Attachment O October 2024 STD LTD Monthly Invoice.pdf

This document is an invoice and premium payment report from UnitedHealthcare for the State of Nebraska's Short Term Disability (STD) and Long Term Disability (LTD) insurance coverage for October 2024, with Group ID 306147. The invoice covers a comprehensive disability insurance program for state employees, detailing premium rates across various age ranges from 00-24 to 70 and over, with separate breakdowns for STD and LTD coverage. The coverage period runs from 10/1/2024 to 10/31/2024, with a due date of 10/1/2024, and includes detailed premium calculations for different employee age brackets.

The total monthly premium for STD coverage is $172,798.51, covering 3,150 employees with current period volume of $2,139,413.54, while LTD coverage totals $87,366.51 for 5,797 employees with a current period volume of $31,887,518.69. The document indicates an ACH payment of $260,165.02 was sent to UnitedHealthcare on 11/5/2024, suggesting this is part of an ongoing insurance contract. The rates vary by age group, with premiums ranging from $0.77 to $1.378 for STD and $0.08 to $0.47 for LTD, reflecting the graduated risk assessment across different employee age ranges.