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Employer
5 Hot Metal Street, Pittsburgh, PA 15203 · EIN 51-0168650 · Apr 1, 2020 to Mar 31, 2021
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 $444,211
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Berkley Life And Health Insurance Company | — | 830 | Comp not disclosed Premium $499,161 |
| Medical | United Health Care (Labor First) | — | 268 | Comp not disclosed Premium $887,803 |
| Other | Community Insurance Company (Anthem) | Anthem Blue Cross And Blue Shield | 562 | $378,601 |
| Death | Hartford Life And Accident Insurance Company | — | 830 | Comp not disclosed Premium $51,961 |
| Other | Delta Dental Of West Virginia | Delta Dental | 830 | $14,169 |
| Other | Envision Insurance Company | Envision Insurance Company | 830 | $334 |
| Other | Empirx (Benecard) | Empirx Health | 830 | $51,107 |
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 $142,477
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Paydhealth | Medical Claims Admin | $121,108 | $141.81 |
| Cds Administrators, Inc. | Other Services (Postage) | $11,369 | $13.31 |
| Segal Advisors | Investment Advisor | $10,000 | $11.71 |
| Cds Administrators, Inc. | Plan Administrator | Comp not disclosed | — |
| Buck Consulting | Actuary | Comp not disclosed | — |
| Kozicki Hughes Tickerhoof Pllc | Auditor | Comp not disclosed | — |
| Macala & Piatt | Attorney | Comp not disclosed | — |
| Baird | Investment Manager | Comp not disclosed | — |
| Ruble Insurance Agency | Insurance Agent | Comp not disclosed | — |
| Wex Health | Medical Claims Admin | Comp not disclosed | — |