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Employer
1116 Manheim Pike, Lancaster, PA 17601 · EIN 82-4084247 · Jan 1, 2020 to Dec 31, 2020
Plan year 2020
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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 $12,459
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | 70 | Comp not disclosed Premium $161,000 |
| Dental | Delta Dental Of Pennsylvania | Assured Partners (Central Pa) | 94 | $3,797 10.3% of $36,989 |
| Vision | The Guardian Life Insurance Company Of America | Assured Partners (Central Pa) | 45 | $767 10.0% of $7,673 |
| Vision | The Guardian Life Insurance Company Of America | Liazon Benefits Inc | 45 | $384 5.0% of $7,673 |
| Vision | The Guardian Life Insurance Company Of America | Independence Planning Group LLC | 45 | $8 0.1% of $7,673 |
| Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 89 | $873 12.0% of $7,276 |
| AD&D | Sun Life Assurance Company Of Canada | Liazon Benefits Inc | 12 | $533 10.4% of $5,121 |
| AD&D | Sun Life Assurance Company Of Canada | Assured Partners (Central Pa) | 12 | $262 5.1% of $5,121 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 89 | $2,620 15.0% of $17,467 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 89 | $3,139 12.0% of $26,156 |
| Legal | Metropolitan Property And Casualty Insurance Co. | Liazon Benefits, Inc. | 1 | $76 27.0% of $281 |
| Telemedicine | Teledoc | — | — | 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 $76,086
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Ap Benefit Advisors, LLC | Broker | $31,878 | $315.62 |
| The Benecon Group | Broker | $17,447 | $172.74 |
| Capital Blue Cross | Admin | $22,191 | $219.71 |
| Connectcare 3 | Patient Advocate | $4,570 | $45.25 |