Specific Reinsurance
 
Includes Claimants Over 50%    
By Group Code Contract Type: 24/12 Report Date: 11/09/2003
  Family Specific Limit: $.00 Contract Period: 10/01/2003 - 10/31/2003 Contract
  Individual Specific Limit: $250,000.00  


Status
Enrollee
SSN
Member
MemID
Dep
Paid YTD		 Over
Specific		 Amount
Reimbursed		 Amount
Open 		Amount
Unreported		 % of
Specific
Group: 99999
Benefit Type: M
  a DOE, J 123456789 PAT 0085203 e 158,717.39 (91,282.61) .00 .00 .00 63.49
c DOE, J 123456789 PAT 0085637 e 131,542.80 (118,457.20) .00 .00 .00 52.62
h DOE, J 123456789 PAT 0085664 s 144,772.68 (105,227.32) .00 .00 .00 57.91
a DOE, J 123456789 PAT 0086442 e 134,338.89 (115,661.11) .00 .00 .00 53.74
a DOE, J 123456789 PAT 0087761 s 151,079.57 (98,920.43) .00 .00 .00 60.43
a DOE, J 123456789 PAT 0087811 s 217,511.69 (32,488.31) .00 .00 .00 87.00
a DOE, J 123456789 PAT 0088532 e 253,448.40 3,448.40 .00 3,448.40 3,448.40 101.38
a DOE, J 123456789 PAT 0088738 e 136,476.13 (113,523.87) .00 .00 .00 54.59
a DOE, J 123456789 PAT 0089470 e 206,435.08 (43,564.92) .00 .00 .00 82.57
a DOE, J 123456789 PAT R . 1 575,753.35 325,753.35 342,050.25 .00 325,753.35 230.30
c DOE, J 123456789 PAT 0091482 e 134,326.56 (115,673.44) .00 .00 .00 53.73
a DOE, J 123456789 PAT . 2 207,134.24 (42,865.76) .00 .00 .00 82.85
a DOE, J 123456789 PAT . 3 222,844.99 (27,155.01) .00 .00 .00 89.14
c DOE, J 123456789 PAT 0095383 e 125,304.61 (124,695.39) .00 .00 .00 50.12
a DOE, J 123456789 PAT . 1 434,068.48 184,068.48 324,860.06 .00 175,493.99 173.63
 
Total Ben Type: M             3,233,754.86 (516,245.14) 666,910.31 .00 .00 86.23
Total Group: 50146             3,233,754.86 (516,245.14) 666,910.31 .00 .00 86.23
 
Specific Reinsurance
Requestor: Report Caster
Report Date: 11/09/2003
Sort fields: Selected Values:
Group: 99999
Benefit Type: ALL
Date: CONT
Contract As of Date: 20030930
Include Claimants Over 50