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Employer
22 S Commerce Way Ste 7, Bethlehem, PA 18017 · EIN 01-0598581 · Jul 1, 2024 to Jun 30, 2025
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 $11,295
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 41 | Comp not disclosed Premium $25,077 |
| Dental + Vision | Principal Life Insurance Company | — | — | Schedule A not provided |
| Critical Care, Accident | Federal Insurance Company (Chubb) | — | — | Schedule A not provided |
| Pre-Paid Legal | Metlife Legal | — | — | Schedule A not provided |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $749 |
| Stop-loss | HM Life Insurance Company | — | 43 | Comp not disclosed Premium $330,305 |
| Medical | Principal Life Insurance Company | Bsi Corporate Benefits, Inc. | 114 | $3,296 6.3% of $51,924 |
| Medical | Principal Life Insurance Company | Emerson Rogers LLC | 114 | $2,515 4.8% of $51,924 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 30 | $1,550 21.4% of $7,257 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 14 | $1,333 24.0% of $5,560 |
| Critical Care, Accident | Combined Insurance Company Of America | Gis Benefits Inc | 10 | $72 3.0% of $2,417 |
| Pre-Paid Legal | Metlife Legal | — | — | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 30 | $292 100.0% of $292 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 26 | $2,237 12.2% of $18,347 |
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 $32,102
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $1,732 | $39.36 |
| The Benecon Group | Broker | $1,137 | $25.84 |
| Innovu | Broker | $164 | $3.73 |
| ConnectCare3 | Patient Advocate | $224 | $5.09 |
| Bsi Corporate Benefits, LLC | Broker | $23,667 | $207.61 |
| The Benecon Group | Broker | $15,798 | $138.58 |
| Innovu | Broker | $2,180 | $19.12 |
| Capital Bluecross | Admin. | $-12,800 | $-112.28 |