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Employer
839 Sesame Street, Bethlehem, PA 18015 · EIN 23-1642883 · 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 $8,420
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 35 | Comp not disclosed Premium $100,976 |
| Dental + Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 55 | $2,661 9.2% of $28,950 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 42 | $2,811 20.3% of $13,833 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 17 | $293 13.1% of $2,239 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 42 | $1,055 19.2% of $5,495 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 42 | $1,600 20.8% of $7,693 |
| 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 $61,412
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $24,522 | $445.85 |
| The Benecon Group, LLC | Broker | $11,756 | $213.75 |
| Innovu | Broker | $2,036 | $37.02 |
| Capital Bluecross | Admin | $16,825 | $305.91 |
| Hy Holdings Inc | Admin | $6,273 | $114.05 |