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Employer
417 Walnut Street, Harrisburg, PA 17101 · EIN 25-1784573 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $13,292
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 46 | Comp not disclosed Premium $320,003 |
| Dental | United Concordia Life And Health Insurance Company | — | 16 | Schedule A not provided |
| Dental | United Concordia Life And Health | — | 50 | Schedule A not provided |
| Vision | National Vision Administrators | — | 37 | Schedule A not provided |
| Life | The Guardian Life Insurance Company | Pci Insurance Agency | 50 | $1,650 39.5% of $4,176 |
| Life | Metlife | Pci Insurance Agency | 72 | $1,945 13.7% of $14,218 |
| Life | Metlife | Gis Benefits Inc | 72 | $908 6.4% of $14,218 |
| Other | Unum Life Insurance Company Of America | Pci Insurance Agency | 41 | $5,580 13.0% of $42,849 |
| EAP | Quest Behavioral Health, Inc. | — | 112 | Schedule A not provided |
| Legal | Metlife | Pci Insurance Agency | 47 | $170 15.5% of $1,098 |
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 $78,069
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group | Broker | $54,710 | $488.48 |
| Pci (Pa Chamber Insurance) | Broker | $15,675 | $139.96 |
| Highmark Blue Shield (Central) | Admin | $6,423 | $57.35 |
| Highmark West | Admin | $1,261 | $11.26 |