April 2025 MODA invoice.pdf
PDF 262 KB Posted
- Attached to
- RFP Insurance Agent Services
- Solicitation number
- S-C00040-00013116
- Issued by
- Benton County, Oregon
About this file
This document is a Delta Dental of Oregon billing invoice for Clatsop County's dental insurance coverage for April 2025. The invoice, dated 3/13/2025, shows a total due amount of $33,420.96 for dental coverage beginning 4/1/2025, with a payment due date of 4/1/2025. The billing summary breaks down the dental coverage across different subscriber types: 77 subscriber-only plans at $5,005.84, 60 subscriber-plus-spouse plans at $7,724.04, 11 subscriber-plus-child plans at $1,458.08, and 12 subscriber-plus-children plans at $1,562.79, totaling 90 plans with a total premium of $17,942.25.
The invoice includes a retroactive adjustment of -$272.04 and shows no outstanding balance from prior months. The group number is 10000137 with subgroup 0001, and the membership accounting contact is Marjorie Bernt, reachable at marjorie.bernt@modahealth.com or 503-265-4737. The billing is for Clatsop County's active and retiree dental insurance, with checks to be made payable to Delta Dental of Oregon and sent to their accounting department in Portland, Oregon.
View the file
Other files
Show all 14
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
Clatsop County 10000137Group Number:
Subgroup(s):
Membership Accounting Contact: Marjorie Bernt, marjorie.bernt@modahealth.com, 503-265-4737 Page 1
3/13/2025 4/1/2025 4/1/2025
$33,420.96
Billing Print Date:
For Coverage Beginning:
Due Date:
Total Due:
Billing Print Date Due Date
Please make checks payable to:
Delta Dental of Oregon
Group Number Amount Due
3/13/2025 4/1/2025
10000137 $33,420.96
Return this portion with the Subgroup Summary page and your payment in the enclosed envelope. Please include your Group number on your check.
Delta Dental of Oregon Attn: Accounting 601 SW Second Ave.
Portland, OR 97204-3199
$Amount Paid
601 SW Second Ave.
Portland, OR 97204 Forwarding Service Requested
J613
CLATSOP COUNTY
CLATSOP COUNTY ACTIVE/RETIREE
800 EXCHANGE STREET SUITE 310
ASTORIA OR 97103
5,754
J613 [5,754] 1 of 3 B 4
[DM-]
20250314B05 J613
1435 39884
Group Number:
Clatsop County
10000137 Subgroup(s): 0001
Billing Summary
Billing Print Date:
For Coverage Beginning:
Due Date:
Total Due:
3/13/2025 4/1/2025 4/1/2025 $33,420.96
Benefit Type Subscriber Only Subscriber + Spouse
Subscriber + Child
Subscriber + Children
Family Total Premium Due
$33,693.00$5,005.84 $7,724.04 $1,458.08 $1,562.79 $17,942.2577 60 11 12 90Dental
See roster for details -$272.04Retroactive Adjustments None to report $0.00Outstanding Balance
$33,420.96April-2025Total Due for Billing Period
Subgroup Summary
Group Subgroup Current Month Amount
Retroactive Amount Subgroup Total
Outstanding From Prior Month Total Due
10000137 0001 $33,693.00 -$272.04 $33,420.96 $0.00 $33,420.96 Subtotal $33,420.96 $0.00 $33,420.96
J613 [5,754] 2 of 3 B 4
[DM-]
20250314B05
THIS PAGE INTENTIONALLY LEFT BLANK
Group Number:
Clatsop County
10000137 Subgroup(s): 0001 Billing Print Date:
For Coverage Beginning:
Due Date:
Total Due:
3/13/2025 4/1/2025 4/1/2025 $33,420.96
Subgroup Summary
Group Subgroup Current Month Amount
Retroactive Amount Subgroup Total
Outstanding From Prior Month Total Due
10000137 0001 $33,693.00 -$272.04 $33,420.96 $0.00 $33,420.96 Subtotal $33,420.96 $0.00 $33,420.96
Please return this summary with your payment in the enclosed envelope.
J613 [5,754] 3 of 3 B 4
[DM-]
20250314B05
THIS PAGE INTENTIONALLY LEFT BLANK
File details come from the government source that posted it. Updated .