Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: ALL
Suffix: ALL
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FP	0000	Flexible Spending Account	$190,973.09	$0.00	$0.00	$190,973.09
000123456	AF	0026	Medco Health	$323,514.56	$245,377.93	$97,361.20	$666,253.69
000123456	AH	0128	Pharmacy - Unknown	$0.00	$0.00	$0.00	$0.00
000123456	AH	0128	Inpatient Hospital Room & Board	$343,450.88	$256,211.80	$98,015.03	$697,677.71
000123456	AH	0128	Inpatient Hospital Miscellaneous	$114,496.75	$102,417.36	$27,876.34	$244,790.45
000123456	AH	0128	Convalescent Facility	$56,479.19	$16,200.11	$0.00	$72,679.30
000123456	FA	0055	ATC/SA Room & Board and Misc.	$0.00	$107.10	$998.00	$1,105.10
000123456	AG	0038	Outpatient Hospital Miscellaneous	$246,485.08	$437,567.55	$171,984.34	$856,036.97
000123456	AH	0128	Emergency Room	$65,721.67	$48,018.61	$48,244.49	$161,984.77
000123456	AG	0101	Surgery	$159,419.60	$202,131.30	$38,593.28	$400,144.18
000123456	AG	0101	Anesthesia	$46,989.94	$78,810.23	$17,474.56	$143,274.73
000123456	AH	0131	Assistant Surgical	$2,283.99	$8,519.83	$624.86	$11,428.68
000123456	AH	0128	Inpatient Medical	$37,864.80	$22,827.43	$5,315.06	$66,007.29
000123456	AF	0037	Outpatient/Professional Medical	$246,882.45	$201,063.72	$226,340.51	$674,286.68
000123456	AH	0131	Other Medical	$17,892.51	$23,927.54	$12,657.48	$54,477.53
000123456	AH	0131	Chemotherapy	$3,182.46	$9,941.58	$151.08	$13,275.12
000123456	AH	0131	Radiation Therapy	$75,659.57	$55,685.48	$0.00	$131,345.05
000123456	AF	0037	Outpatient X-Ray and Lab	$233,569.16	$326,153.41	$165,650.48	$725,373.05
000123456	AH	0131	Outpatient Psychiatric	$10,766.61	$10,732.26	$20,828.39	$42,327.26
000123456	AB	0001	Comprehensive Medical Expenses	$952.29	($1,012.02)	($2,067.36)	($2,127.09)
000123456	AG	0101	Pharmacy - Health	$251,710.51	$228,792.68	$65,717.66	$546,220.85
000123456	AH	0131	Coordination of Benefits - Health	($2,370.21)	($8,294.76)	($48.90)	($10,713.87)
000123456	AB	0001	Total	$2,425,924.90	$2,265,179.14	$995,716.50	$5,686,820.54
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: ALL
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AF	0026	Medco Health	$323,514.56	$245,377.93	$97,361.20	$666,253.69
000123456	AH	0128	Pharmacy - Unknown	$0.00	$0.00	$0.00	$0.00
000123456	AH	0128	Inpatient Hospital Room & Board	$343,450.88	$256,211.80	$98,015.03	$697,677.71
000123456	AH	0128	Inpatient Hospital Miscellaneous	$114,496.75	$102,417.36	$27,876.34	$244,790.45
000123456	AH	0128	Convalescent Facility	$56,479.19	$16,200.11	$0.00	$72,679.30
000123456	FA	0055	ATC/SA Room & Board and Misc.	$0.00	$107.10	$998.00	$1,105.10
000123456	AG	0038	Outpatient Hospital Miscellaneous	$246,485.08	$437,567.55	$171,984.34	$856,036.97
000123456	AH	0128	Emergency Room	$65,721.67	$48,018.61	$48,244.49	$161,984.77
000123456	AG	0101	Surgery	$159,419.60	$202,131.30	$38,593.28	$400,144.18
000123456	AG	0101	Anesthesia	$46,989.94	$78,810.23	$17,474.56	$143,274.73
000123456	AH	0131	Assistant Surgical	$2,283.99	$8,519.83	$624.86	$11,428.68
000123456	AH	0128	Inpatient Medical	$37,864.80	$22,827.43	$5,315.06	$66,007.29
000123456	AF	0037	Outpatient/Professional Medical	$246,882.45	$201,063.72	$226,340.51	$674,286.68
000123456	AH	0131	Other Medical	$17,892.51	$23,927.54	$12,657.48	$54,477.53
000123456	AH	0131	Chemotherapy	$3,182.46	$9,941.58	$151.08	$13,275.12
000123456	AH	0131	Radiation Therapy	$75,659.57	$55,685.48	$0.00	$131,345.05
000123456	AF	0037	Outpatient X-Ray and Lab	$233,569.16	$326,153.41	$165,650.48	$725,373.05
000123456	AH	0131	Outpatient Psychiatric	$10,766.61	$10,732.26	$20,828.39	$42,327.26
000123456	AB	0001	Comprehensive Medical Expenses	$952.29	($1,012.02)	($2,067.36)	($2,127.09)
000123456	AG	0101	Pharmacy - Health	$251,710.51	$228,792.68	$65,717.66	$546,220.85
000123456	AH	0131	Coordination of Benefits - Health	($2,370.21)	($8,294.76)	($48.90)	($10,713.87)
000123456	AB	0001	Total	$2,234,951.81	$2,265,179.14	$995,716.50	$5,495,847.45
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AB
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.62)	($0.62)
000123456	AB	0001	Total	$0.00	$0.00	($0.62)	($0.62)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AB
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.62)	($0.62)
000123456	AB	0001	Total	$0.00	$0.00	($0.62)	($0.62)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AF
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AF	0026	Medco Health	$0.00	$30.00	$20.00	$50.00
000123456	AF	0037	Outpatient/Professional Medical	($90.00)	$0.00	$0.00	($90.00)
000123456	AF	0037	Outpatient X-Ray and Lab	$0.00	$0.00	$0.00	$0.00
000123456	AF	0026	Total	($90.00)	$30.00	$20.00	($40.00)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AF
Account: 0026
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AF	0026	Medco Health	$0.00	$30.00	$20.00	$50.00
000123456	AF	0026	Total	$0.00	$30.00	$20.00	$50.00
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AF
Account: 0037
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AF	0037	Outpatient/Professional Medical	($90.00)	$0.00	$0.00	($90.00)
000123456	AF	0037	Outpatient X-Ray and Lab	$0.00	$0.00	$0.00	$0.00
000123456	AF	0037	Total	($90.00)	$0.00	$0.00	($90.00)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AG
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AG	0101	Medco Health	$722.88	$491.25	$0.00	$1,214.13
000123456	AG	0038	Outpatient Hospital Miscellaneous	$245.70	$1,458.00	$0.00	$1,703.70
000123456	AG	0101	Surgery	$779.14	$2,311.66	$0.00	$3,090.80
000123456	AG	0101	Anesthesia	$0.00	$317.20	$0.00	$317.20
000123456	AG	0038	Outpatient/Professional Medical	$1,070.07	$2,324.46	$385.82	$3,780.35
000123456	AG	0101	Outpatient X-Ray and Lab	$1,341.33	$1,451.37	$0.00	$2,792.70
000123456	AG	0101	Pharmacy - Health	$2.91	$0.00	$0.00	$2.91
000123456	AG	0038	Total	$4,162.03	$8,353.94	$385.82	$12,901.79
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AG
Account: 0038
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AG	0038	Outpatient Hospital Miscellaneous	$245.70	$0.00	$0.00	$245.70
000123456	AG	0038	Outpatient/Professional Medical	$0.00	$95.22	$95.22	$190.44
000123456	AG	0038	Total	$245.70	$95.22	$95.22	$436.14
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AG
Account: 0039
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AG	0039	Outpatient/Professional Medical	$0.00	$0.00	$0.00	$0.00
000123456	AG	0039	Total	$0.00	$0.00	$0.00	$0.00
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AG
Account: 0100
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AG	0100	Outpatient/Professional Medical	$0.00	$68.00	$290.60	$358.60
000123456	AG	0100	Total	$0.00	$68.00	$290.60	$358.60
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AG
Account: 0101
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AG	0101	Medco Health	$722.88	$491.25	$0.00	$1,214.13
000123456	AG	0101	Outpatient Hospital Miscellaneous	$0.00	$1,458.00	$0.00	$1,458.00
000123456	AG	0101	Surgery	$779.14	$2,311.66	$0.00	$3,090.80
000123456	AG	0101	Anesthesia	$0.00	$317.20	$0.00	$317.20
000123456	AG	0101	Outpatient/Professional Medical	$1,070.07	$2,161.24	$0.00	$3,231.31
000123456	AG	0101	Outpatient X-Ray and Lab	$1,341.33	$1,451.37	$0.00	$2,792.70
000123456	AG	0101	Pharmacy - Health	$2.91	$0.00	$0.00	$2.91
000123456	AG	0101	Total	$3,916.33	$8,190.72	$0.00	$12,107.05
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AH
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AH	0128	Medco Health	$139,391.61	$64,753.69	$280.52	$204,425.82
000123456	AH	0128	Pharmacy - Unknown	$0.00	$0.00	$0.00	$0.00
000123456	AH	0128	Inpatient Hospital Room & Board	$56,102.11	$74,604.05	$0.00	$130,706.16
000123456	AH	0128	Inpatient Hospital Miscellaneous	$8,594.48	$3,651.76	$0.00	$12,246.24
000123456	AH	0128	Convalescent Facility	$15,367.44	$0.00	$0.00	$15,367.44
000123456	AH	0128	Outpatient Hospital Miscellaneous	$66,137.05	$4,977.39	$0.00	$71,114.44
000123456	AH	0128	Emergency Room	$7,565.90	$3,446.52	$535.44	$11,547.86
000123456	AH	0128	Surgery	$10,787.82	$10,319.50	$0.00	$21,107.32
000123456	AH	0131	Anesthesia	$1,757.33	$3,228.24	$0.00	$4,985.57
000123456	AH	0131	Assistant Surgical	$146.77	$337.74	$0.00	$484.51
000123456	AH	0128	Inpatient Medical	$15,230.86	$6,507.30	$0.00	$21,738.16
000123456	AH	0128	Outpatient/Professional Medical	$20,503.28	$14,194.65	$213.42	$34,911.35
000123456	AH	0131	Other Medical	$0.00	$1,555.00	$0.00	$1,555.00
000123456	AH	0131	Chemotherapy	$111.73	$0.00	$0.00	$111.73
000123456	AH	0131	Radiation Therapy	$0.00	$168.39	$0.00	$168.39
000123456	AH	0128	Outpatient X-Ray and Lab	$21,315.17	$15,254.76	$18.80	$36,588.73
000123456	AH	0131	Outpatient Psychiatric	$276.33	$0.00	$0.00	$276.33
000123456	AH	0131	Comprehensive Medical Expenses	$0.00	($3.47)	$18.10	$14.63
000123456	AH	0131	Pharmacy - Health	$1,142.39	$423.05	$0.00	$1,565.44
000123456	AH	0131	Coordination of Benefits - Health	($890.68)	($478.49)	$0.00	($1,369.17)
000123456	AH	0128	Total	$363,539.59	$202,940.08	$1,066.28	$567,545.95
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AH
Account: 0128
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AH	0128	Medco Health	$2,892.98	$1,327.08	$0.00	$4,220.06
000123456	AH	0128	Pharmacy - Unknown	$0.00	$0.00	$0.00	$0.00
000123456	AH	0128	Inpatient Hospital Room & Board	$26,201.87	$0.00	$0.00	$26,201.87
000123456	AH	0128	Inpatient Hospital Miscellaneous	$1,773.51	$0.00	$0.00	$1,773.51
000123456	AH	0128	Convalescent Facility	$1,976.80	$0.00	$0.00	$1,976.80
000123456	AH	0128	Outpatient Hospital Miscellaneous	$42,918.60	$260.53	$0.00	$43,179.13
000123456	AH	0128	Emergency Room	$942.48	$0.00	$0.00	$942.48
000123456	AH	0128	Surgery	$1,593.89	$0.00	$0.00	$1,593.89
000123456	AH	0128	Inpatient Medical	$6,258.21	$0.00	$0.00	$6,258.21
000123456	AH	0128	Outpatient/Professional Medical	$1,405.78	$227.83	$0.00	$1,633.61
000123456	AH	0128	Outpatient X-Ray and Lab	$2,302.23	$189.16	$0.00	$2,491.39
000123456	AH	0128	Total	$88,266.35	$2,004.60	$0.00	$90,270.95
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AH
Account: 0131
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AH	0131	Medco Health	$136,498.63	$63,426.61	$280.52	$200,205.76
000123456	AH	0131	Pharmacy - Unknown	$0.00	$0.00	$0.00	$0.00
000123456	AH	0131	Inpatient Hospital Room & Board	$29,900.24	$74,604.05	$0.00	$104,504.29
000123456	AH	0131	Inpatient Hospital Miscellaneous	$6,820.97	$3,651.76	$0.00	$10,472.73
000123456	AH	0131	Convalescent Facility	$13,390.64	$0.00	$0.00	$13,390.64
000123456	AH	0131	Outpatient Hospital Miscellaneous	$23,218.45	$4,716.86	$0.00	$27,935.31
000123456	AH	0131	Emergency Room	$6,623.42	$3,446.52	$535.44	$10,605.38
000123456	AH	0131	Surgery	$9,193.93	$10,319.50	$0.00	$19,513.43
000123456	AH	0131	Anesthesia	$1,757.33	$3,228.24	$0.00	$4,985.57
000123456	AH	0131	Assistant Surgical	$146.77	$337.74	$0.00	$484.51
000123456	AH	0131	Inpatient Medical	$8,972.65	$6,507.30	$0.00	$15,479.95
000123456	AH	0131	Outpatient/Professional Medical	$19,097.50	$13,966.82	$213.42	$33,277.74
000123456	AH	0131	Other Medical	$0.00	$1,555.00	$0.00	$1,555.00
000123456	AH	0131	Chemotherapy	$111.73	$0.00	$0.00	$111.73
000123456	AH	0131	Radiation Therapy	$0.00	$168.39	$0.00	$168.39
000123456	AH	0131	Outpatient X-Ray and Lab	$19,012.94	$15,065.60	$18.80	$34,097.34
000123456	AH	0131	Outpatient Psychiatric	$276.33	$0.00	$0.00	$276.33
000123456	AH	0131	Comprehensive Medical Expenses	$0.00	($3.47)	$18.10	$14.63
000123456	AH	0131	Pharmacy - Health	$1,142.39	$423.05	$0.00	$1,565.44
000123456	AH	0131	Coordination of Benefits - Health	($890.68)	($478.49)	$0.00	($1,369.17)
000123456	AH	0131	Total	$275,273.24	$200,935.48	$1,066.28	$477,275.00
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AJ
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AJ	0135	Medco Health	$6,206.06	$2,571.31	$0.00	$8,777.37
000123456	AJ	0134	Inpatient Hospital Room & Board	$99,205.83	$10,973.74	$0.00	$110,179.57
000123456	AJ	0134	Inpatient Hospital Miscellaneous	$2,211.88	$2,172.05	$46.08	$4,430.01
000123456	AJ	0134	Convalescent Facility	$37,943.45	$3,034.50	$0.00	$40,977.95
000123456	AJ	0134	Outpatient Hospital Miscellaneous	$9,002.22	$5,386.06	$0.00	$14,388.28
000123456	AJ	0134	Emergency Room	$3,066.92	$6,153.48	$0.00	$9,220.40
000123456	AJ	0134	Surgery	$11,007.14	$4,367.11	$0.00	$15,374.25
000123456	AJ	0134	Anesthesia	$1,104.88	$2,166.50	$0.00	$3,271.38
000123456	AJ	0134	Assistant Surgical	$0.00	$19.81	$0.00	$19.81
000123456	AJ	0134	Inpatient Medical	$6,169.46	$1,134.64	$0.00	$7,304.10
000123456	AJ	0134	Outpatient/Professional Medical	$13,560.45	$7,603.84	$0.00	$21,164.29
000123456	AJ	0134	Radiation Therapy	$443.84	$587.51	$0.00	$1,031.35
000123456	AJ	0134	Outpatient X-Ray and Lab	$14,440.85	$7,514.02	$0.00	$21,954.87
000123456	AJ	0134	Outpatient Psychiatric	$495.25	$0.00	$0.00	$495.25
000123456	AJ	0134	Comprehensive Medical Expenses	$1.87	$0.00	$0.00	$1.87
000123456	AJ	0134	Pharmacy - Health	$2,406.73	$313.31	$0.00	$2,720.04
000123456	AJ	0134	Coordination of Benefits - Health	($1,578.85)	($1,974.21)	$0.00	($3,553.06)
000123456	AJ	0134	Total	$205,687.98	$52,023.67	$46.08	$257,757.73
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AJ
Account: 0134
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AJ	0134	Inpatient Hospital Room & Board	$99,205.83	$10,973.74	$0.00	$110,179.57
000123456	AJ	0134	Inpatient Hospital Miscellaneous	$2,211.88	$604.19	$0.00	$2,816.07
000123456	AJ	0134	Convalescent Facility	$37,943.45	$3,034.50	$0.00	$40,977.95
000123456	AJ	0134	Outpatient Hospital Miscellaneous	$9,002.22	$2,138.81	$0.00	$11,141.03
000123456	AJ	0134	Emergency Room	$472.36	$3,204.61	$0.00	$3,676.97
000123456	AJ	0134	Surgery	$7,479.87	$1,442.51	$0.00	$8,922.38
000123456	AJ	0134	Anesthesia	$1,104.88	$476.50	$0.00	$1,581.38
000123456	AJ	0134	Assistant Surgical	$0.00	$19.81	$0.00	$19.81
000123456	AJ	0134	Inpatient Medical	$6,169.46	$1,134.64	$0.00	$7,304.10
000123456	AJ	0134	Outpatient/Professional Medical	$9,225.86	$4,572.87	$0.00	$13,798.73
000123456	AJ	0134	Radiation Therapy	$443.84	$587.51	$0.00	$1,031.35
000123456	AJ	0134	Outpatient X-Ray and Lab	$8,362.67	$4,374.75	$0.00	$12,737.42
000123456	AJ	0134	Outpatient Psychiatric	$495.25	$0.00	$0.00	$495.25
000123456	AJ	0134	Comprehensive Medical Expenses	$1.87	$0.00	$0.00	$1.87
000123456	AJ	0134	Pharmacy - Health	$1,896.99	$24.66	$0.00	$1,921.65
000123456	AJ	0134	Coordination of Benefits - Health	($1,578.85)	($1,974.21)	$0.00	($3,553.06)
000123456	AJ	0134	Total	$182,437.58	$30,614.89	$0.00	$213,052.47
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: AJ
Account: 0135
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	AJ	0135	Medco Health	$6,206.06	$2,571.31	$0.00	$8,777.37
000123456	AJ	0135	Inpatient Hospital Miscellaneous	$0.00	$1,567.86	$46.08	$1,613.94
000123456	AJ	0135	Outpatient Hospital Miscellaneous	$0.00	$3,247.25	$0.00	$3,247.25
000123456	AJ	0135	Emergency Room	$2,594.56	$2,948.87	$0.00	$5,543.43
000123456	AJ	0135	Surgery	$3,527.27	$2,924.60	$0.00	$6,451.87
000123456	AJ	0135	Anesthesia	$0.00	$1,690.00	$0.00	$1,690.00
000123456	AJ	0135	Outpatient/Professional Medical	$4,334.59	$3,030.97	$0.00	$7,365.56
000123456	AJ	0135	Outpatient X-Ray and Lab	$6,078.18	$3,139.27	$0.00	$9,217.45
000123456	AJ	0135	Pharmacy - Health	$509.74	$288.65	$0.00	$798.39
000123456	AJ	0135	Total	$23,250.40	$21,408.78	$46.08	$44,705.26
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: BB
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	BB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.54)	($0.54)
000123456	BB	0001	Total	$0.00	$0.00	($0.54)	($0.54)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: BB
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	BB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.54)	($0.54)
000123456	BB	0001	Total	$0.00	$0.00	($0.54)	($0.54)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: BLANK
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	BLANK	0000	Outpatient/Professional Medical	$0.00	$0.00	$0.00	$0.00
000123456	BLANK	0001	Comprehensive Medical Expenses	$0.00	$0.00	($254.89)	($254.89)
000123456	BLANK	0000	Total	$0.00	$0.00	($254.89)	($254.89)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: BLANK
Account: 0000
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	BLANK	0000	Outpatient/Professional Medical	$0.00	$0.00	$0.00	$0.00
000123456	BLANK	0000	Total	$0.00	$0.00	$0.00	$0.00
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: BLANK
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	BLANK	0001	Comprehensive Medical Expenses	$0.00	$0.00	($254.89)	($254.89)
000123456	BLANK	0001	Total	$0.00	$0.00	($254.89)	($254.89)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: CB
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	CB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.21)	($0.21)
000123456	CB	0001	Total	$0.00	$0.00	($0.21)	($0.21)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: CB
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	CB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.21)	($0.21)
000123456	CB	0001	Total	$0.00	$0.00	($0.21)	($0.21)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: CG
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	CG	0001	Comprehensive Medical Expenses	$0.00	$0.00	($40.52)	($40.52)
000123456	CG	0001	Total	$0.00	$0.00	($40.52)	($40.52)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: CG
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	CG	0001	Comprehensive Medical Expenses	$0.00	$0.00	($40.52)	($40.52)
000123456	CG	0001	Total	$0.00	$0.00	($40.52)	($40.52)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0055	Medco Health	$0.00	$1,344.75	$121.85	$1,466.60
000123456	FA	0073	Inpatient Hospital Room & Board	$4,594.00	$0.00	$252.00	$4,846.00
000123456	FA	0073	Inpatient Hospital Miscellaneous	($795.05)	$0.00	$0.00	($795.05)
000123456	FA	0085	Convalescent Facility	($293.49)	($147.58)	$0.00	($441.07)
000123456	FA	0055	ATC/SA Room & Board and Misc.	$0.00	$0.00	$0.00	$0.00
000123456	FA	0055	Outpatient Hospital Miscellaneous	($996.52)	$1,673.59	$0.00	$677.07
000123456	FA	0055	Emergency Room	$71.30	$250.00	$0.00	$321.30
000123456	FA	0055	Surgery	$772.84	$293.53	$106.77	$1,173.14
000123456	FA	0085	Anesthesia	$35.88	$11.96	$0.00	$47.84
000123456	FA	0055	Assistant Surgical	$0.72	($625.00)	$0.00	($624.28)
000123456	FA	0085	Inpatient Medical	$752.47	$95.55	$0.00	$848.02
000123456	FA	0055	Outpatient/Professional Medical	$2,415.84	$1,645.23	$457.20	$4,518.27
000123456	FA	0055	Other Medical	$2,379.71	$110.02	$1,580.60	$4,070.33
000123456	FA	0085	Chemotherapy	$1.85	$0.00	$0.00	$1.85
000123456	FA	0055	Outpatient X-Ray and Lab	$27.00	$438.20	$7.25	$472.45
000123456	FA	0063	Outpatient Psychiatric	$0.00	$0.00	$3.36	$3.36
000123456	FA	0001	Comprehensive Medical Expenses	$478.46	($30.43)	($887.94)	($439.91)
000123456	FA	0055	Pharmacy - Health	$2,182.00	$42.07	$61.23	$2,285.30
000123456	FA	0085	Coordination of Benefits - Health	$0.00	($28.80)	$0.00	($28.80)
000123456	FA	0001	Total	$11,627.01	$5,073.09	$1,702.32	$18,402.42
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0001	Comprehensive Medical Expenses	$0.00	$0.00	($887.94)	($887.94)
000123456	FA	0001	Total	$0.00	$0.00	($887.94)	($887.94)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: 0055
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0055	Medco Health	$0.00	$1,344.75	$0.00	$1,344.75
000123456	FA	0055	ATC/SA Room & Board and Misc.	$0.00	$0.00	$0.00	$0.00
000123456	FA	0055	Outpatient Hospital Miscellaneous	$0.00	$1,673.59	$0.00	$1,673.59
000123456	FA	0055	Emergency Room	$71.30	$0.00	$0.00	$71.30
000123456	FA	0055	Surgery	$509.89	$230.08	$106.77	$846.74
000123456	FA	0055	Assistant Surgical	$0.00	($625.00)	$0.00	($625.00)
000123456	FA	0055	Outpatient/Professional Medical	$566.97	$1,291.07	$385.31	$2,243.35
000123456	FA	0055	Other Medical	($250.00)	($204.98)	$1,580.60	$1,125.62
000123456	FA	0055	Outpatient X-Ray and Lab	($157.16)	$753.84	$7.25	$603.93
000123456	FA	0055	Pharmacy - Health	$0.00	$35.00	$61.23	$96.23
000123456	FA	0055	Total	$741.00	$4,498.35	$2,141.16	$7,380.51
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: 0058
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0058	Outpatient/Professional Medical	$81.28	$0.00	$0.00	$81.28
000123456	FA	0058	Comprehensive Medical Expenses	$409.24	$0.00	$0.00	$409.24
000123456	FA	0058	Pharmacy - Health	$2,116.80	$0.00	$0.00	$2,116.80
000123456	FA	0058	Total	$2,607.32	$0.00	$0.00	$2,607.32
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: 0063
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0063	Medco Health	$0.00	$0.00	$121.85	$121.85
000123456	FA	0063	Outpatient/Professional Medical	$0.00	$0.00	$71.89	$71.89
000123456	FA	0063	Outpatient Psychiatric	$0.00	$0.00	$3.36	$3.36
000123456	FA	0063	Total	$0.00	$0.00	$197.10	$197.10
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: 0073
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0073	Inpatient Hospital Room & Board	$0.00	$0.00	$252.00	$252.00
000123456	FA	0073	Inpatient Hospital Miscellaneous	$0.00	$0.00	$0.00	$0.00
000123456	FA	0073	Total	$0.00	$0.00	$252.00	$252.00
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FA
Account: 0085
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FA	0085	Inpatient Hospital Room & Board	$4,594.00	$0.00	$0.00	$4,594.00
000123456	FA	0085	Inpatient Hospital Miscellaneous	($795.05)	$0.00	$0.00	($795.05)
000123456	FA	0085	Convalescent Facility	($293.49)	($147.58)	$0.00	($441.07)
000123456	FA	0085	Outpatient Hospital Miscellaneous	($996.52)	$0.00	$0.00	($996.52)
000123456	FA	0085	Emergency Room	$0.00	$250.00	$0.00	$250.00
000123456	FA	0085	Surgery	$262.95	$63.45	$0.00	$326.40
000123456	FA	0085	Anesthesia	$35.88	$11.96	$0.00	$47.84
000123456	FA	0085	Assistant Surgical	$0.72	$0.00	$0.00	$0.72
000123456	FA	0085	Inpatient Medical	$752.47	$95.55	$0.00	$848.02
000123456	FA	0085	Outpatient/Professional Medical	$1,767.59	$354.16	$0.00	$2,121.75
000123456	FA	0085	Other Medical	$2,629.71	$315.00	$0.00	$2,944.71
000123456	FA	0085	Chemotherapy	$1.85	$0.00	$0.00	$1.85
000123456	FA	0085	Outpatient X-Ray and Lab	$184.16	($315.64)	$0.00	($131.48)
000123456	FA	0085	Comprehensive Medical Expenses	$69.22	($30.43)	$0.00	$38.79
000123456	FA	0085	Pharmacy - Health	$65.20	$7.07	$0.00	$72.27
000123456	FA	0085	Coordination of Benefits - Health	$0.00	($28.80)	$0.00	($28.80)
000123456	FA	0085	Total	$8,278.69	$574.74	$0.00	$8,853.43
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FB
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($2.86)	($2.86)
000123456	FB	0001	Total	$0.00	$0.00	($2.86)	($2.86)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FB
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($2.86)	($2.86)
000123456	FB	0001	Total	$0.00	$0.00	($2.86)	($2.86)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GA	0056	Medco Health	$0.00	$1,713.92	$0.00	$1,713.92
000123456	GA	0056	Surgery	$0.00	$0.00	$0.00	$0.00
000123456	GA	0056	Outpatient/Professional Medical	$554.40	($41.40)	$110.40	$623.40
000123456	GA	0056	Outpatient X-Ray and Lab	$896.70	$16.92	$0.00	$913.62
000123456	GA	0001	Comprehensive Medical Expenses	$947.58	$0.00	($286.71)	$660.87
000123456	GA	0001	Total	$2,398.68	$1,689.44	($176.31)	$3,911.81
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GA
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GA	0001	Comprehensive Medical Expenses	$0.00	$0.00	($286.71)	($286.71)
000123456	GA	0001	Total	$0.00	$0.00	($286.71)	($286.71)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GA
Account: 0056
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GA	0056	Medco Health	$0.00	$1,713.92	$0.00	$1,713.92
000123456	GA	0056	Surgery	$0.00	$0.00	$0.00	$0.00
000123456	GA	0056	Outpatient/Professional Medical	$554.40	($41.40)	$110.40	$623.40
000123456	GA	0056	Outpatient X-Ray and Lab	$0.00	$16.92	$0.00	$16.92
000123456	GA	0056	Comprehensive Medical Expenses	$947.58	$0.00	$0.00	$947.58
000123456	GA	0056	Total	$1,501.98	$1,689.44	$110.40	$3,301.82
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GA
Account: 0059
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GA	0059	Outpatient X-Ray and Lab	$896.70	$0.00	$0.00	$896.70
000123456	GA	0059	Total	$896.70	$0.00	$0.00	$896.70
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GC
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GC	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.55)	($0.55)
000123456	GC	0001	Total	$0.00	$0.00	($0.55)	($0.55)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GC
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GC	0001	Comprehensive Medical Expenses	$0.00	$0.00	($0.55)	($0.55)
000123456	GC	0001	Total	$0.00	$0.00	($0.55)	($0.55)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GD
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GD	0001	Comprehensive Medical Expenses	$0.00	$0.00	($14.51)	($14.51)
000123456	GD	0001	Total	$0.00	$0.00	($14.51)	($14.51)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: GD
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	GD	0001	Comprehensive Medical Expenses	$0.00	$0.00	($14.51)	($14.51)
000123456	GD	0001	Total	$0.00	$0.00	($14.51)	($14.51)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: HB
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	HB	0086	Inpatient Hospital Room & Board	$59,408.75	$24,676.92	$0.00	$84,085.67
000123456	HB	0086	Inpatient Hospital Miscellaneous	$6,997.22	$24,689.37	$0.00	$31,686.59
000123456	HB	0086	Convalescent Facility	$3,461.79	$13,313.19	$0.00	$16,774.98
000123456	HB	0086	Outpatient Hospital Miscellaneous	$25,268.96	$71,271.92	$0.00	$96,540.88
000123456	HB	0086	Emergency Room	$5,205.71	$1,485.27	$0.00	$6,690.98
000123456	HB	0086	Surgery	$14,243.32	$30,564.94	$0.00	$44,808.26
000123456	HB	0086	Anesthesia	$2,256.34	$6,985.41	$0.00	$9,241.75
000123456	HB	0086	Assistant Surgical	$95.36	$476.53	$0.00	$571.89
000123456	HB	0086	Inpatient Medical	$4,311.44	$4,475.72	$0.00	$8,787.16
000123456	HB	0086	Outpatient/Professional Medical	$39,900.84	$28,346.80	$595.48	$68,843.12
000123456	HB	0086	Other Medical	$12,925.07	$19,685.92	$0.00	$32,610.99
000123456	HB	0086	Chemotherapy	$0.00	$5,469.36	$0.00	$5,469.36
000123456	HB	0086	Radiation Therapy	$1,406.78	$0.00	$0.00	$1,406.78
000123456	HB	0086	Outpatient X-Ray and Lab	$18,218.10	$23,843.36	$146.93	$42,208.39
000123456	HB	0086	Outpatient Psychiatric	$1,574.71	$737.60	$0.00	$2,312.31
000123456	HB	0001	Comprehensive Medical Expenses	($399.17)	($978.12)	($254.95)	($1,632.24)
000123456	HB	0086	Pharmacy - Health	$177,629.47	$155,004.36	$3.01	$332,636.84
000123456	HB	0086	Coordination of Benefits - Health	$99.32	($564.80)	($48.90)	($514.38)
000123456	HB	0001	Total	$372,604.01	$409,483.75	$441.57	$782,529.33
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: HB
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	HB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($254.95)	($254.95)
000123456	HB	0001	Total	$0.00	$0.00	($254.95)	($254.95)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: HB
Account: 0086
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	HB	0086	Inpatient Hospital Room & Board	$57,120.75	$24,676.92	$0.00	$81,797.67
000123456	HB	0086	Inpatient Hospital Miscellaneous	$6,896.56	$24,689.37	$0.00	$31,585.93
000123456	HB	0086	Convalescent Facility	$3,461.79	$13,313.19	$0.00	$16,774.98
000123456	HB	0086	Outpatient Hospital Miscellaneous	$24,909.90	$71,271.92	$0.00	$96,181.82
000123456	HB	0086	Emergency Room	$5,205.71	$1,485.27	$0.00	$6,690.98
000123456	HB	0086	Surgery	$13,947.72	$30,497.30	$0.00	$44,445.02
000123456	HB	0086	Anesthesia	$2,215.98	$6,985.41	$0.00	$9,201.39
000123456	HB	0086	Assistant Surgical	$95.36	$476.53	$0.00	$571.89
000123456	HB	0086	Inpatient Medical	$4,102.81	$4,475.72	$0.00	$8,578.53
000123456	HB	0086	Outpatient/Professional Medical	$39,004.12	$27,573.87	$595.48	$67,173.47
000123456	HB	0086	Other Medical	$12,219.16	$17,819.98	$0.00	$30,039.14
000123456	HB	0086	Chemotherapy	$0.00	$5,469.36	$0.00	$5,469.36
000123456	HB	0086	Radiation Therapy	$1,406.78	$0.00	$0.00	$1,406.78
000123456	HB	0086	Outpatient X-Ray and Lab	$17,851.88	$23,828.60	$146.93	$41,827.41
000123456	HB	0086	Outpatient Psychiatric	$1,574.71	$737.60	$0.00	$2,312.31
000123456	HB	0086	Comprehensive Medical Expenses	($399.17)	($978.12)	$0.00	($1,377.29)
000123456	HB	0086	Pharmacy - Health	$167,013.24	$152,672.34	$3.01	$319,688.59
000123456	HB	0086	Coordination of Benefits - Health	$99.32	($564.80)	($48.90)	($514.38)
000123456	HB	0086	Total	$356,726.62	$404,430.46	$696.52	$761,853.60
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: HB
Account: 0087
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	HB	0087	Inpatient Hospital Room & Board	$2,288.00	$0.00	$0.00	$2,288.00
000123456	HB	0087	Inpatient Hospital Miscellaneous	$100.66	$0.00	$0.00	$100.66
000123456	HB	0087	Outpatient Hospital Miscellaneous	$359.06	$0.00	$0.00	$359.06
000123456	HB	0087	Surgery	$295.60	$67.64	$0.00	$363.24
000123456	HB	0087	Anesthesia	$40.36	$0.00	$0.00	$40.36
000123456	HB	0087	Inpatient Medical	$208.63	$0.00	$0.00	$208.63
000123456	HB	0087	Outpatient/Professional Medical	$896.72	$772.93	$0.00	$1,669.65
000123456	HB	0087	Other Medical	$705.91	$1,865.94	$0.00	$2,571.85
000123456	HB	0087	Outpatient X-Ray and Lab	$366.22	$14.76	$0.00	$380.98
000123456	HB	0087	Pharmacy - Health	$10,616.23	$2,332.02	$0.00	$12,948.25
000123456	HB	0087	Total	$15,877.39	$5,053.29	$0.00	$20,930.68
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: IA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	IA	0091	Medco Health	$4.85	$0.00	$0.00	$4.85
000123456	IA	0091	Outpatient Hospital Miscellaneous	($44.06)	$0.00	$0.00	($44.06)
000123456	IA	0091	Outpatient/Professional Medical	($29.32)	$0.00	$0.00	($29.32)
000123456	IA	0091	Other Medical	$380.73	$0.00	$0.00	$380.73
000123456	IA	0091	Outpatient X-Ray and Lab	$11.71	$0.00	$0.00	$11.71
000123456	IA	0001	Comprehensive Medical Expenses	$0.00	$0.00	($344.15)	($344.15)
000123456	IA	0001	Total	$323.91	$0.00	($344.15)	($20.24)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: IA
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	IA	0001	Comprehensive Medical Expenses	$0.00	$0.00	($344.15)	($344.15)
000123456	IA	0001	Total	$0.00	$0.00	($344.15)	($344.15)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: IA
Account: 0091
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	IA	0091	Medco Health	$4.85	$0.00	$0.00	$4.85
000123456	IA	0091	Outpatient Hospital Miscellaneous	($44.06)	$0.00	$0.00	($44.06)
000123456	IA	0091	Outpatient/Professional Medical	($29.32)	$0.00	$0.00	($29.32)
000123456	IA	0091	Other Medical	$380.73	$0.00	$0.00	$380.73
000123456	IA	0091	Outpatient X-Ray and Lab	$11.71	$0.00	$0.00	$11.71
000123456	IA	0091	Total	$323.91	$0.00	$0.00	$323.91
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: IB
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	IB	0053	Outpatient/Professional Medical	$0.00	$0.00	$0.00	$0.00
000123456	IB	0053	Other Medical	$0.00	$250.00	$0.00	$250.00
000123456	IB	0053	Outpatient X-Ray and Lab	$53.10	($96.00)	($196.24)	($239.14)
000123456	IB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($3.60)	($3.60)
000123456	IB	0001	Total	$53.10	$154.00	($199.84)	$7.26
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: IB
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	IB	0001	Comprehensive Medical Expenses	$0.00	$0.00	($3.60)	($3.60)
000123456	IB	0001	Total	$0.00	$0.00	($3.60)	($3.60)
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: IB
Account: 0053
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	IB	0053	Outpatient/Professional Medical	$0.00	$0.00	$0.00	$0.00
000123456	IB	0053	Other Medical	$0.00	$250.00	$0.00	$250.00
000123456	IB	0053	Outpatient X-Ray and Lab	$53.10	($96.00)	($196.24)	($239.14)
000123456	IB	0053	Total	$53.10	$154.00	($196.24)	$10.86
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: KA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	KA	0102	Medco Health	$55,544.87	$30,818.79	$14,913.57	$101,277.23
000123456	KA	0102	Inpatient Hospital Room & Board	$28,011.57	$22,442.07	$3,859.80	$54,313.44
000123456	KA	0102	Inpatient Hospital Miscellaneous	$9,364.92	$508.57	$2,317.43	$12,190.92
000123456	KA	0102	ATC/SA Room & Board and Misc.	$0.00	$107.10	$609.00	$716.10
000123456	KA	0102	Outpatient Hospital Miscellaneous	$34,268.06	$49,970.85	$34,703.36	$118,942.27
000123456	KA	0102	Emergency Room	$14,281.15	$2,864.55	$13,293.95	$30,439.65
000123456	KA	0102	Surgery	$33,892.35	$26,260.92	$6,308.94	$66,462.21
000123456	KA	0102	Anesthesia	$9,888.85	$10,219.57	$3,418.04	$23,526.46
000123456	KA	0102	Assistant Surgical	$111.69	$3,866.08	$0.00	$3,977.77
000123456	KA	0102	Inpatient Medical	$1,727.55	$1,416.48	$798.85	$3,942.88
000123456	KA	0102	Outpatient/Professional Medical	$32,519.24	$30,466.76	$45,916.88	$108,902.88
000123456	KA	0102	Other Medical	$0.00	$0.00	$2,743.80	$2,743.80
000123456	KA	0102	Chemotherapy	$0.00	$0.00	$151.08	$151.08
000123456	KA	0102	Outpatient X-Ray and Lab	$32,645.39	$40,077.78	$33,168.39	$105,891.56
000123456	KA	0102	Outpatient Psychiatric	$2,518.19	$3,464.12	$6,114.85	$12,097.16
000123456	KA	0102	Pharmacy - Health	$787.62	$1,593.34	$35,590.29	$37,971.25
000123456	KA	0102	Coordination of Benefits - Health	$0.00	($2,765.08)	$0.00	($2,765.08)
000123456	KA	0102	Total	$255,561.45	$221,311.90	$203,908.23	$680,781.58
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: KA
Account: 0102
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	KA	0102	Medco Health	$37,751.59	$25,013.29	$11,776.71	$74,541.59
000123456	KA	0102	Inpatient Hospital Room & Board	$21,616.33	$19,442.57	$3,035.20	$44,094.10
000123456	KA	0102	Inpatient Hospital Miscellaneous	$7,120.93	$249.55	$1,583.04	$8,953.52
000123456	KA	0102	ATC/SA Room & Board and Misc.	$0.00	$107.10	$609.00	$716.10
000123456	KA	0102	Outpatient Hospital Miscellaneous	$25,558.18	$43,908.78	$24,242.68	$93,709.64
000123456	KA	0102	Emergency Room	$4,548.36	$909.35	$5,140.12	$10,597.83
000123456	KA	0102	Surgery	$20,948.77	$22,994.29	$5,657.71	$49,600.77
000123456	KA	0102	Anesthesia	$8,679.80	$9,360.84	$3,082.88	$21,123.52
000123456	KA	0102	Assistant Surgical	$0.00	$3,866.08	$0.00	$3,866.08
000123456	KA	0102	Inpatient Medical	$749.23	$1,416.48	$676.81	$2,842.52
000123456	KA	0102	Outpatient/Professional Medical	$23,646.83	$25,636.98	$35,624.22	$84,908.03
000123456	KA	0102	Other Medical	$0.00	$0.00	$2,743.80	$2,743.80
000123456	KA	0102	Chemotherapy	$0.00	$0.00	$151.08	$151.08
000123456	KA	0102	Outpatient X-Ray and Lab	$24,019.29	$34,969.01	$30,869.97	$89,858.27
000123456	KA	0102	Outpatient Psychiatric	$694.75	$2,457.87	$4,679.85	$7,832.47
000123456	KA	0102	Pharmacy - Health	$764.11	$883.29	$35,532.76	$37,180.16
000123456	KA	0102	Coordination of Benefits - Health	$0.00	($520.31)	$0.00	($520.31)
000123456	KA	0102	Total	$176,098.17	$190,695.17	$165,405.83	$532,199.17
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: KA
Account: 0103
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	KA	0103	Medco Health	$7,588.22	$0.00	$0.00	$7,588.22
000123456	KA	0103	Inpatient Hospital Miscellaneous	$1,604.21	$0.00	$0.00	$1,604.21
000123456	KA	0103	Outpatient Hospital Miscellaneous	$1,075.34	$0.00	$0.00	$1,075.34
000123456	KA	0103	Emergency Room	$5,926.13	$0.00	$0.00	$5,926.13
000123456	KA	0103	Surgery	$10,785.90	$0.00	$0.00	$10,785.90
000123456	KA	0103	Anesthesia	$485.53	$0.00	$0.00	$485.53
000123456	KA	0103	Inpatient Medical	$142.28	$0.00	$0.00	$142.28
000123456	KA	0103	Outpatient/Professional Medical	$4,213.55	$0.00	$0.00	$4,213.55
000123456	KA	0103	Outpatient X-Ray and Lab	$6,144.47	$0.00	$0.00	$6,144.47
000123456	KA	0103	Outpatient Psychiatric	$143.44	$0.00	$0.00	$143.44
000123456	KA	0103	Pharmacy - Health	$8.20	$0.00	$0.00	$8.20
000123456	KA	0103	Total	$38,117.27	$0.00	$0.00	$38,117.27
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: KA
Account: 0104
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	KA	0104	Medco Health	$1,245.75	$1,932.94	$55.10	$3,233.79
000123456	KA	0104	Inpatient Hospital Miscellaneous	$0.00	$181.35	$0.00	$181.35
000123456	KA	0104	Outpatient Hospital Miscellaneous	$0.00	$4,143.03	$0.00	$4,143.03
000123456	KA	0104	Emergency Room	$0.00	$400.48	$0.00	$400.48
000123456	KA	0104	Surgery	$501.29	$977.54	$71.56	$1,550.39
000123456	KA	0104	Outpatient/Professional Medical	$605.34	$1,790.94	$1,335.79	$3,732.07
000123456	KA	0104	Outpatient X-Ray and Lab	$279.59	$2,112.54	$40.61	$2,432.74
000123456	KA	0104	Outpatient Psychiatric	$0.00	$99.75	$0.00	$99.75
000123456	KA	0104	Pharmacy - Health	$0.00	$35.83	$0.00	$35.83
000123456	KA	0104	Total	$2,631.97	$11,674.40	$1,503.06	$15,809.43
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: KA
Account: 0106
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	KA	0106	Medco Health	$8,959.31	$3,872.56	$3,081.76	$15,913.63
000123456	KA	0106	Inpatient Hospital Room & Board	$6,395.24	$2,999.50	$824.60	$10,219.34
000123456	KA	0106	Inpatient Hospital Miscellaneous	$639.78	$77.67	$734.39	$1,451.84
000123456	KA	0106	Outpatient Hospital Miscellaneous	$7,634.54	$1,919.04	$10,460.68	$20,014.26
000123456	KA	0106	Emergency Room	$3,806.66	$1,554.72	$8,153.83	$13,515.21
000123456	KA	0106	Surgery	$1,656.39	$2,289.09	$579.67	$4,525.15
000123456	KA	0106	Anesthesia	$723.52	$858.73	$335.16	$1,917.41
000123456	KA	0106	Assistant Surgical	$111.69	$0.00	$0.00	$111.69
000123456	KA	0106	Inpatient Medical	$836.04	$0.00	$122.04	$958.08
000123456	KA	0106	Outpatient/Professional Medical	$4,053.52	$3,038.84	$8,956.87	$16,049.23
000123456	KA	0106	Outpatient X-Ray and Lab	$2,202.04	$2,996.23	$2,257.81	$7,456.08
000123456	KA	0106	Outpatient Psychiatric	$1,680.00	$906.50	$1,435.00	$4,021.50
000123456	KA	0106	Pharmacy - Health	$15.31	$674.22	$57.53	$747.06
000123456	KA	0106	Coordination of Benefits - Health	$0.00	($2,244.77)	$0.00	($2,244.77)
000123456	KA	0106	Total	$38,714.04	$18,942.33	$36,999.34	$94,655.71
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: LA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	LA	0108	Medco Health	$75,337.49	$91,850.09	$30,756.77	$197,944.35
000123456	LA	0108	Inpatient Hospital Room & Board	$87,430.34	$108,614.81	$29,740.96	$225,786.11
000123456	LA	0108	Inpatient Hospital Miscellaneous	$81,132.65	$17,757.24	$9,382.31	$108,272.20
000123456	LA	0108	Outpatient Hospital Miscellaneous	$75,247.01	$94,124.48	$36,728.05	$206,099.54
000123456	LA	0108	Emergency Room	$12,232.41	$12,072.63	$13,831.52	$38,136.56
000123456	LA	0108	Surgery	$48,893.36	$48,716.60	$8,483.89	$106,093.85
000123456	LA	0108	Anesthesia	$20,733.23	$22,220.71	$4,554.02	$47,507.96
000123456	LA	0108	Assistant Surgical	$1,929.45	$0.00	$0.00	$1,929.45
000123456	LA	0108	Inpatient Medical	$9,673.02	$6,925.98	$1,619.49	$18,218.49
000123456	LA	0108	Outpatient/Professional Medical	$76,753.17	$50,019.11	$41,280.56	$168,052.84
000123456	LA	0108	Other Medical	$207.00	$0.00	$5,283.60	$5,490.60
000123456	LA	0108	Chemotherapy	$1,991.72	$273.72	$0.00	$2,265.44
000123456	LA	0108	Radiation Therapy	$73,808.95	$5,522.96	$0.00	$79,331.91
000123456	LA	0108	Outpatient X-Ray and Lab	$83,105.06	$93,840.03	$26,566.67	$203,511.76
000123456	LA	0108	Outpatient Psychiatric	$2,538.98	$1,279.68	$1,381.18	$5,199.84
000123456	LA	0001	Comprehensive Medical Expenses	($164.51)	$0.00	$6.59	($157.92)
000123456	LA	0108	Pharmacy - Health	$29,425.48	$18,288.66	$21,601.89	$69,316.03
000123456	LA	0108	Coordination of Benefits - Health	$0.00	($2,380.99)	$0.00	($2,380.99)
000123456	LA	0001	Total	$680,274.81	$569,125.71	$231,217.50	$1,480,618.02
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: LA
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	LA	0001	Comprehensive Medical Expenses	$0.00	$0.00	$6.59	$6.59
000123456	LA	0001	Total	$0.00	$0.00	$6.59	$6.59
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: LA
Account: 0108
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	LA	0108	Medco Health	$72,392.84	$91,472.84	$30,755.52	$194,621.20
000123456	LA	0108	Inpatient Hospital Room & Board	$79,796.99	$108,614.81	$29,740.96	$218,152.76
000123456	LA	0108	Inpatient Hospital Miscellaneous	$80,945.12	$17,757.24	$9,382.31	$108,084.67
000123456	LA	0108	Outpatient Hospital Miscellaneous	$75,247.01	$94,124.48	$36,728.05	$206,099.54
000123456	LA	0108	Emergency Room	$11,567.88	$12,072.63	$13,831.52	$37,472.03
000123456	LA	0108	Surgery	$48,893.36	$48,652.34	$8,483.89	$106,029.59
000123456	LA	0108	Anesthesia	$20,733.23	$22,220.71	$4,554.02	$47,507.96
000123456	LA	0108	Assistant Surgical	$1,929.45	$0.00	$0.00	$1,929.45
000123456	LA	0108	Inpatient Medical	$9,319.25	$6,925.98	$1,619.49	$17,864.72
000123456	LA	0108	Outpatient/Professional Medical	$74,365.74	$49,377.77	$38,390.93	$162,134.44
000123456	LA	0108	Other Medical	$207.00	$0.00	$5,283.60	$5,490.60
000123456	LA	0108	Chemotherapy	$1,991.72	$273.72	$0.00	$2,265.44
000123456	LA	0108	Radiation Therapy	$73,808.95	$5,522.96	$0.00	$79,331.91
000123456	LA	0108	Outpatient X-Ray and Lab	$80,547.71	$92,859.44	$26,566.67	$199,973.82
000123456	LA	0108	Outpatient Psychiatric	$2,013.98	$1,279.68	$1,381.18	$4,674.84
000123456	LA	0108	Comprehensive Medical Expenses	($164.51)	$0.00	$0.00	($164.51)
000123456	LA	0108	Pharmacy - Health	$29,418.45	$18,283.25	$21,601.89	$69,303.59
000123456	LA	0108	Coordination of Benefits - Health	$0.00	($2,380.99)	$0.00	($2,380.99)
000123456	LA	0108	Total	$663,014.17	$567,056.86	$228,320.03	$1,458,391.06
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: LA
Account: 0109
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	LA	0109	Medco Health	$2,876.41	$0.00	$0.00	$2,876.41
000123456	LA	0109	Emergency Room	$573.60	$0.00	$0.00	$573.60
000123456	LA	0109	Outpatient/Professional Medical	$860.97	$0.00	$0.00	$860.97
000123456	LA	0109	Outpatient X-Ray and Lab	$1,000.20	$0.00	$0.00	$1,000.20
000123456	LA	0109	Outpatient Psychiatric	$525.00	$0.00	$0.00	$525.00
000123456	LA	0109	Pharmacy - Health	$0.60	$0.00	$0.00	$0.60
000123456	LA	0109	Total	$5,836.78	$0.00	$0.00	$5,836.78
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: LA
Account: 0110
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	LA	0110	Medco Health	$68.24	$349.83	$0.00	$418.07
000123456	LA	0110	Inpatient Hospital Room & Board	$7,633.35	$0.00	$0.00	$7,633.35
000123456	LA	0110	Inpatient Hospital Miscellaneous	$187.53	$0.00	$0.00	$187.53
000123456	LA	0110	Emergency Room	$90.93	$0.00	$0.00	$90.93
000123456	LA	0110	Surgery	$0.00	$64.26	$0.00	$64.26
000123456	LA	0110	Inpatient Medical	$353.77	$0.00	$0.00	$353.77
000123456	LA	0110	Outpatient/Professional Medical	$1,526.46	$411.63	$0.00	$1,938.09
000123456	LA	0110	Outpatient X-Ray and Lab	$1,557.15	$915.51	$0.00	$2,472.66
000123456	LA	0110	Pharmacy - Health	$6.43	$5.41	$0.00	$11.84
000123456	LA	0110	Total	$11,423.86	$1,746.64	$0.00	$13,170.50
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: LA
Account: 0112
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	LA	0112	Medco Health	$0.00	$27.42	$1.25	$28.67
000123456	LA	0112	Outpatient/Professional Medical	$0.00	$229.71	$2,889.63	$3,119.34
000123456	LA	0112	Outpatient X-Ray and Lab	$0.00	$65.08	$0.00	$65.08
000123456	LA	0112	Total	$0.00	$322.21	$2,890.88	$3,213.09
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: NA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	NA	0114	Medco Health	$41,029.21	$51,119.64	$49,335.64	$141,484.49
000123456	NA	0114	Inpatient Hospital Room & Board	$8,698.28	$4,182.28	$63,085.87	$75,966.43
000123456	NA	0114	Inpatient Hospital Miscellaneous	$6,152.89	$47,594.89	$13,780.09	$67,527.87
000123456	NA	0114	ATC/SA Room & Board and Misc.	$0.00	$0.00	$389.00	$389.00
000123456	NA	0114	Outpatient Hospital Miscellaneous	$32,927.86	$207,297.01	$95,842.46	$336,067.33
000123456	NA	0114	Emergency Room	$23,298.28	$21,746.16	$19,678.50	$64,722.94
000123456	NA	0114	Surgery	$30,442.17	$66,970.95	$22,919.62	$120,332.74
000123456	NA	0114	Anesthesia	$10,188.37	$33,136.08	$8,770.21	$52,094.66
000123456	NA	0114	Assistant Surgical	$0.00	$4,207.10	$624.86	$4,831.96
000123456	NA	0114	Inpatient Medical	$0.00	$1,834.83	$2,629.46	$4,464.29
000123456	NA	0114	Outpatient/Professional Medical	$52,469.58	$54,401.67	$125,233.03	$232,104.28
000123456	NA	0114	Other Medical	$2,000.00	$2,326.60	$2,622.28	$6,948.88
000123456	NA	0114	Chemotherapy	$1,077.16	$4,198.50	$0.00	$5,275.66
000123456	NA	0114	Radiation Therapy	$0.00	$49,406.62	$0.00	$49,406.62
000123456	NA	0114	Outpatient X-Ray and Lab	$52,810.92	$127,414.27	$102,981.16	$283,206.35
000123456	NA	0114	Outpatient Psychiatric	$2,547.15	$4,825.58	$9,700.60	$17,073.33
000123456	NA	0114	Comprehensive Medical Expenses	$88.06	$0.00	$0.00	$88.06
000123456	NA	0114	Pharmacy - Health	$38,127.77	$53,053.53	$8,461.10	$99,642.40
000123456	NA	0114	Coordination of Benefits - Health	$0.00	($102.39)	$0.00	($102.39)
000123456	NA	0114	Total	$301,857.70	$733,613.32	$526,053.88	$1,561,524.90
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: NA
Account: 0114
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	NA	0114	Medco Health	$40,124.88	$50,550.14	$47,998.39	$138,673.41
000123456	NA	0114	Inpatient Hospital Room & Board	$8,698.28	$4,182.28	$63,085.87	$75,966.43
000123456	NA	0114	Inpatient Hospital Miscellaneous	$6,152.89	$47,594.89	$13,780.09	$67,527.87
000123456	NA	0114	ATC/SA Room & Board and Misc.	$0.00	$0.00	$389.00	$389.00
000123456	NA	0114	Outpatient Hospital Miscellaneous	$32,927.86	$207,297.01	$95,842.46	$336,067.33
000123456	NA	0114	Emergency Room	$23,298.28	$21,746.16	$19,678.50	$64,722.94
000123456	NA	0114	Surgery	$30,335.35	$66,853.69	$22,840.33	$120,029.37
000123456	NA	0114	Anesthesia	$10,188.37	$33,136.08	$8,770.21	$52,094.66
000123456	NA	0114	Assistant Surgical	$0.00	$4,207.10	$624.86	$4,831.96
000123456	NA	0114	Inpatient Medical	$0.00	$1,834.83	$2,629.46	$4,464.29
000123456	NA	0114	Outpatient/Professional Medical	$50,409.75	$52,691.98	$124,530.12	$227,631.85
000123456	NA	0114	Other Medical	$2,000.00	$2,326.60	$2,622.28	$6,948.88
000123456	NA	0114	Chemotherapy	$1,077.16	$4,198.50	$0.00	$5,275.66
000123456	NA	0114	Radiation Therapy	$0.00	$49,406.62	$0.00	$49,406.62
000123456	NA	0114	Outpatient X-Ray and Lab	$51,310.82	$127,187.87	$102,843.71	$281,342.40
000123456	NA	0114	Outpatient Psychiatric	$2,457.15	$4,649.58	$9,506.60	$16,613.33
000123456	NA	0114	Comprehensive Medical Expenses	$88.06	$0.00	$0.00	$88.06
000123456	NA	0114	Pharmacy - Health	$38,127.77	$52,964.89	$8,461.10	$99,553.76
000123456	NA	0114	Coordination of Benefits - Health	$0.00	($102.39)	$0.00	($102.39)
000123456	NA	0114	Total	$297,196.62	$730,725.83	$523,602.98	$1,551,525.43
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: NA
Account: 0116
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	NA	0116	Medco Health	$904.33	$569.50	$1,337.25	$2,811.08
000123456	NA	0116	Surgery	$106.82	$117.26	$79.29	$303.37
000123456	NA	0116	Outpatient/Professional Medical	$1,937.76	$1,709.69	$702.91	$4,350.36
000123456	NA	0116	Outpatient X-Ray and Lab	$1,486.77	$226.40	$137.45	$1,850.62
000123456	NA	0116	Outpatient Psychiatric	$90.00	$176.00	$194.00	$460.00
000123456	NA	0116	Pharmacy - Health	$0.00	$88.64	$0.00	$88.64
000123456	NA	0116	Total	$4,525.68	$2,887.49	$2,450.90	$9,864.07
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: NA
Account: 0117
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	NA	0117	Outpatient/Professional Medical	$122.07	$0.00	$0.00	$122.07
000123456	NA	0117	Outpatient X-Ray and Lab	$13.33	$0.00	$0.00	$13.33
000123456	NA	0117	Total	$135.40	$0.00	$0.00	$135.40
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: QA
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	QA	0124	Medco Health	$5,277.59	$684.49	$1,932.85	$7,894.93
000123456	QA	0124	Inpatient Hospital Room & Board	$0.00	$10,717.93	$1,076.40	$11,794.33
000123456	QA	0124	Inpatient Hospital Miscellaneous	$837.76	$6,043.48	$2,350.43	$9,231.67
000123456	QA	0124	Outpatient Hospital Miscellaneous	$4,428.80	$1,408.25	$4,710.47	$10,547.52
000123456	QA	0124	Emergency Room	$0.00	$0.00	$905.08	$905.08
000123456	QA	0124	Surgery	$8,601.46	$12,326.09	$774.06	$21,701.61
000123456	QA	0124	Anesthesia	$1,025.06	$524.56	$732.29	$2,281.91
000123456	QA	0124	Assistant Surgical	$0.00	$237.57	$0.00	$237.57
000123456	QA	0124	Inpatient Medical	$0.00	$436.93	$267.26	$704.19
000123456	QA	0124	Outpatient/Professional Medical	$7,254.90	$12,102.60	$12,147.72	$31,505.22
000123456	QA	0124	Other Medical	$0.00	$0.00	$427.20	$427.20
000123456	QA	0124	Outpatient X-Ray and Lab	$8,703.83	$16,398.70	$2,957.52	$28,060.05
000123456	QA	0124	Outpatient Psychiatric	$816.00	$425.28	$3,628.40	$4,869.68
000123456	QA	0124	Pharmacy - Health	$6.14	$74.36	$0.14	$80.64
000123456	QA	0124	Total	$36,951.54	$61,380.24	$31,909.82	$130,241.60
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: QA
Account: 0124
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	QA	0124	Medco Health	$4,356.88	$684.49	$1,932.85	$6,974.22
000123456	QA	0124	Inpatient Hospital Room & Board	$0.00	$10,717.93	$1,076.40	$11,794.33
000123456	QA	0124	Inpatient Hospital Miscellaneous	$837.76	$6,043.48	$2,350.43	$9,231.67
000123456	QA	0124	Outpatient Hospital Miscellaneous	$1,628.80	$1,408.25	$4,710.47	$7,747.52
000123456	QA	0124	Emergency Room	$0.00	$0.00	$905.08	$905.08
000123456	QA	0124	Surgery	$7,410.26	$12,326.09	$774.06	$20,510.41
000123456	QA	0124	Anesthesia	$1,025.06	$524.56	$732.29	$2,281.91
000123456	QA	0124	Assistant Surgical	$0.00	$237.57	$0.00	$237.57
000123456	QA	0124	Inpatient Medical	$0.00	$436.93	$267.26	$704.19
000123456	QA	0124	Outpatient/Professional Medical	$6,645.78	$12,102.60	$12,147.72	$30,896.10
000123456	QA	0124	Other Medical	$0.00	$0.00	$427.20	$427.20
000123456	QA	0124	Outpatient X-Ray and Lab	$7,628.36	$16,398.70	$2,957.52	$26,984.58
000123456	QA	0124	Outpatient Psychiatric	$816.00	$425.28	$3,628.40	$4,869.68
000123456	QA	0124	Pharmacy - Health	$6.14	$74.36	$0.14	$80.64
000123456	QA	0124	Total	$30,355.04	$61,380.24	$31,909.82	$123,645.10
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: QA
Account: 0125
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	QA	0125	Medco Health	$920.71	$0.00	$0.00	$920.71
000123456	QA	0125	Outpatient Hospital Miscellaneous	$2,800.00	$0.00	$0.00	$2,800.00
000123456	QA	0125	Surgery	$1,191.20	$0.00	$0.00	$1,191.20
000123456	QA	0125	Outpatient/Professional Medical	$609.12	$0.00	$0.00	$609.12
000123456	QA	0125	Outpatient X-Ray and Lab	$1,075.47	$0.00	$0.00	$1,075.47
000123456	QA	0125	Total	$6,596.50	$0.00	$0.00	$6,596.50
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: ALL
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FP	0000	Flexible Spending Account	$190,973.09	$0.00	$0.00	$190,973.09
000123456	FP	0000	Total	$190,973.09	$0.00	$0.00	$190,973.09
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FP
Account: ALL
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FP	0000	Flexible Spending Account	$190,973.09	$0.00	$0.00	$190,973.09
000123456	FP	0000	Total	$190,973.09	$0.00	$0.00	$190,973.09
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FP
Account: 0000
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FP	0000	Flexible Spending Account	$192,107.08	$0.00	$0.00	$192,107.08
000123456	FP	0000	Total	$192,107.08	$0.00	$0.00	$192,107.08
Run Date: 7/17/2012 6:45:24 AM
Payments by Benefit Type
Report Filter:
Book Year/Month = 2012-06, 2012-05, 2012-04, 2012-03, 2012-02, 2012-01, 2011-12, 2011-11, 2011-10, 2011-09, 2011-08, 2011-07
And
-Policy Number = 000123456
And
Funding Arrangement Category = Administrative Services Only
-Policy Number: 000123456
Suffix: FP
Account: 0001
				Subscriber	Spouse	Dependent/Other	Total
-Policy Number	Suffix	Account	Benefit Type	Payments	Payments	Payments	Payments
000123456	FP	0001	Flexible Spending Account	($1,133.99)	$0.00	$0.00	($1,133.99)
000123456	FP	0001	Total	($1,133.99)	$0.00	$0.00	($1,133.99)