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Employer
601 Davisville Road, Willow Grove, PA 19090 · EIN 23-2970467 · 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 $9,106
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 60 | Comp not disclosed Premium $292,576 |
| Dental | Delta Dental Of Pennsylvania | Bsi Corporate Benefits, Inc. | 51 | $3,211 10.0% of $32,108 |
| Vision | National Vision Administrators, LLC | Bsi Corporate Benefits, Inc. | 91 | $266 5.0% of $5,316 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 74 | $630 10.6% of $5,933 |
| AD&D | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 12 | $1,477 15.9% of $9,267 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 74 | $2,679 10.6% of $25,314 |
| Vol Ltd | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 9 | $843 13.3% of $6,345 |
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 $74,205
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $39,777 | $437.11 |
| The Benecon Group | Broker | $14,877 | $163.48 |
| Independence Administrators (Ia) | Admin | $8,379 | $92.08 |
| Hy Holdings Inc | Admin | $7,053 | $77.51 |
| ConnectCare3 | Patient Advocate | $4,119 | $45.26 |