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Employer
1901 Market St., Philadelphia, PA 19103 · EIN 46-3867722 · 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 $487,785
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Ah Hmo, Inc., Pa Early Ret | — | 26 | Comp not disclosed Premium $53,249 |
| Medical | Independence Blue Cross Early Ret Vision | — | 247 | Comp not disclosed Premium $13,638 |
| Medical | Highmark Blue Shield | — | 696 | Comp not disclosed Premium $884,048 |
| Medical | Independence Blue Cross Early Retiree Drug | — | 247 | Comp not disclosed Premium $977,582 |
| Medical | Independence Blue Cross Retiree Vision | — | 173 | Comp not disclosed Premium $7,313 |
| Medical | Independence Blue Cross Retiree Rx | — | 173 | Comp not disclosed Premium $4,213,511 |
| Medical | Keystone Health Plan East Keystone 65 | — | 90 | Comp not disclosed Premium $740,706 |
| Medical | Keystone Health Plan East Early Retiree | — | 118 | Comp not disclosed Premium $663,250 |
| Medical | Personal Choice 65 | — | 71 | Comp not disclosed Premium $712,336 |
| Medical | Personal Choice Pre 65 | — | 129 | Comp not disclosed Premium $1,723,336 |
| Medical | Independence Blue Cross Retiree Medical | — | 698 | Comp not disclosed Premium $744,772 |
| Life | Dearborn National Life Insurance Co. | — | 2221 | Comp not disclosed Premium $36,224 |
| Medical | Magellan Eap Program | — | 4247 | Comp not disclosed Premium $201,994 |
| Medical | Keystone Health Plan East | — | 2354 | Comp not disclosed Premium $16,818,374 |
| Medical | Ibc Personal Choice | — | 5046 | Comp not disclosed Premium $33,084,351 |
| Medical | Ibc Rx Grps | — | 6137 | Comp not disclosed Premium $14,813,444 |
| Medical | Ah Hmo, Inc. - Pa | — | 99 | Comp not disclosed Premium $1,170,628 |
| Vision | Ibc Vision | — | 7556 | Comp not disclosed Premium $390,213 |
| Life | Dearborn National Life Insurance Co. | Bgrand Benefits LLC | 4217 | $109,748 4.5% of $2,435,367 |
| Business Travel Accident | National Union Fire Insurance Co. Of Pittsburgh, Pa | Mercer (Us), Inc. | 4500 | $3,143 30.0% of $10,478 |
| Other | Guardian | James Nelligan & Associates | 973 | $244,050 29.2% of $835,839 |
| Other | Guardian | Sterling Benefits, LLC | 973 | Comp not disclosed Premium $835,839 |
| Other | Unum Life Insurance Company Of America | Sagewell Partners Inc. | 4107 | $93,460 4.3% of $2,188,598 |
| Other | Unum Life Insurance Company Of America | Unmapped | 4107 | $37,384 1.7% of $2,188,598 |
| Medical | Triple-S Salud, Inc. | — | 148 | Comp not disclosed |
| Life | Fort Dearborn Life Insurance Company | — | 165 | Comp not disclosed |
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.