This document is a billing statement from Kaiser Permanente addressed to My Bar LLC/G30. It shows an amount due of $6,032.19 and a due date of "PAY NOW". It provides contact information for billing inquiries and instructions to write the billing unit number on checks payable to Kaiser Foundation Health Plan. It also details policies regarding insufficient funds, termination of coverage, delinquency, and the consequences of nonpayment, including a grace period and potential collection proceedings.
This document is a billing statement from Kaiser Permanente addressed to My Bar LLC/G30. It shows an amount due of $6,032.19 and a due date of "PAY NOW". It provides contact information for billing inquiries and instructions to write the billing unit number on checks payable to Kaiser Foundation Health Plan. It also details policies regarding insufficient funds, termination of coverage, delinquency, and the consequences of nonpayment, including a grace period and potential collection proceedings.
This document is a billing statement from Kaiser Permanente addressed to My Bar LLC/G30. It shows an amount due of $6,032.19 and a due date of "PAY NOW". It provides contact information for billing inquiries and instructions to write the billing unit number on checks payable to Kaiser Foundation Health Plan. It also details policies regarding insufficient funds, termination of coverage, delinquency, and the consequences of nonpayment, including a grace period and potential collection proceedings.
This document is a billing statement from Kaiser Permanente addressed to My Bar LLC/G30. It shows an amount due of $6,032.19 and a due date of "PAY NOW". It provides contact information for billing inquiries and instructions to write the billing unit number on checks payable to Kaiser Foundation Health Plan. It also details policies regarding insufficient funds, termination of coverage, delinquency, and the consequences of nonpayment, including a grace period and potential collection proceedings.
BOX 23219 SAN DIEGO, CA 92193-3219 000724475-0000 S
MY BAR LLC/G30 AMOUNT DUE: $6,032.19
ERIKA RUYBALID 1373 KOOSER RD DUE DATE: PAY NOW SAN JOSE, CA 95118-3822
APRIL 2020 statement includes
membership and financial transactions processed from 01/26/2020 through 02/25/2020
Did you know that Kaiser Permanente can
88936677042020012600000000060321920200325 000724475-0000 APRIL Did MY KAISER Referyou BAR to2020 know the FOUNDATION LLC/G30 Billing statement that Kaiser Summary includes HEALTH SPermanente page(RETURN PLAN for can THIS PORTION WITH REMITTANCE YOURUnit: Billing PAYMENT) 893667704 ADVICE Customer APRIL 2020 ID: now send an automatic email notification membership now ERIKA FILE all billing send 5915 RUYBALID unit(s) an and automatic included financial email intransactions this notification statement. processed FOR: 000724475-0000 Save 1373 LOS time 01/26/2020 ANGELES, KOOSER your byRD managing when your electronic eligibility file has from when electronic CA through 90074-5915 eligibility your 02/25/2020 file has accountSave time by managing your account online. online. been completed? Please contact us for been JOSE, SAN Sign completed? up atCA the95118-3822 Please newlycontactenhanced Sign up at the newly us for account.kp.org. Pleaseenhanced account.kp.org. pay this Amount: $6,032.19 more information. more information.
AMOUNT PAID:
Due Date: PAY NOW
Provide Billing Unit number(s) on check and make it
payable to: KAISER FOUNDATION HEALTH PLAN
Refer to the Billing Summary page for
all billing unit(s) included in this statement.
(RETURN THIS PORTION WITH YOUR PAYMENT)
Billing Unit: 893667704 Customer ID: 000724475-0000 REMITTANCE ADVICE FOR: APRIL 2020 MY BAR LLC/G30 ERIKA RUYBALID Please pay this Amount: $6,032.19 1373 KOOSER RD SAN JOSE, CA 95118-3822 AMOUNT PAID:
Due Date: PAY NOW
Provide Billing Unit number(s) on check and make it payable to:
KAISER FOUNDATION HEALTH PLAN KAISER FOUNDATION HEALTH PLAN FILE 5915 LOS ANGELES, CA 90074-5915
88936677042020012600000000060321920200325 Membership Billing Statement 000724475-0000 APRIL 2020
Membership Billing Statement CONTACT INFORMATION:
Customer CustomerInquiries: 000724475-0000 Inquiries: (800) (800)731-4661 731-4661 Hours of Operation: Hours of Operation: Monday Monday––Friday Friday8:00 8:00a.m. a.m.to to5:00 5:00p.m. p.m. APRIL 2020
Send all membership and address changes to:
KAISER FOUNDATION HEALTH PLAN
CALIFORNIA SERVICE CENTER P.O. BOX 23219 SAN DIEGO, CA 92193-3219
Provide Billing Unit number(s) on check and make it payable to:
KAISER FOUNDATION HEALTH PLAN
FILE 5915 LOS ANGELES, CA 90074-5915
Insufficient Funds Insufficient Funds Kaiser Foundation Health Plan, Inc. charges an administrative service fee for any returned check due to Kaiser Foundation Health Plan, Inc. charges an administrative service fee for any returned check due to insufficient funds in the payer's account. Kaiser Foundation Health Plan, Inc. reserves the right to terminate insufficient funds in the payer's account. Kaiser Foundation Health Plan, Inc. reserves the right to terminate coverage for any account with three returned checks due to insufficient funds within a 12-month period. coverage for any account with three returned checks due to insufficient funds within a 12-month period.
Termination of Coverage Termination of Coverage Kaiser Health Plan, Inc. requires 15 days written notice to terminate group coverage. Kaiser Health Plan, Inc. requires 15 days written notice to terminate group coverage.
Delinquency Delinquency Group Employers delinquent in paying health plan dues may be subject to termination. Group Employers delinquent in paying health plan dues may be subject to termination. Membership Billing Statement 000724475-0000 APRIL 2020
Notice of Consequences for Nonpayment of Premium
We are committed to your health and well-being. We want to make sure that you have coverage for the care and services you need and therefore receipt of full payment of your monthly premium by the due date listed on the first page of this Invoice is essential. Kaiser Permanente is providing you with this notice regarding your rights when you fail to pay your premium on time.
If the Amount Due, as set forth on the first page of this Invoice, is not received on or before the due date indicated on that same page, then a grace period will begin the day we mail you your first late notice. This grace period will last at least 30 days. During the grace period, you may pay the premiums that you owe. Your Kaiser Permanente group coverage will continue during the grace period, and you will continue to owe premiums for your group’s coverage during the grace period.
You must pay the Amount Due as set forth on the first page of this Invoice plus any premium owed for the grace period by the end of your grace period. If you have not paid in full, your membership will terminate on the last day of your grace period. You will remain financially responsible for the payment of premiums and any other amounts due for your group’s coverage. Kaiser Permanente reserves the right to initiate collection proceedings for all monthly premium amounts, payments for services rendered and any other amounts that you owe.
We will continue to bill you, and you will continue to owe premiums for the period during which your Kaiser Permanente coverage remains in effect. To terminate your coverage immediately, contact Kaiser Permanente as soon as possible. Membership Billing Statement 000724475-0000 APRIL 2020
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Billing Summary 000724475-0000 MY BAR LLC/G30 APRIL 2020
