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Employer
4200 Casteel Drive, Coraopolis, PA 15108 · EIN 25-1437196 · 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 $82,491
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Highmark Inc. | Hapanowicz, Tina C | 415 | $11,465 7.6% of $150,188 |
| Life | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 337 | $4,424 16.8% of $26,388 |
| Life | United Of Omaha Life Insurance Company | National Benefit Center | 337 | $892 3.4% of $26,388 |
| AD&D | United Of Omaha Life Insurance Company | Coury Health Services, LLC | 138 | $8,022 15.0% of $53,483 |
| AD&D | United Of Omaha Life Insurance Company | American Insurance Administrators | 138 | $2,674 5.0% of $53,483 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | Coury Health Services, LLC | 137 | $6,036 15.0% of $40,241 |
| Voluntary Long Term Disability | United Of Omaha Life Insurance Company | American Insurance Administrators | 137 | $2,012 5.0% of $40,241 |
| Voluntary Hospital Indem | United Of Omaha Life Insurance Company | Coury Health Services, LLC | 118 | $6,278 25.0% of $25,113 |
| Voluntary Hospital Indem | United Of Omaha Life Insurance Company | American Insurance Administrators | 118 | $1,256 5.0% of $25,113 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legalshield | Brian Hickman | 5 | $43 4.1% of $1,037 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legalshield | Donald K Ward | 5 | $31 3.0% of $1,037 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc. DBA Legalshield | Donald K Ward | 6 | $37 8.9% of $415 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc. DBA Legalshield | Donald K Ward | 7 | $95 6.0% of $1,581 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc. DBA Legalshield | Ricky Logue | 7 | $38 2.4% of $1,581 |
| Other | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 11 | $584 21.1% of $2,767 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 11 | $138 5.0% of $2,767 |
| Other | United Of Omaha Life Insurance Company | National Benefit Center | 11 | $84 3.0% of $2,767 |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | Coury Health Services, LLC | 168 | $12,063 15.0% of $80,423 |
| Voluntary Short Term Disability | United Of Omaha Life Insurance Company | American Insurance Administrators | 168 | $4,021 5.0% of $80,423 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | Coury Health Services, LLC | 125 | $11,530 25.0% of $46,117 |
| Voluntary Critical Illness | United Of Omaha Life Insurance Company | American Insurance Administrators | 125 | $2,306 5.0% of $46,117 |
| Voluntary Accident Only | United Of Omaha Life Insurance Company | Coury Health Services, LLC | 160 | $7,052 25.0% of $28,207 |
| Voluntary Accident Only | United Of Omaha Life Insurance Company | American Insurance Administrators | 160 | $1,410 5.0% of $28,207 |
| Stop-loss | HM Life Insurance Company | — | 186 | Comp not disclosed Premium $508,228 |
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 $410,339
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Coury Health Services, LLC | Broker | $57,400 | $294.36 |
| The Benecon Group, LLC | Broker | $45,297 | $232.29 |
| Ebms, Inc. | Admin | $295,335 | $1,514.54 |
| Connectcare 3 | Patient Advocate | $12,307 | $63.11 |