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Employer
227 Daylesford Court, Kennett Square, PA 19348 · EIN 51-0120719 · 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 $234,913
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Berkley Life And Health Insurance Company | Brokerage Concepts, Inc. | 290 | $113,094 |
| Medical | United Healthcare Insurance Company | Lyons Insurance Agency | 397 | $3,510 10.0% of $35,100 |
| Dental | Standard Insurance Company | One Digital Premier Services | 274 | $5,804 3.0% of $193,477 |
| Dental | Standard Insurance Company | Lyons Insurance Agency Inc | 274 | $4,940 2.6% of $193,477 |
| Vision | Standard Insurance Company | Lyons Insurance Agency | 245 | $2,768 8.6% of $32,147 |
| Life | Standard Insurance Company | Lyons Insurance Agency Inc | 422 | $18,156 12.2% of $148,814 |
| Life | Standard Insurance Company | Kistler Tiffany Benefits Co | 422 | $7,441 5.0% of $148,814 |
| Other | Standard Insurance Company | Lyons Insurance Agency Inc | 467 | $46,051 12.3% of $375,833 |
| Other | Standard Insurance Company | Kistler Tiffany Benefits Co | 467 | $18,792 5.0% of $375,833 |
| Other | Standard Insurance Company | Lyons Insurance Agency Inc | 187 | $10,180 12.2% of $83,539 |
| Other | Standard Insurance Company | Kistler Tiffany Benefits Co | 187 | $4,177 5.0% of $83,539 |
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 $18,132
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| True Rx Management Services, Inc. | Pbm | $18,132 | $38.83 |