Infinity Resources, Inc.

Carrier Name - Adjustments to Billing 04/2002 - 05/2002 Location(s): All Division(s): All Subtotaled by: Location

Montreal Name SSN Division Effective Date Termination Effective Date Months Coverage Adjustments ($) HMO Policy Number 89343 Edwards, Andrew 123-456-789 Marketing 04/12/2002   1 Family 200.00 Gallagher, Susan 987-456-123 Marketing 04/12/2002   1 Single 182.03 POS Policy Number 123343 Jackson, Melissa 234-567-890 Sales 04/12/2002 01/31/2002 1 Family 490.90 Montreal Total $950.00

Rock Island Name SSN Division Effective Date Termination Effective Date Months Coverage Adjustments ($) PPO Policy Number 32443 Edwards, Andrew 123-456-789 Marketing 04/12/2002   1 Family (200.00) Gallagher, Susan 987-456-123 Marketing 04/12/2002   1 Single 182.03 Jackson, Melissa 234-567-890 Sales 04/12/2002 01/31/2002 1 Family 190.90 Rock Island Total $950.00

Total Premium Adjustments            $1,150.00

---

Export to Excel

CLOSE WINDOW
Product Feedback   Copyright © 2004 Sunaro, Inc. All rights reserved.
Powered by