Broker book
Independence Blus Cross
103 Bradford Rd, Wexford, PA 15090 · EIN 23-0370270
Plan year 2022
2 employers · 362 enrolled · Direct (A) $14,822 · Additional (C) $60,569
Employers
Plan year 2022
Groups named on this party’s Form 5500 rows for the selected plan year.
| Employer | Coverage | Carrier | Enrolled | Direct (A) | Additional (C) |
|---|---|---|---|---|---|
| Valley Tire Company | Stop-loss | Sun Life Assurance Company Of Canada | 192 | $0 | $30,107 · $156.81/enrolled |
| Port Erie Plastics | Stop-loss | Symetra Life Insurance Company | 170 | $14,822 · 4.0% | $30,462 · $179.19/enrolled |
About these columns
Direct (A) — Carrier-contract commissions from Schedule A. Not averaged with Schedule C.
Additional (C) — Plan-paid amounts from Schedule C. Shown as total and $ / enrolled / year.