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Employer
3480 Grand Avenue, Pittsburgh, PA 15225 · EIN 23-2474017 · Aug 1, 2024 to Jul 31, 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 $65,538
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | — | Comp not disclosed Premium $27,544 |
| Stop-loss | HM Life Insurance Company | — | 137 | Comp not disclosed Premium $459,993 |
| Dental | Highmark Inc | American Insurance Administrators | 367 | $8,325 9.9% of $83,778 |
| Vision | Vision Benefits Of America | Coury Health Services, LLC | 159 | $913 5.4% of $16,927 |
| Life | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury | 248 | $1,286 8.0% of $16,073 |
| Life | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 248 | $1,089 6.8% of $16,073 |
| Life | United Of Omaha Life Insurance Company | American Insurance Administrators | 248 | $819 5.1% of $16,073 |
| Life | United Of Omaha Life Insurance Company | Alera General Agency | 248 | $141 0.9% of $16,073 |
| AD&D | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury | 70 | $10,562 25.0% of $42,248 |
| AD&D | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 70 | $3,062 7.2% of $42,248 |
| AD&D | United Of Omaha Life Insurance Company | American Insurance Administrators | 70 | $2,223 5.3% of $42,248 |
| AD&D | United Of Omaha Life Insurance Company | Alera General Agency | 70 | $326 0.8% of $42,248 |
| Other | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 248 | $3,695 7.4% of $49,761 |
| Other | United Of Omaha Life Insurance Company | American Insurance Administrators | 248 | $2,594 5.2% of $49,761 |
| Other | United Of Omaha Life Insurance Company | Alera General Agency | 248 | $422 0.8% of $49,761 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury | 81 | $7,014 15.0% of $46,762 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 81 | $3,176 6.8% of $46,762 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | American Insurance Administrators | 81 | $2,414 5.2% of $46,762 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | Alera General Agency | 81 | $378 0.8% of $46,762 |
| Critical Illness | United Of Omaha Life Insurance Company | Web Benefits Design Corporation | 74 | $8,136 49.3% of $16,497 |
| Critical Illness | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury | 74 | $2,475 15.0% of $16,497 |
| Critical Illness | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 74 | $1,191 7.2% of $16,497 |
| Critical Illness | United Of Omaha Life Insurance Company | American Insurance Administrators | 74 | $867 5.3% of $16,497 |
| Critical Illness | United Of Omaha Life Insurance Company | Alera General Agency | 74 | $128 0.8% of $16,497 |
| Accident | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury | 93 | $2,269 15.0% of $15,126 |
| Accident | United Of Omaha Life Insurance Company | Alera Group Inc DBA Coury Health Sv | 93 | $1,117 7.4% of $15,126 |
| Accident | United Of Omaha Life Insurance Company | American Insurance Administrators | 93 | $797 5.3% of $15,126 |
| Accident | United Of Omaha Life Insurance Company | Alera General Agency | 93 | $119 0.8% of $15,126 |
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 $102,736
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $30,371 | $82.75 |
| Umr | Admin | $72,365 | $197.18 |