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Employer
649 Penn Avenue, Pittsburgh, PA 15222 · EIN 47-5520828 · Mar 1, 2020 to Feb 28, 2021
Plan year 2020
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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 $7,083
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Options | Csc Ins Professionals Dbs Csc Insur | — | $301 4.5% of $6,724 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 2 | $243 2.9% of $8,503 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 3 | $524 3.1% of $16,998 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | — | $85 3.9% of $2,204 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 13 | $1,161 3.0% of $38,598 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | — | $420 8.3% of $5,039 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | — | $56 4.4% of $1,267 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 4 | $350 3.2% of $11,052 |
| Medical | Principal Life Insurance Company | Csc Insurance Professionals Inc | 31 | $1,939 11.4% of $16,997 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 6 | $367 3.0% of $12,244 |
| Medical | Upmc Health Options | — | — | Comp not disclosed |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | — | $256 2.7% of $9,472 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | — | $166 3.0% of $5,544 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 2 | $243 2.6% of $9,472 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 3 | $171 2.5% of $6,822 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 3 | $333 3.0% of $11,097 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | 5 | $378 2.7% of $14,172 |
| Medical | Upmc Health Options | Csc Ins Professionals DBA Csc Insur | — | $90 3.0% of $3,003 |
| Medical | Upmc Health Options | — | — | Comp not disclosed |
| Medical | Upmc Health Options | — | 5 | Comp not disclosed Premium $3,017 |
| Medical | Upmc Health Options | — | — | Comp not disclosed |
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.