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Employer
19 Leonberg Road, Cranberry Township, PA 16066 · EIN 25-1872896 · Mar 1, 2023 to Feb 29, 2024
Plan year 2023
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Schedule A
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $9,779
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 71 | Comp not disclosed Premium $179,738 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 73 | Comp not disclosed Premium $44,931 |
| Dental | Unitedhealthcare Insurance Company | First National Insurance Agency | 79 | $906 4.7% of $19,099 |
| Dental | Unitedhealthcare Insurance Company | Benefits Network Inc | 79 | $880 4.6% of $19,099 |
| Vision | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 67 | $110 2.8% of $3,884 |
| Vision | United Of Omaha Life Insurance Company | Benefits Network Inc | 67 | $84 2.2% of $3,884 |
| Vision | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 67 | $66 1.7% of $3,884 |
| Life | United Of Omaha Life Insurance Company | Benefits Network Inc | 49 | $1,055 8.7% of $12,101 |
| Life | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 49 | $760 6.3% of $12,101 |
| Life | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 49 | $152 1.3% of $12,101 |
| Other | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 110 | $1,112 7.2% of $15,460 |
| Other | United Of Omaha Life Insurance Company | Benefits Network Inc | 110 | $743 4.8% of $15,460 |
| Other | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 110 | $141 0.9% of $15,460 |
| Voluntary | United Of Omaha Life Insurance Company | Benefits Network Inc | 42 | $450 7.3% of $6,179 |
| Voluntary | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 42 | $291 4.7% of $6,179 |
| Voluntary | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 42 | $73 1.2% of $6,179 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Benefits Network Inc | 28 | $312 8.7% of $3,600 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 28 | $228 6.3% of $3,600 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 28 | $46 1.3% of $3,600 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Benefits Network Inc | 33 | $349 8.6% of $4,047 |
| Voluntary Accident | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 33 | $258 6.4% of $4,047 |
| Voluntary Accident | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 33 | $52 1.3% of $4,047 |
| Other | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 110 | $498 5.1% of $9,779 |
| Other | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 110 | $320 3.3% of $9,779 |
| Voluntary Hospital Indemnity | United Of Omaha Life Insurance Company | Benefits Network Inc | 28 | $466 11.1% of $4,188 |
| Voluntary Hospital Indemnity | United Of Omaha Life Insurance Company | First National Ins Agency LLC | 28 | $371 8.9% of $4,188 |
| Voluntary Hospital Indemnity | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 28 | $56 1.3% of $4,188 |
Schedule C
Plan-paid amounts to each named party on the filing, with the role they reported. This is not a carrier commission and is not added to Schedule A.
Visible subtotal $84,550
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| First National Insurance Agency | Broker | $23,065 | $315.96 |
| The Benecon Group | Broker | $16,990 | $232.74 |
| The Meltzer Group (Nfp-Md) | Broker | $5,215 | $71.44 |
| Umr | Admin | $34,844 | $477.32 |
| ConnectCare3 | Patient Advocate | $4,436 | $60.77 |