|
| |
| CIGNA Account |
This account covers the following
types of services:
Medical, Prescription
|
Beginning Balance |
$1400.00 |
| Used (YTD) |
$250.00 |
| Available Balance |
$1150.00 |
| % Used |
17.86%
|
|
|
| Claim # |
Date
Processed |
Amount
Processed |
Amount Paid |
Employee
Responsibility |
Status |
| 435634534543543
| 1/15/2004 |
$100.00
| $50.00 |
$50.00 |
Paid |
| Your HRA coverage is self-funded by your employer, who is solely responsible for contributing the funds used to pay HRA benefits. You are not required to make any contribution to the HRA account. (Except that contributions are required from those under COBRA coverage.) Your HRA benefits are subject to all applicable provisions of your employer's Plan. |
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