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Employer
3500 High Point Boulevard, Bethlehem, PA 18017 · EIN 23-7402943 · 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 $102,160
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 486 | Comp not disclosed Premium $868,811 |
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 829 | $12,483 |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 667 | $2,151 10.0% of $21,510 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 575 | $13,659 16.4% of $83,237 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 241 | $17,046 16.6% of $102,699 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 13 | $598 15.0% of $3,986 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 575 | $28,079 12.1% of $232,104 |
| Long Term Disability Voluntary | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 248 | $28,144 22.0% of $128,024 |
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 $553,096
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits | Broker | $243,871 | $294.17 |
| The Benecon Group | Broker | $76,423 | $92.19 |
| Innovu | Broker | $24,833 | $29.96 |
| Capital Bluecross | Admin | $184,948 | $223.10 |
| ConnectCare3 | Patient Advocate | $23,021 | $27.77 |