Remittance worksheet
Exceptions to Billed Amounts

[MD] MISSED DEDUCTIONS NOT MADE UP BY PAYROLL DEDUCTION:
Write the employee's name and ID on remittance worksheet or draw a line through the employee's name on the bill and use the "MD" (missed deduction) code. We will bill the responsible party directly for the missed premium.

[UD] DIFFERENCES IN PREMIUM AMOUNTS:
If there is a discrepancy in what we billed and what you are collecting, there is usually a reason. Please deduct amounts currently on your bill and call your Billing Administrator if you have any questions. Monitoring the blue change reports upon receipt will reduce differences.

[AB] REMITTING PREMIUM FOR AN EMPLOYEE NOT LISTED ON YOUR BILL
We do not encourage payroll centers to "make-up" premium that is not specifically billed unless the procedure is coordinated beforehand. If you are deducting for employees not on the billing report, please contact your Billing Administrator.

[DB] IF AN EMPLOYEE IS LEAVING EMPLOYMENT:
We can help eligible employees retain their coverage by converting their policies to individual pay at the same rate. Please help us offer this benefit by providing us a current mailing address for any employee leaving your employment. Please enter the employee's name and the "DB" exception code. When the payment is remitted, we will immediately place this policy on direct billing to the responsible party. Additional bills may be printed for your account before we receive your changes. Please continue to make the change until it is reflected on your invoice.

[LS/MD] CONTINUING COVERAGE WHILE ON LEAVE:
If an employee will be on unpaid leave for at least 6 weeks, please have them contact our Customer Service Department directly when they start their leave and upon their return to work. Their coverage will be placed on a home billing to prevent their coverage from lapsing. For leaves less than 6 weeks, a missed deduction notice will be sent to the responsible party to recover missed premiums while billing continues on payroll deduction.

[CN] CANCELLATION OF COVERAGE:
Should an employee decide that they no longer wish to participate in the program, please direct them to our Customer Service Department. Payroll deductions for employees requesting cancellation may be stopped at the discretion of the payroll center (providing notification is sent to us to ensure that the appropriate forms are filled out by the responsible party).

The cancellation request must include the name of the insured, the signature of the responsible party, and the policy/certificate number(s). If an insured has more than one type of coverage, it is recommended that they specify their intentions for each coverage on their cancellation request. Deductions will only be stopped for the coverages listed on the cancellation request. If additional premium is deducted after a particular coverage is canceled, we will refund it directly to the employee's home address within 10 days of receipt.