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Invoice

The billing statement for Rosa E Sevillano indicates a total amount due of $0.00, with the due date set for 04/01/2025. The premium has been reduced by a Tax Credit of $1,197.00, and the previous balance was -$55.80. Members are reminded to pay the full amount to avoid losing coverage and can manage prescriptions through MyPrime on the Florida Blue website.

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rosaelvirasevillano
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110 views2 pages

Invoice

The billing statement for Rosa E Sevillano indicates a total amount due of $0.00, with the due date set for 04/01/2025. The premium has been reduced by a Tax Credit of $1,197.00, and the previous balance was -$55.80. Members are reminded to pay the full amount to avoid losing coverage and can manage prescriptions through MyPrime on the Florida Blue website.

Uploaded by

rosaelvirasevillano
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Billing Statement

Due Date 04/01/2025


Enrollment & Billing Department Total Amount Due $0.00
P.O. Box 44236
Jacksonville, FL 32231-4236 You’re setup for autopay. If you don’t get
emails about your payment, please log in
to update.

Rosa E Sevillano
495 W FAIRWAYS VIEW DR
BEVERLY HILLS, FL 34465-3597

Member ID:H61657716
Plan Information Billing Details Amount Due
BlueSelect Silver 1443B
Previous Balance Amount: -$55.80
Coverage Period: 04/01/2025 – $55.80
04/30/2025
Your premium has been reduced by
a Tax Credit amount of $1,197.00
Better You Rewards:
-$55.80
Amount Due: $0.00

Shop for the best price on prescription drugs with MyPrime, the prescription management tool in your online
account. Log in at [Link] and click [Link] under Pharmacy Resources. Then click Search
Medicines to compare your costs at all the pharmacies in your network.

Statement created: 03/11/2025


Address changes:
If you purchased a plan through the MarketplaceSM, call 1-800-318-2596 (or go to [Link]) to
change your address. Otherwise, log in to your account at [Link] and update your info under My
Account.
Payment reminders:
It’s important to pay the full amount. If you are late, miss payments or make partial payments, you may lose
your coverage. Please make sure to pay on or before the due date shown at the top of your bill. If you do not
pay the full amount due by the end of your grace period, your coverage will be canceled for nonpayment.
Important: If you apply for a new policy with us, any past due amounts owed within the last 12 months may
need to be paid before your new coverage can start.

Any adjustments or payments posted to your account within the last 7-10 days may not be reflected in this
statement.

85897 0418R
CVS/pharmacy®, Navarro Discount Pharmacy, Family Dollar, MoneyGram, Dollar General and ACE
Cash Express are independent companies assisting in the collection of premium payments on behalf of
Florida Blue, Florida Blue HMO, and Florida Combined Life Insurance Company, Inc.

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