A nivel de objetivos

Your billing statement is divided into three sections Section 1: Summary of the Current Billing Period Section 2: Detailed Summary Sheet of Your Rates

& Benefits

Section 3: List of Your Covered Employees

Section 1 – Summary of the Current Billing Period

1. GROUP NUMBER: The unique number that identifies your group. Following the group number is the subgroup number and check digit, which further identifies your group. Please be sure to use all of these numbers when your group number is requested. 2. CURRENT BILLING PERIOD: “From” identifies the

start date covered by the bill. “To” identifies the date the group was billed up to. This is one day after the last day of coverage.

3. BILLING ASSISTANCE: This is where the phone number is located if you need to contact your billing reconciliation representative who is assigned to help you with any billing questions you may have.

4. BASIC COVERAGE: The sum of the group’s individual subscriber billed amounts—current dues within the

5. GRAND TOTAL DUE: This is the sum of your current dues, arrears (retroactive additions, cancellations or changes to your account), and payments past due (amounts from previous bills if applicable).

6. PAYMENT COUPON: To avoid a delay in processing your payment, detach and remit bottom portion of the bill with your payment.

7. AMOUNT PAID: This is the amount of the total bill you are paying.

8. CHECK NUMBER: This is the number on the check you are enclosing with your bill payment.

Section 2 – Detailed Summary of Your Rates & Benefits

1. COVERAGE: A brief description of your benefit coverage by line of business.

2. CONTRACTS: Indicates the type of subscribers covered within each package (e.g., single, two-party, family).

3. BILLED: Indicates the number of subscribers billed per contract type.

4. MONTHLY RATE: Indicates the package rate per contract type.

5. CURRENT AMOUNT: This is the amount equal to the number of subscribers in each contract type multiplied by their corresponding monthly rate.

6. RETRO AMOUNT: This column should have a zero balance except for those occasions when a change to a subscriber’s status (e.g., changing contract types – single to two-party) is submitted requesting cover- age for the same billing period and the bill has already been generated. In this case, the following month’s bill will show a “retro amount” to be paid for the difference between the single and two-party rate for which the subscriber was covered but not yet billed.

For example, this billing has already been generated and HMSA receives a change in contract type from

Contracts Current Retro Amount

Two-Party $625.19 $$$

Single $$$ credit

7. TOTAL AMOUNT: The sum of the current amount plus the retro amount.

8. TOTAL PACKAGE: These are the subtotals for the number of subscribers, Current Amount column, Retro Amount column, Total Amount column for a particular package.

9. TOTAL CURRENT PERIOD: The sum of the group’s package subtotals. This field should correspond to the basic coverage amount on the summary page (page 1) of the current billing period.

10. TOTAL PRIOR UNPAID BILLS: The sum of the group’s past due amounts. This field should correspond to the payment past due indicated on the summary page (page 1) of the current billing period.

NOTE: If there is no past due amount, there will be no payment past due field on the summary sheet.

TOTAL AMOUNT DUE: The sum of the total current period plus the sum of the total prior unpaid bills. This field should correspond to the grand total due indicated on the summary page (page 1) of the current billing period.

1. SUBSCRIBER IDENTIFICATION NO.: A unique number assigned to the subscriber. 2. SUBSCRIBER NAME: Identifies the name of the

subscriber.

3. FROM: Identifies the start date covered by the bill. 4. TO: Identifies the date the group was billed up to for

the subscriber’s coverage.

5. CONT TYPE (CONTRACT TYPE): Indicates the type of contract that covers this subscriber (e.g., single, two-party, family).

6. TYP CHG (TYPE CHANGE): Indicates a code for any maintenance performed during the current billing period. The codes are as follows:

A = Add

B = Benefit Changes

C = Cancellation

7. CURRENT AMOUNT: Indicates the subscriber’s dues payment (package rate).

8. RETRO AMOUNT: This column should have a zero balance except for those occasions when a change to a subscriber’s status (e.g., changing contract types – single to two-party) is submitted requesting cover- age for the same billing period that the bill has already been prepared for. In this case, the following month’s bill will show a “retro amount” to be paid for the difference between the single and two-party rate for which the subscriber was covered but not yet billed. 9. TOTAL AMOUNT: The sum of the current amount plus

the retro amount.

10. PACKAGE NUMBER: Identifies the package the subscriber is enrolled under.

11. SUBTOTAL PACKAGE: The subtotal figures for your group’s current amount, retro amount, and total amount for a particular package.

12. TOTAL CURRENT BILLING PERIOD: The sum of your group’s package subtotals. This field should

correspond to the basic coverage amount on the summary page (page 1) of the current billing period.

Billing – How to Read Your Bill (continued)