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{{Plan Name}}

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Benefits

Eligibility (Coverage Month)

{{Current month year}} Coverage Month
Eligible
{{Next month year}} Coverage Month
Not eligible

Account Balance

{{Dollar or Hour Bank}} as of {{current month +1}}
{{00.00}}

Claims

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Group Number: {{Group number}}
AdjudiCare Number: {{Adjudicare number}}
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Pension

$9,620.05

Accrued pension at  

{{processedDate}}

$950.00

Contributions received in 

{{processedYear}}

{{decimal value}}

Hours reported in 

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Vested

Vesting status

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