Monthly Premiums- Attachment 4.pdf

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S-CA525-09-R-1037
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Embassy of the United States of America L.T.D / Dental / Health

Paid Claims Report

Month L.T.D. Paid Claims ($) Dental Paid Claims ($) Health Paid Claims ($) *

Jul-08 4,363 19,285 33,570

Aug-08 4,363 16,116 28,348

Sep-08 4,363 16,440 27,444

Oct-08 4,363 25,684 23,700

Nov-08 9,363 19,030 18,674

Dec-08 12,913 17,693 31,936

Jan-09 7,913 14,008 19,954

Feb-09 2,913 18,145 27,682

Mar-09 60,913 17,335 27,849

Apr-09 7,913 19,584 26,568

May-09 6.913 27,953 21,347

Jun-09 4,363 21,285 28,066

(*) excluding any claim over the pooling level

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