HEALTH INSURANCE RECEIPT GENERATOR
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HEALTH INSURANCE ADMINISTRATION
Health Insurance Payment Receipt
April 12, 2025
Emma Thompson
emma.thompson@example.com
+1 (555) 987-6543
Policy Number:
GHI-123456789
Receipt Code:
HI-78945-D3
Payment Details
Payment Method:
Card Payment
Payment Date:
April 12, 2025
Insurance Provider:
Global Health Insurance
Description:
Health Insurance Premium Payment
Account Name:
Approved
Authorization Code:
AUTH-78954-2X
Processor ID:
VISA-INT-4567
Settlement Time:
14:32:45 GMT
Insurance Details
Insurance Type:
Premium Health Coverage
Coverage Period:
April 15, 2025 - April 14, 2026
Additional Coverage:
Dental Coverage
Vision Coverage
Prescription Drugs
Fee Breakdown
Base Premium
$500.00
Additional Coverage Fees
$150.00
Service Charge
$50.00
Total Premium
$700.00
Verification Authority
Health Insurance Administration
Status: Authorized
Global Health Insurance Association
Scan to verify authenticity
Verified by HIA Security
Generated on: April 12, 2025 at 10:45:32 AM EDT
Valid until: April 12, 2026