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Employer
40 Rolling Rock Rd., Boyertown, PA 19512 · EIN 23-1940698 · 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 $3,360
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 30 | Comp not disclosed Premium $150,232 |
| Dental | Delta Dental - Sba Pa | Bsi Corporate Benefits, Inc. | 30 | $1,793 10.0% of $17,934 |
| Vision | Capital Advantage Assurance Company | Bsi Corporate Benefits, Inc. | 68 | $118 4.0% of $2,943 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 31 | $285 10.0% of $2,849 |
| Other | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 31 | $1,164 10.0% of $11,637 |
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 $29,417
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits | Broker | $19,102 | $280.91 |
| The Benecon Group, LLC | Broker | $9,304 | $136.82 |
| ConnectCare3 | Patient Advocate | $2,026 | $29.79 |
| Hy Holdings Inc | Admin | $1,969 | $28.96 |
| Innovu | Other | $1,560 | $22.94 |
| Capital Bluecross | Admin | $-4,544 | $-66.82 |