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Employer
1337 E 5th St, Bethlehem, PA 18015 · EIN 23-1669589 · Jan 1, 2024 to Dec 31, 2024
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 $17,387
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 93 | Comp not disclosed Premium $659,695 |
| Dental | The Guardian Life Insurance Company Of America | — | 94 | Schedule A not provided |
| Dental | The Guardian Life Insurance Company Of America | — | 94 | Schedule A not provided |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 211 | $514 4.0% of $12,847 |
| Life | Dearborn Life Insurance Company | Bsi Corporate Benefits, Inc. | 99 | $10,429 13.7% of $76,209 |
| Telemedicine | Healthiest You | — | — | Schedule A not provided |
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 $85,208
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $57,971 | $623.34 |
| The Benecon Group | Broker | $21,924 | $235.74 |
| Innovu | Broker | $4,543 | $48.85 |
| Hy Holdings Inc | Admin | $10,832 | $116.47 |
| ConnectCare3 | Patient Advocate | $5,837 | $62.76 |
| Capital Bluecross | Admin | $-15,899 | $-170.96 |