Monthly Supplemental Insurance Invoice

This is a Monthly Supplemental Insurance Invoice for new enrollments only.
invoice 9 page 001
1  -  Statement number ending in "MS" indicates this is a "Monthly Supplemental Insurance" invoice.
2  -  This is the newly enrolled member and the insurance item(s) being billed.
3  -  This is the total monthly insurance premium amount due for this listed member "John Smith".