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Employer
4714 Gettysburg Road, Mechanicsburg, PA 17055 · EIN 23-2872718 · 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 $2,931,072
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Metropolitan Life Insurance Company | — | 11219 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 11219 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 11776 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 11776 | Schedule A not provided |
| Medical | University Health Alliance | Atlas Insurance Agency, Inc. | 8 | $4,285 5.0% of $85,697 |
| Medical | Metropolitan Life Insurance Company | — | 5966 | Schedule A not provided |
| Medical | Metropolitan Life Insurance Company | — | 5966 | Schedule A not provided |
| Medical | Upmc Health Options | — | 14 | Comp not disclosed Premium $145,002 |
| Medical | Upmc Health Options | — | 30 | Comp not disclosed Premium $332,570 |
| Dental | Delta Dental Of Pennsylvania | — | 25883 | Comp not disclosed Premium $14,801,093 |
| Dental | Hawaii Dental Services | Atlas Insurance Agency, Inc. | 5 | $99 3.0% of $3,286 |
| Dental | Hawaii Dental Services | Atlas Insurance Agency, Inc. | 4 | $105 3.1% of $3,379 |
| Vision | Vision Service Plan | — | 22747 | Comp not disclosed Premium $3,229,727 |
| Life | Metropolitan Life Insurance Company | Marsh & Mclennan Agency, LLC East | 6450 | $100 0.0% of $1,161,305 |
| Life | Metropolitan Life Insurance Company | Marsh & Mclennan Agency, LLC East | 41261 | $1,010,508 5.1% of $19,928,676 |
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 $12,262,132
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Providence Risk & Insurance Svcs | None | $113,356 | $21.74 |
| Highmark | Claims Administrator | $8,908,036 | $215.89 |
| Express Scripts, Inc. | Claims Administrator | $3,240,740 | $78.54 |