Scribd Logo
Încărcați

Bine ați venit la Scribd!

  • Green Shield Canada claims search results for ZHICHAO WANG

    Încărcat de

    omgcharlie12
    17 vizualizări1 pagină
    This document provides a summary of claims for ZHICHAO WANG under their Green Shield Canada dental, drug, and extended health insurance plan between January 1, 2017 and March 31, 2017. It shows one dental claim for a tooth extraction in January 2017 that was paid out at $323.41 with a $107.80 copayment. It also shows one prescription drug claim from January 2017 for $16.09 where $9.71 was paid and there was a $4.16 copayment. No extended health claims were submitted during this period.

    Descriere originală:

    green shield

    Titlu original

    Green Shield Canada

    Drepturi de autor

    © © All Rights Reserved

    Formate disponibile

    PDF, TXT sau citiți online pe Scribd

    Vi se pare util acest document?

    Este necorespunzător acest conținut?

    Raportați acest document
    This document provides a summary of claims for ZHICHAO WANG under their Green Shield Canada dental, drug, and extended health insurance plan between January 1, 2017 and March 31, 2017. It shows one dental claim for a tooth extraction in January 2017 that was paid out at $323.41 with a $107.80 copayment. It also shows one prescription drug claim from January 2017 for $16.09 where $9.71 was paid and there was a $4.16 copayment. No extended health claims were submitted during this period.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    17 vizualizări1 pagină

    Green Shield Canada claims search results for ZHICHAO WANG

    Încărcat de

    omgcharlie12
    This document provides a summary of claims for ZHICHAO WANG under their Green Shield Canada dental, drug, and extended health insurance plan between January 1, 2017 and March 31, 2017. It shows one dental claim for a tooth extraction in January 2017 that was paid out at $323.41 with a $107.80 copayment. It also shows one prescription drug claim from January 2017 for $16.09 where $9.71 was paid and there was a $4.16 copayment. No extended health claims were submitted during this period.

    Drepturi de autor:

    © All Rights Reserved
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 1

    31/03/2017 GreenShieldCanada

    CLAIMSINFORMATIONSEARCHRESULTS
    Thefollowingsummarylistofclaimsrecordswascreatedforthefollowingsearchcriteria:

    GreenShieldIDNumber:MUN201038627
    PlanMemberName: ZHICHAOWANG

    Participant: 00:WANG,ZHICHAO
    ClaimType: Claims
    LineofBusiness: Dental,Drug,ExtendedHealthServices
    Period: Jan01,2017toMar31,2017
    Paidto: PlanMember,ServiceProvider

    Dental
    ServiceDate ClaimForm Service Claimed OtherPaid Paid Copay/ PaymentDate PaidTo
    Number Description Amount Amount Amount Deductible
    ($Cdn) ($Cdn) ($Cdn)
    EXTRACTION,
    Jan03,
    1 511951483 COMPLICATED, $431.21 $0.00 $323.41 $107.80 Jan23,2017 ServiceProvider
    2017
    ToothCode48
    Copaymenteligibleforcoordination(StudentDentalProgram).

    Totals: $431.21 $0.00 $323.41 $107.80

    Drug
    Service ClaimForm Service Quantity Claimed OtherPaid Paid Copay/ Payment PaidTo
    Date Number Description Amount Amount Amount Deductible Date
    ($Cdn) ($Cdn) ($Cdn)
    Jan03, Prescription
    1 511963231 30 $16.09 $0.00 $9.71 $4.16 Jan16,2017 ServiceProvider
    2017 Drug

    Totals: 30 $16.09 $0.00 $9.71 $4.16

    ExtendedHealthServices
    ServiceDate ClaimForm Service Claimed OtherPaid Paid Copay/ PaymentDate PaidTo
    Number Description Amount Amount Amount Deductible
    ($Cdn) ($Cdn) ($Cdn)
    NoClaimsfoundforselectioncriteria

    Totals: $0.00 $0.00 $0.00 $0.00
    DateofInquiry:Mar31,201710:09AMEDT

    636265517477345801.P2.5.0.6289.CL4

    https://onlineservices.greenshield.ca/PlanMember/Claim/ViewClaimsP.aspx 1/1

    S-ar putea să vă placă și