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Employer
2333 Reach Road, Williamsport, PA 17701 · EIN 23-2736400 · Jan 1, 2021 to Dec 31, 2021
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.
Visible subtotal $20,279
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Geisinger Quality Options Inc. | Mercer (Us), Inc. | — | Comp not disclosed Premium $207,428 |
| Medical | Geisinger Health Plan | Mercer (Us), Inc. | — | Comp not disclosed Premium $2,398,070 |
| Dental | United Concordia Insurance Company | — | — | Schedule A not provided |
| Vision | Vsp Vision Care | Roche Financial Inc | — | Comp not disclosed Premium $28,832 |
| Life | Madison National Life Insurance Company | Mercer (Us), Inc. | — | $6,265 2.3% of $270,647 |
| Life | Madison National Life Insurance Company | North American Benefits Company | — | $5,903 2.2% of $270,647 |
| Life | Madison National Life Insurance Company | Roche Financial Inc | — | $3,211 1.2% of $270,647 |
| Cancer | American Fidelity Assurance Company | Roche Financial Inc | — | $2,717 9.1% of $29,962 |
| Other | American Fidelity Assurance Company | Roche Financial Inc | — | $1,539 13.5% of $11,359 |
| Critical Illness | Unum Life Insurance Company Of America | Roche Financial Inc | — | $494 9.8% of $5,034 |
| Critical Illness | Unum Life Insurance Company Of America | Mercer (Us), Inc. | — | $150 3.0% of $5,034 |
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.