Attachment O October 2024 STD LTD Monthly Invoice.pdf

This is an invoice and premium payment report from UnitedHealthcare to the State of Nebraska's Employee Wellness & Benefits department for disability insurance coverage. The invoice (#242590000935) covers the period from 10/1/2024 to 10/31/2024, with payment due on 10/1/2024. The document includes premium rates for both Short Term Disability (STD) and Long Term Disability (LTD) coverage across various age groups, with a notice indicating that premiums for prior months have not been received and the grace period has expired.

The premium payment report shows that for October 2024, the STD coverage includes 3,150 employees with a total monthly premium of $172,798.51 and a current period volume of $2,139,413.54. The LTD coverage encompasses 5,797 employees with a total monthly premium of $87,366.51 and a current period volume of $31,887,518.69. An ACH payment of $260,165.02 was sent to UnitedHealthcare on 11/5/2024. Both STD and LTD plans are based on 60% salary coverage, with premium rates varying by age brackets ranging from 00-24 years to 70+ years.