Employer
Occupational Health Centers Of California, A Medical Corporation
4714 Gettysburg Road, Mechanicsburg, PA 17055 · EIN 77-0469725 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
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Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $113,248
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Reliastar Life Insurance Company | — | 371 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 212 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 205 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 133 | Schedule A not provided |
| Dental | Delta Dental Insurance Company | — | 361 | Comp not disclosed Premium $288,470 |
| Vision | Vision Service Plan | — | 309 | Comp not disclosed Premium $47,218 |
| Life | Metropolitan Life Insurance Company | — | 550 | Schedule A not provided |
Schedule C
Additional compensation
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 $137,973
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark | Claims Administrator | $137,973 | $250.86 |