Please deduct your advance payment when completing your first report and remitting premium.

Transcription

1 The Prudential Insurance Company of America Group Insurance Client Operations Service Center PO Box 7827 Philadelphia, PA September 29, LOCNIC BLAIZE PAYNE 1313 MOCKINGBIRD PL PHILADELPHIA, PA Client Number: Dear Blaize Payne: Welcome and thank you for selecting Prudential Group Insurance Enclosed is a detailed informational packet intended to help you familiarize yourself with Prudential's Group Insurance billing process Included are: Your company's first Billing Report(s) A Volume Calculation Guide Remittance Envelopes Please deduct your advance payment when completing your first report and remitting premium If you have any questions or concerns, please contact our Client Operations Service Center, Monday through Friday from 8:00 AM to 8:00 PM Eastern Time: Phone: Fax: We look forward to working with you and developing a strong relationship with Sample Client BilledCase Sincerely, COSC Call Center Billing Representative Enclosures Page 1 of 6

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3 GROUP INSURANCE PREMIUM REMITTANCE REPORT LOCNIC BLAIZE PAYNE 1313 MOCKINGBIRD PL PHILADELPHIA, PA Control Number: Bill Group: Bill Ref Number: Due Date: Billing Period: Bill Production Date: /01/ /01/ /31/ /29/2017 Thank you for choosing to do business with The Prudential Insurance Company of America Enclosed is your current Premium Remittance Report Please complete the report and return it with your payment, following the instructions below Instructions for Completing the Report 1 Insert current COVERED LIVES and VOLUME (if applicable; use whole $) for each product line 2 Calculate the CURRENT AMOUNT DUE for each product using the rate shown 3 Complete the ADJUSTMENT AMOUNT and ADJUSTMENT PERIOD for each applicable product (Example: a change to your life insurance amounts for a 2-month period will require you to identify this adjustment period) 4 Determine the NET AMOUNT DUE by summing the CURRENT AMOUNT DUE, plus or minus any ADJUSTMENT AMOUNTS for each product line 5 Calculate the TOTAL AMOUNT DUE by adding the NET AMOUNT DUE for each product line 6 At the end of the Premium Remittance Report, please be sure to provide complete client representative information, in case we need to contact you We recommend that you keep a copy of your completed report for your records Payment Instructions - Please remit "Total Amount Due" To pay by check - Make your check payable to "Prudential" and indicate your Control Number and Bill Ref Number on your check Send your payment and completed Premium Remittance Report in the enclosed envelope to: Regular Mail: The Prudential Insurance Company of America PO Box Atlanta, GA Overnight Mail: The Prudential Insurance Company of America c/o Wachovia Bank, Attn: Lockbox # Atlanta Avenue Hapeville, GA To pay by EFT (wire transfer or ACH) - please use the following information: Receiving Bank/Location: ABA Routing Number: Name of Account: Bank Account Number: Reference: JP Morgan Chase/New York, New York Prudential Group Insurance Concentration Account [Control Number],[Client Name],[PO Box #],[Due Date],[Bill Ref Number] SEE REVERSE SIDE FOR ADDITIONAL IMPORTANT INFORMATION Page 3 of 6

4 GROUP INSURANCE PREMIUM REMITTANCE REPORT Contact Information If you have any questions regarding your Premium Remittance Report, please contact: Name: Phone: Fax: COSC Call Center Product Key Products AD&D NY PFL New York DBL Life Description Accidental Death & Dismemberment NY Paid Family Leave New York Disability Benefits Law Basic Life Grace Period Your group policy provides that premium must be paid within the policy grace period If the required premium is not paid within the policy grace period your group policy will terminate, and unless otherwise provided in the policy, Prudential will not be liable for losses incurred after the grace period Neither payment of partial premium nor your receipt of a Premium Remittance Report generated after such partial payment will constitute a waiver of the requirement that full premium be paid within the grace period in order for the group policy to continue in force Page 4 of 6

5 GROUP INSURANCE PREMIUM REMITTANCE REPORT Client Name: Control Number: Bill Ref Number: Due Date: Billing Period: Bill Group #/Name: Sample Client BilledCase /01/ /01/ /31/ All Employees (see instructions on page 1) BILL LINE PRODUCT key on page All Employees All Employees Dbl Males Dbl Female Male Pfl Female Pfl Basic benamt Life (Client) AD&D benamt (Client) 6 New benamt York DBL (Client New benamt York DBL (Client NY PFL benamt (Client) NY PFL benamt (Client) COVERED LIVES VOLUME (dollars) Previous 100 Previous 100 Previous 6 Previous 4 Previous 6 Previous 4 1,000,000 1,000,000 N/A N/A 24,000 16,000 Report Prepared By Date Prepared (Please Print) ( ) Phone Number Address/Fax Number Check here if any of your contact information has changed Please provide new contact information New contact information: Street Address: City, State, Zip: Contact Name: Phone: Fax: If you have any questions regarding this report please contact: Name: Phone: Fax: COSC Call Center RATE CURRENT AMOUNT DUE $10000 per 1000 ADJUSTMENT AMOUNT ADJUSTMENT PERIOD NET AMOUNT DUE $05000 per 1000 $30000 per indiv $30000 per indiv $01260 per 100 $01260 per 100 Total Amount Due Total Adjustment Amount Total Amount Due $ $ $ Mail Payment (payable to Prudential) and completed Premium Remittance Reports to: The Prudential Insurance Company of America PO Box Atlanta, GA Page 5 of 6 NI01

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