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Employer
150 Monument Road, Bala Cynwyd, PA 19004 · EIN 13-5459480 · 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 $146,456
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Independence Blue Cross | — | 30 | Schedule A not provided |
| Medical | Independence Blue Cross | — | 30 | Schedule A not provided |
| Medical | Amerihealth Insurance Company | — | 1 | Schedule A not provided |
| Medical | Amerihealth Insurance Company | — | 1 | Schedule A not provided |
| Dental | Keystone | — | 255 | Schedule A not provided |
| Dental | Keystone | — | 255 | Schedule A not provided |
| Dental | The Guardian Life Insurance Company Of America | Lockton Companies, LLC | 165 | $10,654 8.9% of $119,810 |
| Dental | The Guardian Life Insurance Company Of America | Amerihealth Administrators, Inc. | 165 | $312 0.3% of $119,810 |
| Life | Prudential Insurance Company Of America | Lockton Companies, LLC | 291 | $36,662 16.0% of $229,252 |
| Life | Prudential Insurance Company Of America | Img | 291 | $56 0.0% of $229,252 |
| Vision | National Vision Administrators, LLC | Lockton Companies, LLC | 132 | $823 10.0% of $8,227 |
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.