... November 7, The Prudential Insurance Company of America Group Insurance Mid-Large Billing Organization P.O. Box 7639 Philadelphia, PA 19176

Transcription

1 Group Insurance Mid-Large Billing Organization PO Box 7639 Philadelphia, PA November 7, LOCNIC111 JANELL PAYNE ABC COMPANY 1212 MAIN ST NEW YORK, NY 16 Client Number: 42 Dear Janell 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 feel free to contact me at: Phone: POLEY@OPTONLINENET Fax: We look forward to working with you and developing a strong relationship with ABC COMPANY Sincerely, Jalma Taylor Billing Representative Enclosures Page 1 of 6

2 Page 2 of 6

3 GROUP INSURANCE PREMIUM REMITTANCE REPORT LOCNIC111 JANELL PAYNE ABC COMPANY 1212 MAIN ST NEW YORK, NY 16 Control Number: Bill Group: Bill Ref Number: Due Date: Billing Period: Bill Production Date: /1/219 1/1/219-1/31/219 11/7/218 Thank you for choosing to do business with 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 Regular Mail: PO Box Atlanta, GA Overnight Mail: c/o Wachovia Bank, Attn: Lockbox # Atlanta Avenue Hapeville, GA 3354 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: INSURED MUNICIPAL INCOME FUND 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: Jalma Taylor Product Key Products New York DBL NY PFL Description New York Disability Benefits Law NY Paid Family Leave 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: ABC COMPANY /1/219 1/1/219-1/31/219 3 Wisconsin (see instructions on page 1) BILL LINE PRODUCT key on page 2 2 Female Ee 3 Male Ees 35 Nypfl F 36 Nypfl M New benamt York DBL New benamt York DBL NY PFL benamt (Client) NY PFL benamt (Client) COVERED LIVES VOLUME (dollars) Previous 12 Previous 15 Previous 15 Previous 12 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: Jalma Taylor POLEY@OPTONLINENET RATE CURRENT AMOUNT DUE $695 per indiv ADJUSTMENT AMOUNT ADJUSTMENT PERIOD NET AMOUNT DUE $3 per indiv $153 per 1 $153 per 1 Total Amount Due Total Adjustment Amount Total Amount Due $ $ $ Mail Payment (payable to Prudential) and completed Premium Remittance Reports to: PO Box Atlanta, GA Page 5 of 6 NI1

6 Page 6 of 6 NI1