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Employer
884 Marcon Boulevard, Allentown, PA 18019 · EIN 23-2740061 · 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 $4,895
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 24 | Comp not disclosed Premium $81,749 |
| Medical | Equitable Financial Life Insurance Company Of America | Bsi Corporate Benefits, Inc. | 32 | $1,706 15.1% of $11,316 |
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 40 | $1,149 10.0% of $11,490 |
| Vision | Capital Advantage Assurance Company | — | 39 | Comp not disclosed Premium $1,927 |
| Voluntary Accident | Reliance Standard Life Insurance Company | — | 13 | Schedule A not provided |
| Voluntary Accident | Reliance Standard Life Insurance Company | — | 13 | Schedule A not provided |
| Voluntary Critical Illness | Reliance Standard Life Insurance Company | Bsi Corporate Benefits, Inc. | 12 | $897 20.0% of $4,482 |
| Voluntary Critical Illness | Reliance Standard Life Insurance Company | Gis Benefits, Inc | 12 | $284 6.3% of $4,482 |
| Telemedicine | Healthiest You | — | — | Schedule A not provided |
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 $19,543
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $14,910 | $372.75 |
| The Benecon Group | Broker | $8,599 | $214.98 |
| Innovu | Broker | $1,207 | $30.18 |
| Capital Bluecross | Admin | $-5,173 | $-129.33 |