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Employer
35 North 35th Street, Camp Hill, PA 17011 · EIN 23-1575558 · 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 $8,908
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 53 | Comp not disclosed Premium $313,790 |
| Dental | Highmark, Inc. | Brown & Brown Of Pennsylvania | 110 | $4,430 20.2% of $21,912 |
| Vision | National Vision Administrators, LLC | — | — | Schedule A not provided |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Life | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Other | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Voluntary Std | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Voluntary Std | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Accident, Voluntary Accident | Life Insurance Company Of North America | — | — | Schedule A not provided |
| Accident, Voluntary Accident | Life Insurance Company Of North America | — | — | 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 $28,529
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Brown & Brown (Pa) | Broker | $22,860 | $207.82 |
| The Benecon Group | Broker | $12,654 | $115.04 |
| ConnectCare3 | Patient Advocate | $3,568 | $32.44 |
| Capital Bluecross | Admin | $-10,553 | $-95.94 |