| 1 |
Choice Plus AUW5 Gold |
1 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
1 |
8/14/2019 6:58 am |
681.02 |
0.00 |
681.02 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634454_3701406_586 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=1 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 2 |
Choice Plus AUW5 Gold |
1 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
2 |
8/14/2019 6:58 am |
1362.04 |
0.00 |
1362.04 |
Employee + Spouse |
Alex Olupitan |
2071 |
466 |
val_2634455_3701406_689 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=2 |
2 |
Employee + Spouse |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 3 |
Choice Plus AUW5 Gold |
1 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
3 |
8/14/2019 6:58 am |
1259.89 |
0.00 |
1259.89 |
Employee + Children |
Alex Olupitan |
2071 |
466 |
val_2634456_3701406_850 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=3 |
3 |
Employee + Children |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 4 |
Choice Plus AUW5 Gold |
1 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
4 |
8/14/2019 6:58 am |
1940.91 |
0.00 |
1940.91 |
Employee + Family |
Alex Olupitan |
2071 |
466 |
val_2634457_3701406_755 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=4 |
4 |
Employee + Family |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 5 |
DHMO D1069 |
2 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
5 |
8/14/2019 7:01 am |
12.20 |
0.00 |
12.20 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634466_3701406_297 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=5 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 6 |
DHMO D1069 |
2 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
6 |
8/14/2019 7:01 am |
21.36 |
0.00 |
21.36 |
Employee + Spouse |
Alex Olupitan |
2071 |
466 |
val_2634467_3701406_411 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=6 |
2 |
Employee + Spouse |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 7 |
DHMO D1069 |
2 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
7 |
8/14/2019 7:01 am |
26.44 |
0.00 |
26.44 |
Employee + Children |
Alex Olupitan |
2071 |
466 |
val_2634468_3701406_901 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=7 |
3 |
Employee + Children |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 8 |
DHMO D1069 |
2 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
8 |
8/14/2019 7:01 am |
33.56 |
0.00 |
33.56 |
Employee + Family |
Alex Olupitan |
2071 |
466 |
val_2634469_3701406_428 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=8 |
4 |
Employee + Family |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 9 |
HMO AVM1 Silver |
3 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
9 |
8/14/2019 7:03 am |
437.33 |
0.00 |
437.33 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634476_3701406_729 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=9 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 10 |
HMO AVM1 Silver |
3 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
10 |
8/14/2019 7:03 am |
874.66 |
0.00 |
874.66 |
Employee + Spouse |
Alex Olupitan |
2071 |
466 |
val_2634477_3701406_719 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=10 |
2 |
Employee + Spouse |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 11 |
HMO AVM1 Silver |
3 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
11 |
8/14/2019 7:03 am |
809.06 |
0.00 |
809.06 |
Employee + Children |
Alex Olupitan |
2071 |
466 |
val_2634478_3701406_160 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=11 |
3 |
Employee + Children |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 12 |
HMO AVM1 Silver |
3 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
12 |
8/14/2019 7:03 am |
1246.39 |
0.00 |
1246.39 |
Employee + Family |
Alex Olupitan |
2071 |
466 |
val_2634479_3701406_172 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=12 |
4 |
Employee + Family |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 13 |
HMO AVNH Gold |
4 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
13 |
8/14/2019 7:04 am |
557.74 |
0.00 |
557.74 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634484_3701406_463 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=13 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 14 |
HMO AVNH Gold |
4 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
14 |
8/14/2019 7:04 am |
1115.48 |
0.00 |
1115.48 |
Employee + Spouse |
Alex Olupitan |
2071 |
466 |
val_2634485_3701406_302 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=14 |
2 |
Employee + Spouse |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 15 |
HMO AVNH Gold |
4 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
15 |
8/14/2019 7:04 am |
1031.82 |
0.00 |
1031.82 |
Employee + Children |
Alex Olupitan |
2071 |
466 |
val_2634486_3701406_897 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=15 |
3 |
Employee + Children |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 16 |
HMO AVNH Gold |
4 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
16 |
8/14/2019 7:04 am |
1589.56 |
0.00 |
1589.56 |
Employee + Family |
Alex Olupitan |
2071 |
466 |
val_2634487_3701406_616 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=16 |
4 |
Employee + Family |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 17 |
LTD Insurance |
5 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
17 |
8/14/2019 7:04 am |
0.00 |
0.00 |
0.00 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634488_3701406_210 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=17 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 18 |
STD Insurance |
6 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
18 |
8/14/2019 7:04 am |
0.00 |
0.00 |
0.00 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634489_3701406_120 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=18 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 19 |
VPPO F3303 |
7 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
19 |
8/14/2019 7:05 am |
27.05 |
0.00 |
27.05 |
Employee Only |
Alex Olupitan |
2071 |
466 |
val_2634490_3701406_687 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=19 |
1 |
Employee Only |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 20 |
VPPO F3303 |
7 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
20 |
8/14/2019 7:05 am |
54.11 |
0.00 |
54.11 |
Employee + Spouse |
Alex Olupitan |
2071 |
466 |
val_2634491_3701406_755 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=20 |
2 |
Employee + Spouse |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 21 |
VPPO F3303 |
7 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
21 |
8/14/2019 7:05 am |
54.56 |
0.00 |
54.56 |
Employee + Children |
Alex Olupitan |
2071 |
466 |
val_2634492_3701406_111 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=21 |
3 |
Employee + Children |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|
| 22 |
VPPO F3303 |
7 |
Standard Benefits - Benefit Coverage Form |
-1466 |
|
F |
F |
22 |
8/14/2019 7:05 am |
85.29 |
0.00 |
85.29 |
Employee + Family |
Alex Olupitan |
2071 |
466 |
val_2634493_3701406_201 |
customrecord_bt_plan_tier |
|
rectype=466&e=T&id=22 |
4 |
Employee + Family |
|
2071 |
Benefits - Benefit Coverage |
|
customrecordentry |
466 |
F |
custrecordentry |
|