| Name | Espense type | Service date | Amount submitted | Amount eligible | % paid | Deductible | Benefit paid | Details |
|---|---|---|---|---|---|---|---|---|
| John Braddock | Dental | 01 Oct 2011 | $100.00 | $100.00 | 95% | $100.00 | $100.00 | Details |
| John Braddock | Dental | 01 Oct 2011 | $100.00 | $100.00 | 95% | $100.00 | $100.00 | Details |
| John Braddock | Dental | 01 Oct 2011 | $100.00 | $100.00 | 95% | $100.00 | $100.00 | Details |
| Total | $9100.00 | $100.00 | $100.00 | $100.00 |
Access your electronic claim statement outlines our assessment of your claim.