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Employer
Po Box 50, Dillsburg, PA 17019 · EIN 23-1688154 · 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 $21,019
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | United Concordia Insurance Company | Assured Partners (Central Pa) | 96 | $5,217 10.0% of $52,032 |
| Vision | Shelterpoint Insurance Company | Assured Partners (Central Pa) | 101 | $717 12.0% of $5,978 |
| Life | Reliance Standard Life Insurance Company | Assured Partners (Central Pa) | 44 | $2,087 18.0% of $11,591 |
| Other | Reliance Standard Life Insurance Company | Assured Partners (Central Pa) | 57 | $6,753 23.0% of $29,360 |
| Other | Reliance Standard Life Insurance Company | Assured Partners (Central Pa) | 63 | $6,245 23.0% of $27,151 |
| Organ Transplant | United Healthcare Insurance Company | — | 116 | Comp not disclosed Premium $7,748 |
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 $137,031
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Ap Benefit Advisors LLC | Broker | $25,605 | $99.63 |
| Luminare Health Benefits Inc. | Medical Tpa | $63,169 | $245.79 |
| Highmark Inc. | Tpa | $21,907 | $85.24 |
| Ap Benefit Advisors, LLC | Consulting Fees | $12,000 | $46.69 |
| Multiplan Inc. | Tpa | $8,104 | $31.53 |
| Bhs | Eap Fees | $6,246 | $24.30 |