4703DA27-CDA6-EDC7-014A9FC1481F13BA.pdf
PDF 352 KB Posted
- Attached to
- Franklin County EOC Technology Upgrade
- Solicitation number
- RFP 2026-62-10
- Issued by
- Franklin County, Ohio
About this file
This document contains MetLife Group Insurance invoices for the Franklin County Board of Commissioners for May 2025 coverage. The invoices detail group health insurance premiums across multiple policy divisions, covering both standard regular (STDREG) and long-term disability (LTD) insurance products. The invoices are organized by coverage code and age bracket categories ranging from 0-29 years to 65+ years, with lives covered varying by division. The billing is based on recorded payroll amounts and applicable per-unit rates, with coverage month identified as May 2025.
The total amount due across all invoice divisions is $152,527.99, comprised of individual division totals including $149,855.67, $1,710.56, $530.76, and $431.10. Payment is directed to MetLife's P.O. Box 360229 in Pittsburgh, PA 15251-6229, with customer number 157775 and vendor number 159546. The invoices emphasize the importance of accurate reporting of lives, volume, and premium information for renewal processes and request verification that rates listed reflect current billing rates. Remittance adjustments and lockbox processing information are included for payment tracking purposes.
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Text version
MetLife Group Insurance Invoice Format: FIN
Cust No: 157775 Customer: Franklin County Board of Commissioners Inv #: 05012025 Division : Page: 1 of 1
Office: NSC Admin. Code: 05K Printed : Currency : US
Exp. Bill Coverage Ceverage PD Recorded Insurance/Benefit/ Number Format Abbr Description Code Lives Covered Payroll Rate Per Subtotal
0157775 000003 STDREG 40 TO 49 P0103 2676 1,965,050 $0.397 /10 78,012.50$
0157775 000003 LTD P01 03 40 TO 49 P0103 2341 9,381,899 $0.792 /100 74,304.64$
(2,461.47)$
Date:
Please remit payment to: Accurately reporting lives, volume, and premium on your Metlife MetLife invoice is critical in the renewal process. Your renewal is based on P.O. Box 360229 the information you submit on a monthly basis. Please verify that the Pittsburgh, PA 15251-6229 rates listed on your Metlife invoice reflect your current billing rates.
Vendor 159546 8252 284601
Coverage Month: May-25
Authorized By:
Important! Please write your customer number on your check and include this invoice with payment.
Franklin County
(Current Month) $149,855.67
Remittance Adjustment Remittance Adjustment LOA
Total Amount Due
May 2025
Batch: 1005, Tran: 6, Date: 20250602, Amount: 0.00, Lockbox#: 360229, Acc#: -
Cust No: 157775 Customer: Franklin County Board of Commissioners Inv #:
Division : Page: 1 of 1
Office: NSC Admin. Code: 05K Printed : Currency : US
Exp. Bill Coverage Ceverage PD Recorded Insurance/Benefit/ Number Format Abbr Description Code Lives Covered Payroll Rate Per Subtotal
0157775 000005 STDREG 0 TO 29 P02 5 4,827 $0.282 10 $136.12
0157775 000005 STDREG 30 TO 39 P02 9 8,814 $0.278 10 $245.04
0157775 000005 STDREG 40 TO 49 P02 6 6,459 $0.316 10 $204.10
0157775 000005 STDREG 50 TO 59 P02 2 1,518 $0.479 10 $72.71
0157775 000005 STDREG 60 TO 64 P02 1 550 $0.629 10 $34.58
0157775 000005 STDREG 65+ P02 1 610 $0.629 10 $38.38
0157775 000005 LTD 0 TO 29 P02 6 37,066 $0.351 100 $130.10
0157775 000005 LTD 30 TO 39 P02 9 68,804 $0.418 100 $287.60
0157775 000005 LTD 40 TO 49 P02 7 56,769 $0.627 100 $355.94
0157775 000005 LTD 50 TO 59 P02 1 6,180 $0.639 100 $39.49
0157775 000005 LTD 60 TO 64 P02 2 18,874 $0.522 100 $98.52
0157775 000005 LTD 65+ P02 2 17,796 $0.382 100 $67.98
Date:
Please remit payment to: Accurately reporting lives, volume, and premium on your Metlife
MetLife invoice is critical in the renewal process. Your renewal is based on P.O. Box 360229 the information you submit on a monthly basis. Please verify that the Pittsburgh, PA 15251-6229 rates listed on your Metlife invoice reflect your current billing rates.
Total Amount Due (Current Month)
$1,710.56
Remittance Adjustment
Remittance Adjustment LOA
Coverage Month: May-25
Authorized By:
Important! Please write your customer number on your check and include this invoice with payment.
Division : Page: 1 of 1
Office: NSC Admin. Code: 05K Printed : Currency : US
Exp. Bill Coverage Ceverage PD Recorded Insurance/Benefit/ Number Format Abbr Description Code Lives Covered Payroll Rate Per Subtotal
0157775 000006 STDREG 0 TO 29 P01 1 959 $0.282 10 $27.04
0157775 000006 STDREG 30 TO 39 P01 0 0 $0.278 10 $0.00
0157775 000006 STDREG 40 TO 49 P01 3 2,356 $0.316 10 $74.44
0157775 000006 STDREG 50 TO 59 P01 2 1,554 $0.479 10 $74.42
0157775 000006 STDREG 60 TO 64 P01 0 0 $0.629 10 $0.00
0157775 000006 STDREG 65+ P01 1 1,385 $0.629 10 $87.10
0157775 000006 LTD 0 TO 29 P01 2 10,906 $0.351 100 $38.28
0157775 000006 LTD 30 TO 39 P01 1 5,230 $0.418 100 $21.86
0157775 000006 LTD 40 TO 49 P01 2 12,306 $0.627 100 $77.16
0157775 000006 LTD 50 TO 59 P01 2 11,221 $0.639 100 $71.70
0157775 000006 LTD 60 TO 64 P01 0 0 $0.522 100 $0.00
0157775 000006 LTD 65+ P01 1 15,382 $0.382 100 $58.76
Date:
Please remit payment to: Accurately reporting lives, volume, and premium on your Metlife
MetLife invoice is critical in the renewal process. Your renewal is based on P.O. Box 360229 the information you submit on a monthly basis. Please verify that the Pittsburgh, PA 15251-6229 rates listed on your Metlife invoice reflect your current billing rates.
Coverage Month: May-25
Authorized By:
Important! Please write your customer number on your check and include this invoice with payment.
Total Amount Due (Current Month)
$530.76
Remittance Adjustment
Remittance Adjustment LOA
Batch: 1005, Tran: 1, Date: 20250602, Amount: 0.00, Lockbox#: 360229, Acc#: -
Division : Page: 1 of 1
Office: NSC Admin. Code: 05K Printed : Currency : US
Exp. Bill Coverage Ceverage PD Recorded Insurance/Benefit/ Number Format Abbr Description Code Lives Covered Payroll Rate Per Subtotal
0157775 000010 LTD 0 TO 29 P01 0 0.00 $0.351 100 $0.00
0157775 000010 LTD 30 TO 39 P01 5 33,631.58 $0.418 100 $140.58
0157775 000010 LTD 40 TO 49 P01 1 7,888.36 $0.627 100 $49.46
0157775 000010 LTD 50 TO 59 P01 1 4,456.96 $0.639 100 $28.48
0157775 000010 LTD 60 TO 64 P01 0 0.00 $0.522 100 $0.00
0157775 000010 LTD 65+ P01 1 8,000.00 $0.382 100 $30.56
0157775 000010 STDREG 0 TO 29 P01 0 0.00 $0.282 10 $0.00
0157775 000010 STDREG 30 TO 39 P01 4 2,977.70 $0.278 10 $82.78
0157775 000010 STDREG 40 TO 49 P01 0 0.00 $0.316 10 $0.00
0157775 000010 STDREG 50 TO 59 P01 1 617.12 $0.479 10 $29.56
0157775 000010 STDREG 60 TO 64 P01 0 0.00 $0.629 10 $0.00
0157775 000010 STDREG 65+ P01 1 1,107.79 $0.629 10 $69.68
Date:
Please remit payment to: Accurately reporting lives, volume, and premium on your Metlife
MetLife invoice is critical in the renewal process. Your renewal is based on P.O. Box 360229 the information you submit on a monthly basis. Please verify that the Pittsburgh, PA 15251-6229 rates listed on your Metlife invoice reflect your current billing rates.
Coverage Month: May-25
Authorized By:
Important! Please write your customer number on your check and include this invoice with payment.
Total Amount Due (Current Month)
$431.10
Remittance Adjustment
Remittance Adjustment LOA
| 0525 000003 Franklin County-Invoice.pdf (p.1) |
| Franklin County |
| 0525 000004 Franklin County-Invoice.pdf (p.2) |
| 0525 000005 Franklin County-Invoice.pdf (p.3) |
| 0525 000006 Franklin County-Invoice.pdf (p.4) |
| 0525 000009 Franklin County-Invoice.pdf (p.5) |
| 0525 000010 Franklin County-Invoice.pdf (p.6) |
File details come from the government source that posted it. Updated .