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  • 0000530008-91208-0002379038 145429877 11072014 00 05 59 PDF

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    Mollie McKeown
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    This claims payment statement from Sagicor Life Jamaica Limited provides details of a payment made to Maureen P McKeown. It lists 10 drug charges from May 16th and June 20th totaling $11,180.51, with 20% of each charge excluded amounting to $1,118.04. An insured payment of $8,049.98 was made to reimburse McKeown for the remaining 80% of the charges. A remark indicates that the services received were not covered under the health plan.

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    This claims payment statement from Sagicor Life Jamaica Limited provides details of a payment made to Maureen P McKeown. It lists 10 drug charges from May 16th and June 20th totaling $11,180.51, with 20% of each charge excluded amounting to $1,118.04. An insured payment of $8,049.98 was made to reimburse McKeown for the remaining 80% of the charges. A remark indicates that the services received were not covered under the health plan.

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    18 views1 page

    0000530008-91208-0002379038 145429877 11072014 00 05 59 PDF

    Uploaded by

    Mollie McKeown
    This claims payment statement from Sagicor Life Jamaica Limited provides details of a payment made to Maureen P McKeown. It lists 10 drug charges from May 16th and June 20th totaling $11,180.51, with 20% of each charge excluded amounting to $1,118.04. An insured payment of $8,049.98 was made to reimburse McKeown for the remaining 80% of the charges. A remark indicates that the services received were not covered under the health plan.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Sagicor Life Jamaica Limited

    28 - 48 Barbados Avenue., Kingston 5, Jamaica W.I.


    Telephone: (876) 929 - 8920-9

    PAGE 1

    CLAIMS PAYMENT STATEMENT

    JAMES J MCKEOWN
    LOT 233 TRYALL GARDENS
    SANDY BAY P O
    HANOVER, 09

    CHEQUE #:

    000023982

    CHEQUE DATE:

    07/10/14

    GROUP NUMBER :

    0000530008-91208-0002379038

    BULK CLAIM IDENTIFIER:

    145429877

    ============================================================================================================================
    CLAIMANT NAME:
    POLICY NUMBER
    CHEQUE NUMBER
    CLAIM NUMBER:
    MCKEOWN, MAUREEN P
    530008-91208-0002379038
    000023982
    141881029P
    DATES OF SERVICE
    05/16/14-05/16/14
    05/16/14-05/16/14
    05/16/14-05/16/14
    05/16/14-05/16/14
    05/16/14-05/16/14
    05/16/14-05/16/14
    06/20/14-06/20/14
    06/20/14-06/20/14
    06/20/14-06/20/14
    06/20/14-06/20/14

    SERVICE
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS
    DRUGS

    CHARGE
    1077.26
    969.00
    2037.14
    618.22
    2308.80
    129.63
    2308.80
    129.63
    969.00
    633.03

    EXCLUDED
    107.73
    96.90
    203.71
    61.82
    230.88
    12.96
    230.88
    12.96
    96.90
    63.30

    DUE
    775.62
    697.68
    1466.74
    445.12
    1662.34
    93.34
    1662.34
    93.34
    697.68
    455.78

    TOTALS:

    11180.51

    1118.04

    8049.98

    %
    80
    80
    80
    80
    80
    80
    80
    80
    80
    80

    PAYABLE
    775.62
    697.68
    1466.74
    445.12
    1662.34
    93.34
    1662.34
    93.34
    697.68
    455.78

    REMARK CODE
    14
    14
    14
    14
    14
    14
    14
    14
    14
    14

    8049.98

    INSURED PAYMENT:
    8049.98
    14 Services received are not covered under the health plan.
    ============================================================================================================================

    TOTALS
    PAYMENT(S):
    8,049.98
    TRANSACTION FEE:
    .00
    G.C.T.:
    .00
    ============================================================================================================================
    YOU MAY E-MAIL ANY QUERIES TO claim-inquiries@sagicor.com OR CALL OUR CALL CENTRE MONDAYS TO SATURDAYS 8:00a.m. TO 9:00p.m.
    - 929-8920 (Select option 3).

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