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Employer
4250 Crums Mill Road, Harrisburg, PA 17112 · EIN 25-1696385 · Mar 1, 2024 to Feb 28, 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 $18,224
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Delta Dental Of Pennsylvania | American Insurance Administrators | 89 | $4,930 10.0% of $49,299 |
| Vision | National Vision Administrators, LLC | American Insurance Administrators | 77 | $841 6.0% of $14,022 |
| Life | United Of Omaha Life Insurance Company | Aia American Administrators LLC | 104 | $809 15.0% of $5,391 |
| Life | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 104 | $242 4.5% of $5,391 |
| AD&D | United Of Omaha Life Insurance Company | Aia American Administrators LLC | 35 | $1,483 15.0% of $9,887 |
| AD&D | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 35 | $442 4.5% of $9,887 |
| Other | United Of Omaha Life Insurance Company | Aia American Administrators LLC | 104 | $3,951 15.0% of $26,339 |
| Other | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 104 | $1,154 4.4% of $26,339 |
| Other | United Of Omaha Life Insurance Company | Aia American Administrators LLC | 104 | $2,272 15.0% of $15,150 |
| Other | United Of Omaha Life Insurance Company | Brown & Brown Of Pennsylvania | 104 | $666 4.4% of $15,150 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Aia American Administrators LLC | 30 | $521 10.0% of $5,208 |
| Voluntary Accident Only | United Of Omaha Life Insurance Company | Aia American Administrators LLC | 50 | $913 10.0% of $9,132 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 88 | Comp not disclosed Premium $350,724 |
| Stop-loss | Crum & Forster | — | 71 | Comp not disclosed Premium $71,890 |
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 $84,577
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $46,394 | $446.10 |
| Fnl Insurance Group (Frank N. Lotma | Broker | $17,064 | $164.08 |
| Silberstein Ins. Group (Alera Md) | Broker | $9,120 | $87.69 |
| Innovu | Broker | $3,708 | $35.65 |
| ConnectCare3 | Patient Advocate | $6,159 | $59.22 |
| Revivehealth, Inc. | Admin | $2,132 | $20.50 |