Attachment O October 2024 STD LTD Monthly Invoice.pdf

This file is an invoice and premium payment report from UnitedHealthcare to the State of Nebraska for Short Term Disability (STD) and Long Term Disability (LTD) insurance coverage for October 2024. The document shows coverage details for Group ID 306147, with invoice number 242590000935, dated September 15, 2024, for the coverage period of October 1-31, 2024. The invoice includes rate schedules for different age brackets for both STD and LTD coverage, with STD rates ranging from $0.643000 to $1.378000 per $100 of coverage and LTD rates ranging from $0.050000 to $0.470000 per $100 of coverage.

The premium payment report details that 3,150 employees are enrolled in STD coverage with a total monthly premium of $172,798.51, while 5,797 employees are enrolled in LTD coverage with a total monthly premium of $87,366.51. The current period volume for STD coverage totals $2,139,413.54 and LTD coverage totals $31,887,518.69. An ACH payment of $260,165.02 was sent to UnitedHealthcare on November 5, 2024. The document includes a notice about premiums for prior months not being received and warns about potential coverage lapse if payment is not made.