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Employer
1541 Alta Drive, Suite 202, Whitehall, PA 18052 · EIN 23-3039587 · 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 $10,238
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $2,861 |
| Stop-loss | HM Life Insurance Company | — | 148 | Comp not disclosed Premium $880,152 |
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 276 | $9,573 10.0% of $95,729 |
| Vision | National Vision Administrators (Ngl) | Bsi Corporate Benefits, Inc. | 239 | $665 5.0% of $13,292 |
| Life | Hartford Life & Accident Insurance | — | — | Schedule A not provided |
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 $106,371
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $65,254 | $429.30 |
| The Benecon Group | Broker | $49,414 | $325.09 |
| Innovu | Broker | $7,544 | $49.63 |
| ConnectCare3 | Patient Advocate | $9,978 | $65.64 |
| Hy Holdings Inc | Admin | $9,941 | $65.40 |
| Highmark Blue Shield (Central) | Admin | $-35,760 | $-235.26 |