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Employer
600 W. Germantown Pike, Plymouth Meeting, PA 19462 · EIN 20-3774139 · 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 $5,118
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $1,547 |
| Stop-loss | HM Life Insurance Company | — | 23 | Comp not disclosed Premium $92,360 |
| Medical | Principal Life Insurance Company | Bsi Corporate Benefits, Inc. | 39 | $2,275 15.0% of $15,166 |
| Vision | Capital Advantage Assurance Company | — | — | Schedule A not provided |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | — | $788 16.7% of $4,710 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | — | $502 20.7% of $2,424 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | — | $1,498 16.4% of $9,160 |
| EAP | 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 $22,917
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $17,062 | $437.49 |
| The Benecon Group | Broker | $7,196 | $184.51 |
| ConnectCare3 | Patient Advocate | $1,567 | $40.18 |
| Innovu | Other | $1,152 | $29.54 |
| Capital Bluecross | Admin | $-4,060 | $-104.10 |