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Employer
350 Poplar Church Road, Camp Hill, PA 17011 · EIN 23-1483991 · 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 $426,236
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Life | First Unum Life Insurance Company | Optavise, LLC | 2 | $26 3.5% of $738 |
| Life | First Unum Life Insurance Company | Usi Insurance Services (Ri) | 2 | $11 1.5% of $738 |
| Life | Provident Life And Accident Insurance Company | Optavise, LLC | 680 | $43,966 17.0% of $258,899 |
| Life | Provident Life And Accident Insurance Company | Usi Insurance Services (Ri) | 680 | $18,211 7.0% of $258,899 |
| Life | Provident Life And Accident Insurance Company | Martin Ray Miracle | 680 | $15,024 5.8% of $258,899 |
| Life | Provident Life And Accident Insurance Company | Cbiz Benefits & Ins. Services | 680 | $269 0.1% of $258,899 |
| Life | Unum Life Insurance Company Of America | Usi Insurance Services (Ri) | 3841 | $58,898 2.2% of $2,719,890 |
| Accidental Death And Dismemberment | National Union Fire Insurance Company Of Pittsburgh, Pa | — | 3884 | Schedule A not provided |
| Employee Assistance Program | Telus Health (Us) Limited | — | 4210 | Comp not disclosed Premium $42,753 |
| Accident, Critical Illness, Hospital | Continental American Insurance Company | Optavise, LLC | 804 | $277,676 27.8% of $1,000,179 |
| Accident, Critical Illness, Hospital | Continental American Insurance Company | Usi Insurance Services Southwest | 804 | $10,901 1.1% of $1,000,179 |
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.
No Schedule C parties in this year.