Benefit Statement

Test Retro 62 Employee : 1000001449 Plan sponsor: Billing Test_Retro

Test Address Date of birth: 02/12/1981 Division: All Eligible
Noida,MB Effective date: 06/01/2021 Class Code: bill

D1D 4S25 Coverage: $0.00 Employment status: Termination

Salary: $ 34,344.00 Occupation:
Pay Period Per Year: Weekly (52) Smoker status: Non smoker

This is confirmation for your enrollment. Please print this page for your records; you will not receive a statement in the mail.

Your Flex Credits

Benefit Flex Dollars $1,119.98

Total $1,119.98

Your Benefit Statement

Annual Salary Deduction
Annual Annual Flex
Benefit Details Carrier/Policy Employer Annual Per Pay
Price Tag Credits Used
Cost Deduction Deduction
Life Insurance Manulife Financial
Basic-$10,000.00 Corporation $33.84 $0.00 $33.84 $0.00 $0.00
06/01/2021 655643
Optional Life Insurance Manulife Financial
Option 5-$50,000.00 Corporation $720.00 $0.00 $0.00 $720.00 $13.85
06/01/2021 655643
Accidental Death & Dismemberment
Manulife Financial
Insurance (AD&D)
Corporation $23.52 $0.00 $23.52 $0.00 $0.00
option 1-$34,344.00
655643
06/01/2021
Critical Illness Insurance Manulife Financial
10000-$10,000.00 Corporation $101.04 $0.00 $101.04 $0.00 $0.00
06/01/2021 655643
Short Term Disability Insurance Manulife Financial
Option 1-$396.28 Corporation $2.52 $0.00 $2.52 $0.00 $0.00
06/01/2021 655643
Long Term Disability Insurance Manulife Financial
option 1-$495.35 Corporation $117.60 $0.00 $117.60 $0.00 $0.00
06/01/2021 655643
Health Care Insurance
Manulife Financial
Option 1
Corporation $601.44 $0.00 $601.44 $0.00 $0.00
Single
655643
06/01/2021

SubTotal $1,599.96 $0.00 $879.96 $720.00 $13.85

Sales Tax - 0 $106.48 $50.40 $0.97

 Total $1,599.96 $0.00 $986.45 $770.40 $14.82

*Note: This option is pending approval by the insurance carrier

Taxable Benefit and Annual Sales Tax:

$50.40 Employee sales tax

$0.00 Provincial taxable benefit

$0.00 Federal taxable benefit

Your remaining Flex credit:

You have $0.00 in Additional Flex Credits