017 | 09/28/2017 | 59 | 210,000.00 | Optional Life EE |
| M | 08/03/2017 | 09/28/2017 | 59 | 182,700.00 | Basic Life - Active |
| F | 08/29/2017 | 09/28/2017 | 70 | 11,250.00 | Basic Life - OCC Retiree |
| F | 09/05/2017 | 10/04/2017 | 60 | 200,000.00 | Basic Life - OCC Retiree |
| F | 06/27/2017 | 10/26/2017 | 85 | 8,250.00 | Basic Life - OCC Retiree |
| F | 06/27/2017 | 10/26/2017 | 85 | 284.79 | Basic Life - OCC Retiree |
| F | 09/24/2017 | 10/26/2017 | 74 | 22,750.00 | Basic Life - OTS Retiree |
| F | 10/03/2017 | 10/26/2017 | 79 | 10,250.00 | Basic Life - OTS Retiree |
| M | 09/29/2017 | 11/06/2017 | 70 | 31,000.00 | Basic Life - OCC Retiree |
| M | 11/01/2017 | 11/29/2017 | 75 | 9,000.00 | Basic Life - OCC Retiree |
| M | 08/03/2017 | 12/08/2017 | 59 | 90,000.00 | Optional Life EE |
| M | 08/03/2017 | 12/08/2017 | 59 | 78,300.00 | Basic Life - Active |
| M | 10/10/2017 | 12/08/2017 | 90 | 51,500.00 | Basic Life - OTS Retiree |
| M | 10/26/2017 | 12/14/2017 | 63 | 148,000.00 | Basic Life - OCC Retiree |
| M | 09/10/2017 | 12/19/2017 | 81 | 17,500.00 | Basic Life - OCC Retiree |
| F | 11/13/2017 | 12/20/2017 | 55 | 25,000.00 | Dependent Life Family |
| M | 06/17/2017 | 12/29/2017 | 82 | 4,296.00 | Basic Life - OTS Retiree |
| M | 06/17/2017 | 12/29/2017 | 82 | 73,000.00 | Basic Life - OTS Retiree |
| F | 11/13/2017 | 01/04/2018 | 55 | 261,000.00 | Dependent Life Spouse |
| M | 06/17/2017 | 01/12/2018 | 82 | 73,000.00 | Basic Life - OTS Retiree |
| M | 06/17/2017 | 01/12/2018 | 82 | 4,632.00 | Basic Life - OTS Retiree |
| M | 12/08/2017 | 01/19/2018 | 59 | 100,000.00 | Dependent Life Spouse |
| M | 12/08/2017 | 01/19/2018 | 59 | 25,000.00 | Dependent Life Family |
| M | 01/04/2018 | 02/01/2018 | 81 | 34,000.00 | Basic Life - OTS Retiree |
| M | 05/10/2017 | 02/06/2018 | 79 | 10,583.34 | Basic Life - OCC Retiree |
| M | 01/11/2018 | 02/06/2018 | 77 | 14,500.00 | Basic Life - OCC Retiree |
| M | 09/29/2017 | 02/07/2018 | 70 | 241,000.00 | Basic Life - OTS Retiree |
| M | 01/07/2018 | 02/08/2018 | 77 | 166,000.00 | Basic Life - OTS Retiree |
| M | 01/07/2018 | 02/08/2018 | 77 | 244.50 | Basic Life - OTS Retiree |
| M | 01/04/2018 | 02/14/2018 | 81 | 20,400.00 | Basic Life - OTS Retiree |
| M | 12/28/2017 | 02/21/2018 | 72 | 20,250.00 | Basic Life - OCC Retiree |
| M | 01/14/2018 | 03/12/2018 | 74 | 24,000.00 | Basic Life - OCC Retiree |
| M | 01/23/2018 | 03/15/2018 | 80 | 189,000.00 | Basic Life - OTS Retiree |
| F | 04/13/2015 | 03/26/2018 | 60 | 194,000.00 | Basic Life - OCC Retiree |
| M | 09/18/2017 | 04/05/2018 | 81 | 24,500.00 | Basic Life - OCC Retiree |
| M | 02/13/2018 | 04/12/2018 | 63 | 4,368.65 | Basic Life - OTS Retiree |
| M | 02/13/2018 | 04/20/2018 | 63 | 88,631.35 | Basic Life - OTS Retiree |
| F | 04/25/2017 | 05/01/2018 | 86 | 6,500.00 | Basic Life - OCC Retiree |
| M | 05/06/2018 | 05/25/2018 | 77 | 172,000.00 | Basic Life - OTS Retiree |
| M | 02/20/2018 | 06/01/2018 | 80 | 20,500.00 | Basic Life - OCC Retiree |
| M | 01/03/2018 | 06/22/2018 | 86 | 18,500.00 | Basic Life - OCC Retiree |
| F | 05/30/2018 | 06/29/2018 | 65 | 121,000.00 | Dependent Life Spouse |
| M | 07/04/2018 | 07/24/2018 | 86 | 189,000.00 | Basic Life - OTS Retiree |
| F | 07/05/2018 | 07/25/2018 | 70 | 7,750.00 | Basic Life - OCC Retiree |
| M | 01/04/2018 | 08/09/2018 | 81 | 13,600.00 | Basic Life - OTS Retiree |
| M | 01/04/2018 | 08/09/2018 | 81 | 321.93 | Basic Life - OTS Retiree |
| M | 07/09/2018 | 08/21/2018 | 53 | 150,000.00 | Basic Life - Active |
| F | 07/22/2018 | 08/29/2018 | 80 | 14,500.00 | Basic Life - OTS Retiree |
| F | 09/04/2018 | 09/27/2018 | 68 | 45,500.00 | Basic Life - OTS Retiree |
| F | 10/02/2017 | 10/17/2018 | 62 | 50,000.00 | Optional Life EE |
| F | 10/02/2017 | 10/17/2018 | 62 | 34,000.00 | Basic Life - Active |
| F | 09/13/2018 | 10/18/2018 | 86 | 16,312.50 | Basic Life - OTS Retiree |
| F | 10/02/2017 | 10/26/2018 | 62 | 50,000.00 | Optional Life EE |
| F | 10/02/2017 | 10/26/2018 | 62 | 34,000.00 | Basic Life - Active |
| F | 09/13/2018 | 11/01/2018 | 86 | 5,437.50 | Basic Life - OTS Retiree |
| M | 09/14/2018 | 11/02/2018 | 81 | 6,062.50 | Basic Life - OTS Retiree |
| M | 09/14/2018 | 11/13/2018 | 81 | 6,062.50 | Basic Life - OTS Retiree |
| M | 09/14/2018 | 11/20/2018 | 81 | 6,062.50 | Basic Life - OTS Retiree |
| M | 06/05/2018 | 11/30/2018 | 70 | 41,250.00 | Basic Life - OCC Retiree |
| M | 06/05/2018 | 11/30/2018 | 70 | 100.58 | Basic Life - OCC Retiree |
| M | 09/14/2018 | 12/07/2018 | 81 | 167.42 | Basic Life - OTS Retiree |
| M | 09/14/2018 | 12/07/2018 | 81 | 6,062.50 | Basic Life - OTS Retiree |
| F | 10/30/2018 | 12/10/2018 | 74 | 74,000.00 | Basic Life - OTS Retiree |
| M | 09/11/2018 | 12/14/2018 | 53 | 74.68 | Basic Life - OTS Retiree |
| M | 09/11/2018 | 12/14/2018 | 53 | 58,000.00 | Basic Life - OTS Retiree |
| M | 08/20/2014 | 12/20/2018 | 65 | 500.00 | Basic Life - OCC Retiree |
| M | 11/05/2018 | 12/31/2018 | 85 | 13,375.00 | Basic Life - OTS Retiree |
| M | 12/31/2018 | 01/22/2019 | 65 | 27,500.00 | Basic Life - OCC Retiree |
| M | 11/08/2018 | 01/22/2019 | 84 | 56,500.00 | Basic Life - OTS Retiree |
| M | 11/05/2018 | 01/30/2019 | 85 | 13,375.00 | Basic Life - OTS Retiree |
| F | 01/27/2019 | 02/19/2019 | 72 | 29,000.00 | Basic Life - OCC Retiree |
| F | 11/19/2018 | 03/04/2019 | 50 | 70,948.15 | Dependent Life Spouse |
| F | 11/19/2018 | 03/04/2019 | 50 | 25,000.00 | Dependent Life Family |
| F | 12/24/2018 | 04/01/2019 | 71 | 5,750.00 | Basic Life - OCC Retiree |
| F | 12/24/2018 | 04/19/2019 | 71 | 11,500.00 | Basic Life - OCC Retiree |
| M | 10/21/2018 | 04/25/2019 | 78 | 183,000.00 | Basic Life - OTS Retiree |
| M | 04/12/2019 | 05/03/2019 | 60 | 258,000.00 | Basic Life - Active |
| F | 12/24/2018 | 05/15/2019 | 71 | 5,750.00 | Basic Life - OCC Retiree |
| F | 03/31/2019 | 05/23/2019 | 66 | 46,500.00 | Dependent Life Spouse |
| M | 04/21/2019 | 06/11/2019 | 72 | 17,125.00 | Basic Life - OCC Retiree |
| F | 04/21/2019 | 06/11/2019 | 59 | 257,000.00 | Basic Life - OCC Retiree |
| M | 04/21/2019 | 06/18/2019 | 72 | 17,125.00 | Basic Life - OCC Retiree |
| M | 03/13/2019 | 06/21/2019 | 63 | 140,000.00 | Basic Life - OCC Retiree |
| M | 03/13/2019 | 06/24/2019 | 93 | 174.00 | Basic Life - OTS Retiree |
| M | 03/13/2019 | 06/24/2019 | 93 | 36,500.00 | Basic Life - OTS Retiree |
| F | 05/28/2019 | 07/12/2019 | 83 | 73,000.00 | Dependent Life Spouse - OTS Retiree |
| F | 04/28/2019 | 08/02/2019 | 71 | 55,000.00 | Basic Life - OTS Retiree |
| F | 04/28/2019 | 08/09/2019 | 71 | 55,000.00 | Basic Life - OTS Retiree |
| M | 05/30/2019 | 08/22/2019 | 76 | 37,750.00 | Basic Life - OTS Retiree |
| M | 07/16/2019 | 08/27/2019 | 68 | 31,750.00 | Basic Life - OCC Retiree |
| M | 07/16/2019 | 08/27/2019 | 68 | 77.82 | Basic Life - OCC Retiree |
| F | 08/15/2019 | 09/12/2019 | 60 | 133,500.00 | Dependent Life Spouse |
| M | 02/09/2019 | 09/18/2019 | 82 | 37,250.00 | Basic Life - OTS Retiree |
| M | 04/21/2019 | 10/03/2019 | 72 | 17,125.00 | Basic Life - OCC Retiree |
| F | 09/15/2019 | 10/09/2019 | 66 | 15,375.00 | Dependent Life Spouse - OTS Retiree |
| F | 08/28/2019 | 10/25/2019 | 45 | 158,000.00 | Dependent Life Spouse |
| F | 08/28/2019 | 10/25/2019 | 45 | 25,000.00 | Dependent Life Family |
| M | 11/01/2019 | 11/01/2019 | 67 | 57,500.00 | Optional Life EE |
| F | 07/31/2019 | 11/05/2019 | 48 | 10,000.00 | Dependent Life Family |
| M | 04/21/2019 | 11/14/2019 | 72 | -12,843.75 | Basic Life - OCC Retiree |
| M | 10/21/2019 | 11/27/2019 | 78 | 27,750.00 | Basic Life - OTS Retiree |
| M | 11/25/2019 | 12/31/2019 | 71 | 43,000.00 | Basic Life - OTS Retiree |
| M | 12/30/2019 | 01/23/2020 | 62 | 162,000.00 | Basic Life - OCC Retiree |
| M | 12/21/2019 | 01/30/2020 | 67 | 194,000.00 | Basic Life - OTS Retiree |
| M | 10/27/2019 | 02/13/2020 | 67 | 42,500.00 | Basic Life - OCC Retiree |
| M | 12/26/2019 | 02/13/2020 | 79 | 208,000.00 | Basic Life - OTS Retiree |
| M | 12/26/2019 | 02/13/2020 | 79 | 2,256.65 | Basic Life - OTS Retiree |
| M | 01/14/2020 | 02/18/2020 | 75 | 55,250.00 | Basic Life - OTS Retiree |
| F | 01/21/2020 | 02/19/2020 | 43 | 12,500.00 | Dependent Life Family |
| M | 02/05/2020 | 02/28/2020 | 81 | 20,000.00 | Basic Life - OCC Retiree |
| M | 01/07/2020 | 04/13/2020 | 73 | 11,250.00 | Basic Life - OCC Retiree |
| M | 03/06/2020 | 04/16/2020 | 60 | 100,000.00 | Optional Life EE |
| M | 03/06/2020 | 04/16/2020 | 60 | 150,000.00 | Basic Life - Active |
| M | 03/04/2020 | 04/16/2020 | 67 | 41,250.00 | Basic Life - OCC Retiree |
| M | 03/13/2020 | 04/22/2020 | 66 | 26,500.00 | Basic Life - OCC Retiree |
| F | 02/13/2020 | 04/24/2020 | 73 | 21,000.00 | Basic Life - OCC Retiree |
| M | 02/21/2020 | 04/28/2020 | 91 | 12,750.00 | Basic Life - OTS Retiree |
| F | 04/07/2020 | 05/01/2020 | 75 | 7,400.00 | Basic Life - OCC Retiree |
| F | 04/07/2020 | 05/07/2020 | 75 | 11,100.00 | Basic Life - OCC Retiree |
| M | 04/08/2020 | 05/11/2020 | 61 | 500,000.00 | Optional Life EE |
| M | 04/08/2020 | 05/11/2020 | 61 | 269,000.00 | Basic Life - Active |
| M | 09/28/2019 | 05/13/2020 | 89 | 17,000.00 | Basic Life - OCC Retiree |
| M | 04/07/2020 | 06/02/2020 | 78 | 300,000.00 | Basic Life - OTS Retiree |
| M | 03/09/2019 | 06/05/2020 | 83 | 55,000.00 | Basic Life - OTS Retiree |
| M | 04/27/2020 | 06/19/2020 | 60 | 138,000.00 | Basic Life - Active |
| M | 06/12/2020 | 07/15/2020 | 87 | 255,000.00 | Basic Life - OTS Retiree |
| M | 06/04/2020 | 07/22/2020 | 94 | 17,250.00 | Basic Life - OTS Retiree |
| M | 06/12/2020 | 07/27/2020 | 87 | 45,000.00 | Basic Life - OTS Retiree |
| F | 11/21/2019 | 08/06/2020 | 68 | 63,000.00 | Basic Life - OTS Retiree |
| F | 11/21/2019 | 08/06/2020 | 68 | 655.89 | Basic Life - OTS Retiree |
| M | 06/24/2020 | 08/11/2020 | 81 | 20,000.00 | Basic Life - OCC Retiree |
| F | 11/21/2019 | 08/14/2020 | 68 | 21,000.00 | Basic Life - OTS Retiree |
| F | 11/21/2019 | 08/14/2020 | 68 | 230.14 | Basic Life - OTS Retiree |
| F | 04/21/2020 | 09/09/2020 | 89 | 12,250.00 | Basic Life - OTS Retiree |
| M | 08/25/2020 | 09/22/2020 | 89 | 49,250.00 | Basic Life - OTS Retiree |
| M | 09/06/2020 | 10/05/2020 | 66 | 500,000.00 | Optional Life EE |
| M | 08/29/2020 | 10/13/2020 | 47 | 97,000.00 | Dependent Life Spouse |
| F | 09/10/2020 | 10/26/2020 | 54 | 116,000.00 | Dependent Life Spouse |
| F | 10/23/2020 | 11/23/2020 | 51 | 15,000.00 | Dependent Life Family |
| M | 09/06/2020 | 10/05/2020 | 66 | 231,000.00 | Basic Life - Active |
| M | 04/24/2020 | 10/12/2020 | 73 | 47,250.00 | Basic Life - OCC Retiree |
| M | 05/06/2020 | 12/14/2020 | 96 | 29,000.00 | Basic Life - OCC Retiree |
| F | 05/07/2020 | 10/01/2020 | 87 | 44.30 | Basic Life - OTS Retiree |
| F | 05/07/2020 | 10/01/2020 | 87 | 22,000.00 | Basic Life - OTS Retiree |
| M | 10/13/2020 | 11/09/2020 | 84 | 154,000.00 | Basic Life - OTS Retiree |
| M | 10/23/2020 | 11/06/2020 | 73 | 277,000.00 | Basic Life - OTS Retiree |
| F | 12/31/2020 | 01/28/2021 | 65 | 250,000.00 | Optional Life EE |
| M | 01/06/2021 | 03/11/2021 | 63 | 306.85 | Optional Life EE |
| M | 01/06/2021 | 03/11/2021 | 63 | 350,000.00 | Optional Life EE |
| M | 10/04/2020 | 01/29/2021 | 47 | 12,500.00 | Dependent Life Family |
| F | 12/31/2020 | 01/28/2021 | 65 | 168,000.00 | Basic Life - Active |
| M | 01/06/2021 | 03/11/2021 | 63 | 201.64 | Basic Life - Active |
| M | 01/06/2021 | 03/11/2021 | 63 | 230,000.00 | Basic Life - Active |
| M | 06/20/2020 | 02/11/2021 | 74 | 75,000.00 | Basic Life - Retiree |
| M | 12/23/2020 | 02/08/2021 | 85 | 13,500.00 | Basic Life - Retiree |
| M | 01/17/2021 | 03/23/2021 | 79 | 25,750.00 | Basic Life - Retiree |
| F | 10/24/2020 | 01/08/2021 | 91 | 10.68 | Basic Life - OTS Retiree |
| F | 10/24/2020 | 01/08/2021 | 91 | 10,250.00 | Basic Life - OTS Retiree |
| M | 12/03/2020 | 01/05/2021 | 69 | 47,200.00 | Basic Life - OTS Retiree |
| M | 12/03/2020 | 01/22/2021 | 69 | 11,800.00 | Basic Life - OTS Retiree |
| M | 12/07/2020 | 01/22/2021 | 82 | 41,750.00 | Basic Life - OTS Retiree |
| M | 11/18/2020 | 02/16/2021 | 77 | 104,250.00 | Basic Life - OTS Retiree |
| M | 11/18/2020 | 02/12/2021 | 77 | 34,750.00 | Basic Life - OTS Retiree |
| M | 01/17/2021 | 02/19/2021 | 72 | 10,106.85 | Basic Life - OTS Retiree |
| M | 01/17/2021 | 03/15/2021 | 72 | 10,893.15 | Basic Life - OTS Retiree |
| M | 01/17/2021 | 03/24/2021 | 79 | 35,000.00 | Basic Life - OTS Retiree |
| M | 02/11/2021 | 03/24/2021 | 88 | 20,000.00 | Basic Life - OTS Retiree |
| M | 03/05/2021 | 04/14/2021 | 53 | 122,000.00 | Dependent Life Spouse |
| F | 02/20/2021 | 04/16/2021 | 73 | 16,750.00 | Basic Life - Retiree |
| M | 02/10/2021 | 05/04/2021 | 73 | 46,500.00 | Basic Life - Retiree |
| M | 01/10/2021 | 04/02/2021 | 78 | 22,250.00 | Basic Life - OTS Retiree |
Claim Summary 2021
| Attachment 5 - Technical Exhibit OCC Life Claims - Jan 2016 thru June 2021 | ||
| RFQ: 2031JW21Q00092 | ||
| Amendment 1 | ||
| Total Claims by Date Paid | ||
| 2016 | $2,492,555.82 | |
| 2017 | $2,916,324.04 | |
| 2018 | $2,655,749.45 | |
| 2019 | $1,964,981.22 | |
| 2020 | $4,328,686.98 | |
| 2021 | $1,658,769.17 | |
| 2016 | Basic Life Actives | $377,720.62 |
| 2016 | Basic Life - OCC Retiree | $237,634.72 |
| 2016 | Basic Life - OTS Retiree | $1,349,803.26 |
| 2016 | Dependent Life Family | $35,016.78 |
| 2016 | Dependent Life Spouse | $128,085.92 |
| 2016 | Dependent Life Spouse - OTS Retiree | $63,000.00 |
| 2016 | Optional Life EE | $301,294.52 |
| 2017 | Basic Life Actives | $261,000.00 |
| 2017 | Basic Life - OCC Retiree | $540,484.24 |
| 2017 | Basic Life - OTS Retiree | $1,587,839.80 |
| 2017 | Dependent Life Family | $50,000.00 |
| 2017 | Dependent Life Spouse | $177,000.00 |
| 2017 | Dependent Life Spouse - OTS Retiree | $0.00 |
| 2017 | Optional Life EE | $300,000.00 |
| 2018 | Basic Life Actives | $218,000.00 |
| 2018 | Basic Life - OCC Retiree | $382,933.92 |
| 2018 | Basic Life - OTS Retiree | $1,447,815.53 |
| 2018 | Dependent Life Family | $25,000.00 |
| 2018 | Dependent Life Spouse | $482,000.00 |
| 2018 | Dependent Life Spouse - OTS Retiree | $0.00 |
| 2018 | Optional Life EE | $100,000.00 |
| 2019 | Basic Life Actives | $258,000.00 |
| 2019 | Basic Life - OCC Retiree | $546,859.07 |
| 2019 | Basic Life - OTS Retiree | $545,299.00 |
| 2019 | Dependent Life Family | $60,000.00 |
| 2019 | Dependent Life Spouse | $408,948.15 |
| 2019 | Dependent Life Spouse - OTS Retiree | $88,375.00 |
| 2019 | Optional Life EE | $57,500.00 |
| 2020 | Basic Life Actives | $788,000.00 |
| 2020 | Basic Life - OCC Retiree | $456,250.00 |
| 2020 | Basic Life - OTS Retiree | $1,743,936.98 |
| 2020 | Dependent Life Family | $27,500.00 |
| 2020 | Dependent Life Spouse | $213,000.00 |
| 2020 | Dependent Life Spouse - OTS Retiree | $0.00 |
| 2020 | Optional Life EE | $1,100,000.00 |
| 2021 | Basic Life Actives | $398,201.64 |
| 2021 | Basic Life - OCC Retiree | $177,500.00 |
| 2021 | Basic Life - OTS Retiree | $348,260.68 |
| 2021 | Dependent Life Family | $12,500.00 |
| 2021 | Dependent Life Spouse | $122,000.00 |
| 2021 | Dependent Life Spouse - OTS Retiree | $0.00 |
| 2021 | Optional Life EE | $600,306.85 |
File details come from the government source that posted it. Updated .