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Employer
3400 S Water St, Pittsburgh, PA 15203 · EIN 27-0778265 · Jan 1, 2023 to Dec 31, 2023
Plan year 2023
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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 $101,480
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Benefits | James L. Smith Insurance Agency | 1 | $1 3.7% of $27 |
| Medical | Upmc Health Benefits | Acrisure, LLC DBA Ashton Benefits | 1 | $1 5.3% of $19 |
| Medical | Upmc Health Benefits | James L. Smith Insurance Agency | 1 | Comp not disclosed Premium $19 |
| Medical | Upmc Health Benefits | James L. Smith Insurance Agency | 139 | $115 3.9% of $2,942 |
| Medical | Upmc Health Benefits | Acrisure, LLC DBA Ashton Benefits | 133 | $89 4.1% of $2,195 |
| Medical | Upmc Health Benefits | James L. Smith Insurance Agency | 133 | Comp not disclosed Premium $2,195 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 262 | $18,939 2.0% of $948,592 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 262 | $15,271 2.0% of $763,556 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 262 | $2,682 0.4% of $763,556 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 48 | $2,373 1.4% of $169,629 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 51 | $2,009 1.4% of $139,412 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 51 | $943 0.7% of $139,412 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 8 | $400 1.9% of $20,854 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 10 | $491 2.0% of $24,544 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 10 | $69 0.3% of $24,544 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 2 | $87 1.4% of $6,058 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 3 | $176 6.5% of $2,708 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 3 | $35 1.3% of $2,708 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 3 | $255 2.0% of $12,728 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 3 | $204 2.0% of $10,181 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 3 | $36 0.4% of $10,181 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 3 | $4 4.5% of $88 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 3 | Comp not disclosed Premium $63 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 3 | $3 4.8% of $63 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 262 | $236 4.0% of $5,913 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 263 | $173 4.0% of $4,302 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 263 | Comp not disclosed Premium $4,302 |
| Medical | Upmc Health Benefits | James L. Smith Insurance Agency | 55 | $50 3.5% of $1,431 |
| Medical | Upmc Health Benefits | Acrisure, LLC DBA Ashton Benefits | 58 | $37 4.0% of $927 |
| Medical | Upmc Health Benefits | James L. Smith Insurance Agency | 58 | Comp not disclosed Premium $927 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 138 | $9,435 1.9% of $491,017 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 132 | $8,148 2.0% of $407,378 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 132 | $1,696 0.4% of $407,378 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 1 | $97 2.0% of $4,841 |
| Medical | Upmc Health Options | Acrisure, LLC DBA Ashton Benefits | 1 | $98 2.5% of $3,873 |
| Medical | Upmc Health Options | James L. Smith Insurance Agency | 1 | $14 0.4% of $3,873 |
| Dental | Delta Dental | — | 630 | Comp not disclosed Premium $210,700 |
| Life | United Of Omaha Life Insurance Company | Acrisure, LLC DBA Ashton Benefits | 209 | $2,689 2.7% of $99,970 |
| Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 209 | $8,320 8.3% of $99,970 |
| Life | United Of Omaha Life Insurance Company | Acrisure, LLC DBA Ashton Benefits | 189 | $1,797 2.3% of $77,413 |
| Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 189 | $7,627 9.9% of $77,413 |
| Life | United Of Omaha Life Insurance Company | Acrisure, LLC DBA Ashton Benefits | 51 | $1,755 6.6% of $26,730 |
| Life | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 51 | $3,856 14.4% of $26,730 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | Acrisure, LLC DBA Ashton Benefits | 62 | $3,270 6.2% of $52,385 |
| Short Term Disability Voluntary | United Of Omaha Life Insurance Company | The Hdh Group, Inc. | 62 | $7,999 15.3% of $52,385 |
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.
No Schedule C parties in this year.