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Employer
2042-48 Arch Street, Philadelphia, PA 19103 · EIN 45-5470563 · 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 $14,836
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 142 | Comp not disclosed Premium $529,775 |
| Vision | Eyemed Vision Care | — | 183 | Comp not disclosed Premium $11,594 |
| Life | Prudential Insurance Company Of America | Patriot (Exude, Inc.) | 186 | $9,819 27.3% of $35,938 |
| AD&D | Prudential Insurance Company Of America | Patriot (Exude, Inc.) | 186 | $4,976 86.1% of $5,776 |
| Other | Prudential Insurance Company Of America | Img | 164 | $41 0.1% of $27,980 |
| Other | Prudential Insurance Company Of America | — | 164 | Comp not disclosed Premium $50,709 |
| EAP | Main Line Health | — | 100 | Comp not disclosed Premium $2,100 |
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 $216,365
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $57,305 | $303.20 |
| Patriot (Exude, Inc.) | Broker | $56,508 | $298.98 |
| Meritain Health, An Aetna Company | Admin | $73,875 | $390.87 |
| United Concordia Companies, Inc. | Admin | $16,610 | $87.88 |
| ConnectCare3 | Patient Advocate | $9,451 | $50.01 |
| Compsych | Admin | $2,616 | $13.84 |