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Employer
777 Water Wheel Dr, Champion, PA 15622 · EIN 25-1075087 · Jul 1, 2021 to Jun 30, 2022
Plan year 2021
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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.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Upmc Health Plan | — | 3 | Comp not disclosed Premium $50,011 |
| Medical | Upmc Health Plan | — | — | Comp not disclosed Premium $10,691 |
| Medical | Upmc Health Plan | — | 2 | Comp not disclosed Premium $79,100 |
| Medical | Upmc Health Plan | — | 9 | Comp not disclosed Premium $277,785 |
| Medical | Upmc Health Plan | — | 24 | Comp not disclosed Premium $926,966 |
| Medical | Upmc Health Plan | — | — | Comp not disclosed Premium $892 |
| Medical | Upmc Health Plan | — | 3 | Comp not disclosed Premium $28,793 |
| Dental | Metropolitan Life Insurance Company | — | 64 | Comp not disclosed Premium $74,447 |
| Vision | Highmark Inc. | — | 38 | Comp not disclosed Premium $16,163 |
| Vision | Upmc Health Plan | — | 38 | Comp not disclosed Premium $2,116 |
| Vision | Upmc Health Plan | — | 3 | Comp not disclosed Premium $74 |
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.