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Employer
625 Lincoln Ave, North Charleroi, PA 15022 · EIN 25-1570641 · Jul 1, 2024 to Jun 30, 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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health Unimerica Insurance Company | — | — | Comp not disclosed Premium $831 |
| Stop-loss | HM Life Insurance Company | — | 161 | Comp not disclosed Premium $237,665 |
| Dental | Metropolitan Life Insurance Company | — | — | Schedule A not provided |
| Vision | Upmc Benefits | — | — | Schedule A not provided |
| Life | Reliance Standard Life Insurance Company | — | — | Schedule A not provided |
| Other | Reliance Standard Life Insurance Company | — | — | Schedule A not provided |
| Other | Reliance Standard Life Insurance Company | — | — | Schedule A not provided |
| Accident | Reliance Standard Life Insurance Company | — | — | Schedule A not provided |
| Critical Care Illness | Reliance Standard Life Insurance Company | — | — | Comp not disclosed |
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 $219,588
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Henderson Brothers, Inc | Broker | $47,970 | $297.95 |
| The Benecon Group, LLC | Broker | $40,792 | $253.37 |
| Upmc Benefit Management | Admin | $120,456 | $748.17 |
| ConnectCare3 | Patient Advocate | $10,370 | $64.41 |