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Employer
2280 Newlins Mill Road, Easton, PA 18045 · EIN 23-2125274 · 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 $14,538
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 91 | Comp not disclosed Premium $654,768 |
| Vision | The Guardian Life Insurance Company Of America | Bsi Corporate Benefits, Inc. | 84 | $39 0.2% of $20,874 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 109 | $1,421 16.8% of $8,450 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 40 | $6,299 33.7% of $18,682 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 109 | $3,925 17.6% of $22,360 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 95 | $2,854 7.8% of $36,500 |
| Telemed | 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 $-8,352
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $57,375 | $365.45 |
| The Benecon Group | Broker | $19,179 | $122.16 |
| Innovu | Broker | $5,130 | $32.68 |
| United Concordia Companies, Inc. | Admin | $7,537 | $48.01 |
| ConnectCare3 | Patient Advocate | $6,662 | $42.43 |
| Capital Bluecross | Admin | $-104,235 | $-663.92 |