The Standard March 2025 invoice.pdf

7 KB Posted

Attached to
RFP Insurance Agent Services
Solicitation number
S-C00040-00013116
Issued by
Benton County, Oregon

About this file

Written by GovTribe AI ·

This document is a Premium Statement from Standard Insurance Company for Clatsop County, dated March 21, 2025, covering insurance benefits with a premium payment due on March 1, 2025. The statement details multiple benefit plans for the county, including Long-Term Disability (LTD), Optional Riders Life FEV (ORLFEV), Basic Accidental Death and Dismemberment (BAD&D), Basic Life (BLIFE), and Dependent Life (DEPLF). The policy covers 242 lives for most benefits, with a total insured amount ranging from 0 to 9,366,000, and a total premium amount due of $3,376.31.

The breakdown shows detailed premium calculations for each benefit plan, with specific rates and per-unit costs. The document indicates 242 lives are insured for most plans, with 52 lives for the Optional Riders Life FEV plan and 191 lives for the Dependent Life plan. The premium components include various rates and calculations, with minimal back charges or credits. The statement provides a comprehensive overview of the county's insurance coverage, showing the breadth of benefits and the associated costs for the specified coverage period.

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/1 2

CLATSOP COUNTY

ATTN BUDGET AND FINANCE

800 EXCHANGE ST STE 410

ASTORIA,OR 97103

Premium Statement

Policy Number 146667 0001

-- Payment is due on REMINDER March 1, 2025 Contact: ebpremiums@standard.com / (800) 348-3226

Benefit Premium Totals:

Total Amount Due $ 3,376.31

Total Billing Fees $ 0.00

Amount to be Paid $ 3,376.31

Please fold and return pages to .all Standard Insurance Company

Policy Number 146667 0001 PREMIUM DUE DATE March 1, 2025

STANDARD INSURANCE COMPANY

PO BOX 3789

PORTLAND 97208-3789

March 21, 2025 Retain a completed copy for your records. No additional back up is needed.

Policy Number: 146667 0001 March 1, 2025

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Benefit Plan Rate Per

LTD

LIVES INSURED AMOUNT Bill Category

Actual Figures This Month: 242 754,703

Totals and Adjustments: $ 1,962.23 $ 0.00 $ 0.00 $ 1,962.23

Amount Due Back Charge Back Credit Total Amount Due

ORLFEV $0.05 $1,000

LIVES INSURED AMOUNT Bill Category

Actual Figures This Month: 52 520,000 0100

Totals and Adjustments: $ 26.00 $ 0.00 $ 0.00 $ 26.00

Amount Due Back Charge Back Credit Total Amount Due

BAD&D

LIVES INSURED AMOUNT Bill Category

Actual Figures This Month: 242 9,366,000

Totals and Adjustments: $ 374.64 $ 0.00 $ 0.00 $ 374.64

Amount Due Back Charge Back Credit Total Amount Due

BLIFE

LIVES INSURED AMOUNT Bill Category

Actual Figures This Month: 242 6,317,462

Totals and Adjustments: $ 846.54 $ 0.73 $ 0.00 $ 847.27

Amount Due Back Charge Back Credit Total Amount Due

DEPLF

LIVES INSURED AMOUNT Bill Category

Actual Figures This Month: 191 0

Totals and Adjustments: $ 166.17 $ 0.00 $ 0.00 $ 166.17

Amount Due Back Charge Back Credit Total Amount Due

File details come from the government source that posted it. Updated .