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Employer
800 Wayne Ave, Chambersburg, PA 17201 · EIN 25-1150379 · 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 $19,563
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health Unimerica Insurance Company | — | 139 | Comp not disclosed Premium $610,695 |
| Dental | The Guardian Life Insurance Company Of America | Onedigital (Philadelphia) | 200 | $2,050 11.9% of $17,181 |
| Dental | The Guardian Life Insurance Company Of America | Onedigital Premier Services LLC | 200 | $859 5.0% of $17,181 |
| Vision | Fidelity Security Life Insurance Company | — | 305 | Comp not disclosed Premium $8,715 |
| Life | United Of Omaha Life Insurance Company | Onedigital (Philadelphia) | 202 | $6,316 12.8% of $49,284 |
| Life | United Of Omaha Life Insurance Company | Onedigital Premier Services LLC | 202 | $2,464 5.0% of $49,284 |
| Other | United Of Omaha Life Insurance Company | Onedigital (Philadelphia) | 197 | $5,883 14.8% of $39,823 |
| Other | United Of Omaha Life Insurance Company | Onedigital Premier Services LLC | 197 | $1,991 5.0% of $39,823 |
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 $51,071
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Onedigital (Philadelphia) | Broker | $45,058 | $306.52 |
| The Benecon Group, LLC | Broker | $28,092 | $191.10 |
| Connectcare 3 | Patient Advocate | $9,740 | $66.26 |
| Capital Bluecross | Admin | $-31,819 | $-216.46 |