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Employer
101 Poplar St, Scranton, PA 18509 · EIN 23-2153159 · 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 $2,641
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $531 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 16 | Comp not disclosed Premium $66,959 |
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 19 | $748 10.0% of $7,481 |
| Vision | National Vision Administrators Ngl | Bsi Corporate Benefits, Inc. | 23 | $65 5.0% of $1,297 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 22 | $200 17.2% of $1,160 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 4 | $618 23.9% of $2,590 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | — | $163 25.0% of $653 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 17 | $847 16.9% of $5,019 |
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 $17,703
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits | Broker | $6,788 | $295.13 |
| The Benecon Group | Broker | $4,124 | $179.30 |
| Geisinger Health Plan | Admin | $3,568 | $155.13 |
| Hy Holdings, Inc | Admin | $1,650 | $71.74 |
| ConnectCare3 | Patient Advocate | $889 | $38.65 |
| Innovu | Other | $684 | $29.74 |