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Employer
7520 Morris Court, Allentown, PA 18106 · EIN 23-2962365 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
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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 $7,277
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 37 | Comp not disclosed Premium $28,160 |
| Dental + Vision | Capital Advantage Assurance Company | Brown & Brown Of Pennsylvania | 99 | $593 9.6% of $6,184 |
| Other | Hartford Life And Accident | Brown & Brown Of Pennsylvania | 124 | $228 |
| Other | Hartford Life And Accident | Brown & Brown Insurance Services | 124 | Comp not disclosed |
| Stop-loss | HM Life Insurance Company | — | 26 | Comp not disclosed Premium $164,194 |
| Dental + Vision | Capital Advantage Assurance Company | Brown & Brown Of Pennsylvania | 57 | $2,563 9.3% of $27,586 |
| Other | Hartford Life And Accident | Foley Ins Agency Inc | 129 | $2,106 9.7% of $21,668 |
| Other | Hartford Life And Accident | Brown & Brown Of Pennsylvania | 129 | $1,049 4.8% of $21,668 |
| Other | Hartford Life And Accident | Strategic Non-Medical Solutions, Ll | 129 | $518 2.4% of $21,668 |
| Other | Hartford Life And Accident | Brown & Brown Insurance Services | 129 | $220 1.0% of $21,668 |
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 $70,190
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown (Pa) | Broker | $2,640 | $21.29 |
| The Benecon Group | Broker | $1,649 | $13.30 |
| Capital Bluecross | Admin | $6,580 | $53.06 |
| ConnectCare3 | Patient Advocate | $360 | $2.90 |
| Brown & Brown (Pa) | Broker | $16,240 | $125.89 |
| The Benecon Group | Broker | $12,732 | $98.70 |
| Capital Bluecross | Admin | $29,989 | $232.47 |