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Employer
311 West Stiegel Street, Manheim, PA 17545 · EIN 36-2646332 · 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 $220,195
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Highmark Inc. | Assured Partners (Central Pa) | 310 | $133,575 4.0% of $3,335,510 |
| Vision | Eyemed Vision Care | Assured Partners (Central Pa) | 520 | $2,496 9.9% of $25,327 |
| Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 359 | $6,217 10.0% of $62,172 |
| Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 359 | $5,724 9.2% of $62,172 |
| AD&D | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 273 | $484 10.0% of $4,836 |
| AD&D | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 273 | $304 6.3% of $4,836 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 324 | $7,245 10.0% of $72,450 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 324 | $6,321 8.7% of $72,450 |
| Ny Disability, Ny Family Leave | Lincoln Life And Annuity Company Of New York | Assured Partners (Central Pa) | 2 | $66 14.9% of $442 |
| Ny Disability, Ny Family Leave | Lincoln Life And Annuity Company Of New York | Assured Partners (Central Pa) | 2 | $5 1.1% of $442 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 323 | $20,031 19.4% of $103,384 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 323 | $10,338 10.0% of $103,384 |
| Other | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 323 | $9,693 9.4% of $103,384 |
| Vol Life, Vol Child Life, Vol Spouse Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 273 | $8,848 17.3% of $51,001 |
| Vol Life, Vol Child Life, Vol Spouse Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 273 | $5,100 10.0% of $51,001 |
| Vol Life, Vol Child Life, Vol Spouse Life | The Lincoln National Life Insurance Company | Assured Partners (Central Pa) | 273 | $3,748 7.3% of $51,001 |
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 $19,200
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Cigna Behavioral Health, Inc. | Eap Admin | $9,600 | $18.46 |
| Cigna Behavioral Health, Inc. | Eap Admin | $9,600 | $18.46 |