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Employer
123 East Lancaster Avenue, Ardmore, PA 19003 · EIN 23-2655466 · Jul 1, 2024 to Jun 30, 2025
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 $74,081
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $1,717 |
| Stop-loss | Fair American Insurance And Reinsurance Company | — | 190 | Comp not disclosed Premium $618,834 |
| Dental | Starmount Life Insurance Company | Kistler Tiffany Benefits Co | 227 | $14,890 9.7% of $153,617 |
| Dental | Starmount Life Insurance Company | Onedigital Premier Services LLC | 227 | $11,445 7.5% of $153,617 |
| Vision | National Vision Administrators, LLC | Kristler Tiffany Benefits General | 347 | $1,521 10.0% of $15,209 |
| Life | Unum Life Insurance Company Of America | Kistler Tiffany Benefits Co | 331 | $6,323 7.4% of $85,014 |
| Life | Unum Life Insurance Company Of America | Onedigital Premier Services | 331 | $4,150 4.9% of $85,014 |
| AD&D | Unum Life Insurance Company Of America | Kistler Tiffany Benefits Co | 135 | $11,614 16.4% of $70,653 |
| AD&D | Unum Life Insurance Company Of America | Onedigital Premier Services | 135 | $3,416 4.8% of $70,653 |
| Other | Unum Life Insurance Company Of America | Kistler Tiffany Benefits Co | 95 | $8,514 16.4% of $51,969 |
| Other | Unum Life Insurance Company Of America | Onedigital Premier Services | 95 | $2,504 4.8% of $51,969 |
| Grp Accident | Unum Insurance Company | Kistler Tiffany Benefits Co | 142 | $3,661 15.1% of $24,262 |
| Critical Illness | Unum Insurance Company | Kistler Tiffany Benefits Co | 87 | $6,043 16.5% of $36,599 |
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 $276,041
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Onedigital (Philadelphia) | Broker | $97,342 | $512.33 |
| The Benecon Group, LLC | Broker | $35,860 | $188.74 |
| Meritain Health, An Aetna Company | Admin | $130,406 | $686.35 |
| ConnectCare3 | Patient Advocate | $12,433 | $65.44 |