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Employer
970 East Earl Road, New Holland, PA 17557 · EIN 23-1899085 · Jul 1, 2021 to Jun 30, 2022
Plan year 2021
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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 $5,820
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $30,887 |
| Dental | Starmount Life Insurance Company | Gis Benefits, Inc | 19 | $2,068 13.9% of $14,826 |
| Dental | Starmount Life Insurance Company | Ccab Insurance & Benefits, Inc. | 19 | $1,362 9.2% of $14,826 |
| Vision | Vision Benefits Of America | Ccab Insurance & Benefits, Inc. | 22 | $192 12.0% of $1,601 |
| Life | Unum Life Insurance Company | Gis Benefits, Inc | 25 | $1,277 9.8% of $12,983 |
| Life | Unum Life Insurance Company | Ccab Insurance & Benefits, Inc. | 25 | $921 7.1% of $12,983 |
| Accident, Critical Illness | Unum Life Insurance Company Of America | — | — | Schedule A not provided |
| Accident, Critical Illness | Unum Life Insurance Company Of America | — | — | 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 $5,349
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $2,136 | $79.11 |
| Ccab Insurance & Benefits, Inc | Broker | Comp not disclosed | — |
| Engle Hambright & Davies, Inc. | Broker | Comp not disclosed | — |
| Highmark | Admin | $3,213 | $119.00 |
| Connectcare 3 | Patient Advocate | Comp not disclosed | — |