RFP%2031786-00193%20Appendix%207.12%20Basic%20Term%20Life%20and%20ADD%20Invoice%20Template.xlsx
XLSX spreadsheet 72 KB Posted
- Solicitation number
- RFP 31786-00193
- Issued by
- Davidson County, Tennessee
About this file
This is an invoice template for the State of Tennessee's Basic Term Life and Accidental Death and Dismemberment (AD&D) insurance program under RFP 31786-00193, Appendix 7.12. The template is designed to track monthly invoicing and premium adjustments for employee life and AD&D coverage provided to state employees. The invoice template establishes a structured format for calculating contract premiums based on covered lives, with premium rates expressed per $1,000 of coverage. The document includes designated fields for tracking employee enrollment numbers, which range from approximately 69,300 to 74,300 employees across the monthly periods shown from January 2023 through February 2026. The template provides a comprehensive framework for monthly premium reconciliation and payment processing.
The invoice template incorporates multiple financial tracking mechanisms including current contract premiums, IBNR (Incurred But Not Reported) reserves, premium adjustments, minimum premium calculations, group liability assessments, and surplus or deficit balance reconciliations. The template structure includes columns for tracking conversion charges, interest calculations, tax adjustments, and prior month balances to facilitate accurate monthly invoicing and financial reconciliation. This standardized template ensures consistent billing practices and allows for transparent premium calculation methodology between the State of Tennessee and the insurance carrier throughout the contract period.
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State of TN Invoice Template
| RFP 31786-00193 Appendix 7.12 Basic Term Life and ADD Invoice Template | ||||||||
| State Of Tennessee Contract Number: ##### | ||||||||
| Current | Contract | Annualized | IBNR Reserve | |||||
| Contract Premium | Volume (000) or lives | Adjustment | Premium | Contract Premium | Premium Factor | IBNR Reserve | ||
| Employee Basic Term Life | $ - 0 | per $1000 | 5,606,210 | |||||
| Employee Basic AD&D | $ - 0 | per $1000 | 5,606,210 |
| Minimum Premium | YYYY | YYYY | YYYY | YYYY | YYYY | |
| Retention | per employee | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
| IBNR | per employee | $ - 0 |
| (A) | (B) | (C) | (D) | (E) | (F) | (G) | (H) | (I) | (J) | (K) | (L) | (M) | (N) | (O) | (P) | |
| B+C | E+F+G+H+I+J | MIN(K,D) | D-K | J-K | ||||||||||||
| Prior | Tax & | Prior | Minimum | |||||||||||||
| Number of | Contract | Surplus | Group Max | Change In | Conversion | Interest | Deficit | Premium | Monthly | Payment | Payment | Current | Current | IBNR | ||
| Month | Employees | Premium | Balance | Liability | Claims | Waiver Reserve | Charge | Reconciliation | Balance | Charge | Cost | Due | Received | Surplus | Deficit | Balance |
| Jan-23 | 69,323 |
| Feb-23 | 69,343 |
| Mar-23 | 70,030 |
| Apr-23 | 70,085 |
| May-23 | 70,052 |
| Jun-23 | 70,521 |
| Jul-23 | 70,609 |
| Aug-23 | 70,540 |
| Sep-23 | 70,958 |
| Oct-23 | 71,454 |
| Nov-23 | 71,796 |
| Dec-23 | 71,796 |
| Jan-24 | 71,898 |
| Feb-24 | 72,055 |
| Mar-24 | 72,256 |
| Apr-24 | 72,277 |
| May-24 | 72,507 |
| Jun-24 | 72,675 |
| Jul-24 | 72,636 |
| Aug-24 | 72,827 |
| Sep-24 | 73,123 |
| Oct-24 | 73,556 |
| Nov-24 | 73,762 |
| Dec-24 | 73,915 |
| Jan-25 | 74,043 |
| Feb-25 | 73,880 |
| Mar-25 | 73,754 |
| Apr-25 | 73,798 |
| May-25 | 73,885 |
| Jun-25 | 73,920 |
| Jul-25 | 73,713 |
| Aug-25 | 73,662 |
| Sep-25 | 73,930 |
| Oct-25 | 74,141 |
| Nov-25 | 74,192 |
| Dec-25 | 74,375 |
| Jan-26 | 74,282 |
| Feb-26 | 74,034 |
Month Year Invoice Total:
File details come from the government source that posted it. Updated .