KAISER FOUNDATION HEALTH PLAN P.O. Box 12345 El Dorado Hills, CA 95762-9028 Total Amount Due $9,840.00 (Includes past due and current charges) Due Before 3/1/2021 Summary of Amount Due Previous Balance $5,900.00 Payments -$4,800.00 Amount Past Due $1,100.00 Current Activity $8,245.00 Retro & Other Activity $500.00 Account Adjustments & Fees -$5.00 Total Current Charges $8,740.00 ABC Company John Doe 123 Main St Los Angeles, CA 94404 You’re signed up for autopay. Your account ending in 5029 will be charged $9,840.00 on 2/28/2021. Any activity processed after 02/15/2021 will appear on your next bill. Accounts included in this bill Purchaser ID Region Billing Unit ID Total charges 54321 NCR 2345 $3,100.00 54321 NCR 1000 $100.00 43210 SCR 7891 $3,000.00 65432 SCR 3456 $2,545.00 A BETTER WAY TO TAKE CARE OF BUSINESS NEW EASIER-TO-READ BILL ABC Company Customer ID: 12345 Statement ID: 139902412401 March 2021 Here’s a quick look at where to find key information on your new bill EXAMPLE 1 Customer ID is a unique account identifier within our new billing system. Note: Invoice number will appear in place of Statement ID on non-consolidated bills. 2 Bill cut-off date 3 Payment and invoice summary, and due date 4 Autopay status 5 Accounts included in bill, with region and billing ID 6 Payment details
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Test ABC Company Customer ID: 12345 Invoice No. 999999
February 2021 KAISER FOUNDATION HEALTH PLAN P.O. Box 12345 El Dorado Hills, CA 95762-9028
Page 1 of 7
Total Amount Due $3,800.00 (Includes past due and current charges)
Due Before 2/1/2021
Summary of Amount Due
Previous Balance $9,000.00Payments -$7,800.00
Amount Past Due $1,200.00
Current Activity $1,960.00Retro & Other Activity $645.00
Account Adjustments & Fees -$5.00Total Current Charges $2,600.00
Test ABC Company John Doe 123 Main St New York City, NY 12345
You’re signed up for autopay. Your account ending in 8888 will be charged $3,800.00 on 1/25/2021.
Accounts included in this billPurchaser ID Region Billing unit ID
5001 NCal 34567
Any activity processed after 1/17/2021 will appear on your next bill.
Page 1 of 9
Total Amount Due $9,840.00 (Includes past due and current charges)
Due Before 3/1/2021
Summary of Amount Due
Previous Balance $5,900.00 Payments -$4,800.00
Amount Past Due $1,100.00
Current Activity $8,245.00
Retro & Other Activity $500.00 Account Adjustments & Fees -$5.00
Total Current Charges $8,740.00
ABC Company John Doe 123 Main St Los Angeles, CA 94404
You’re signed up for autopay. Your account ending in 5029 will be charged $9,840.00 on 2/28/2021.
Accounts included in this bill Purchaser ID Region Billing Unit ID Total charges
54321 NCR 23456 $3,100.00 54321 NCR 10001 $100.00 43210 SCR 78912 $3,000.00 65432 SCR 34567 $2,545.00
Any activity processed after 02/15/2021 will appear on your next bill.
Page 1 of 9
Total Amount Due $9,840.00 (Includes past due and current charges)
Due Before 3/1/2021
Summary of Amount Due
Previous Balance $5,900.00 Payments -$4,800.00
Amount Past Due $1,100.00
Current Activity $8,245.00
Retro & Other Activity $500.00 Account Adjustments & Fees -$5.00
Total Current Charges $8,740.00
ABC Company John Doe 123 Main St Los Angeles, CA 94404
You’re signed up for autopay. Your account ending in 5029 will be charged $9,840.00 on 2/28/2021.
Accounts included in this bill Purchaser ID Region Billing Unit ID Total charges
54321 NCR 2345 $3,100.00 54321 NCR 1000 $100.00 43210 SCR 7891 $3,000.00 65432 SCR 3456 $2,545.00
Any activity processed after 02/15/2021 will appear on your next bill.
A BETTER WAY TO TAKE CARE OF BUSINESS
NEW EASIER-TO-READ BILL
ABC Company Customer ID: 12345
Statement ID: 139902412401 March 2021
Here’s a quick look at where to find key information on your new bill
EXAMPLE
1Customer ID is a unique account identifier within our new billing system.
Note: Invoice number will appear in place of Statement ID on non-consolidated bills.
2Bill cut-off date
3Payment and invoice summary, and due date
4Autopay status
5Accounts included in bill, with region and billing ID
6Payment details
Test ABC Company Customer ID: 12345 Invoice No. 999999
February 2021 KAISER FOUNDATION HEALTH PLAN P.O. Box 12345 El Dorado Hills, CA 95762-9028
Page 7 of 7
Any activity processed after 1/17/2021 will appear on your next bill.
Provide billing account number(s) on check and make it payable to: KAISER FOUNDATION HEALTH PLAN
(RETURN THIS PORTION WITH YOUR PAYMENT) ----------------------------------------------------------------------------------------------------------------------------------------------------------
You’ve got a few simple and easy ways to pay your bill
Pay online Go to account.kp.org to make a one-time payment or schedule monthly payments directly from your bank account.
Pay by automated clearing house (ACH) Go to account.kp.org to learn more about making convenient bank-to-bank payments.
Pay by mail Use the form below to pay by check in the envelope provided. Checks that lack funds or can’t be cashed aren’t considered payment and will result in a nonsufficient funds fee.
We appreciate your business.
ABC COMPANY JOHN DOE 123 MAIN ST NEW YORK CITY, NY 12345
Kaiser Foundation Health Plan Inc. P.O. Box 741562 Los Angeles, CA 90074-1562
Billing Unit ID 34567 Customer ID 12345
REMITTANCE ADVICE FOR February 2021
Please pay this Amount: $3,800.00
AMOUNT PAID: $ ______
Due Date: February 1, 2021
00000100000010000001000000100000010000001
EXAMPLE
7
(continued from front)
Membership details, with both current and retroactive information, Medicare assignment, and active/retired status
Note: For details on an employee or dependents, you can log in or create your account at account.kp.org.
Consolidated statements will show a table for each account.
8Account adjustments and details are reflected at the summary level. For details by account, go to account.kp.org.
Note: Due to our recent conversion to a new billing system, you may see one-time adjustments on your new bill.
EXAMPLE
9Please note our new payment address.
590243933 May 2021
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