The amounts listed on this invoice are based, in part, on the age and/or gender of each covered employee and spouse (where applicable), and are provided solely for internal billing purposes. You are solely responsible for establishing the contribution practices for your employees. Federal, State, and local laws may prohibit you from charging different contribution amounts based on an employee`s gender or other protected class status.
To keep your group insurance coverage in effect, it is important that we receive full payment of all amounts due, as required by your Group Contract/Policy. If your coverage is terminated for non-payment of premium, this statement will serve as the required initial advance notice of termination that will be effective in accordance with your Group Contract/Policy at the end of your premium payment notification period.
