Employer
Select Cal Physical Therapy, P.C.
4714 Gettysburg Road, Mechanicsburg, PA 17055 · EIN 87-3156301 · Jan 1, 2024 to Dec 31, 2024
Plan year 2024
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Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
Visible subtotal $24,064
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Reliastar Life Insurance Company | — | 122 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 67 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 73 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 30 | Schedule A not provided |
| Dental | Delta Dental Insurance Company | — | 1 | Comp not disclosed Premium $1,068 |
| Vision | Vision Service Plan | — | 111 | Comp not disclosed Premium $11,524 |
| Life | Metropolitan Life Insurance Company | — | 175 | Comp not disclosed Premium $54,842 |
Schedule C
Additional compensation
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 $18,232
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Highmark | Claims Administrator | $18,232 | $102.43 |