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Employer
Po Box 803, Bloomsburg, PA 17815 · EIN 23-2549609 · 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 $43,225
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $5,189 |
| Stop-loss | HM Life Insurance Company | — | 252 | Comp not disclosed Premium $790,592 |
| Dental + Vision | Highmark, Inc. | Dare, Anthony J | 329 | $6,328 7.9% of $80,108 |
| Dental + Vision | Highmark, Inc. | The Benecon Group, Inc. | 329 | $1,582 2.0% of $80,108 |
| Life | United Of Omaha Life Insurance Company | Bsi Corporate Benefits, Inc. | 418 | $2,609 14.8% of $17,649 |
| Life | Trustmark Insurance Company | Benechoice Enrollment Solutions | 74 | $7,905 21.1% of $37,462 |
| Life | Trustmark Insurance Company | Brown & Brown Of Pennsylvania | 74 | $6,542 17.5% of $37,462 |
| Critical Illness | Trustmark Insurance Company | Benechoice Enrollment Solutions | 24 | $1,860 20.9% of $8,916 |
| Critical Illness | Trustmark Insurance Company | Brown & Brown Of Pennsylvania | 24 | $1,659 18.6% of $8,916 |
| Critical Illness | Trustmark Insurance Company | Bsi Corporate Benefits, Inc. | 24 | $156 1.7% of $8,916 |
| Voluntary Group Accident | Trustmark Insurance Company | Bsi Corporate Benefits, Inc. | 100 | $2,483 22.3% of $11,134 |
| Voluntary Group Accident | Trustmark Insurance Company | Benechoice Enrollment Solutions | 100 | $781 7.0% of $11,134 |
| Voluntary Group Accident | Trustmark Insurance Company | Brown & Brown Of Pennsylvania | 100 | $521 4.7% of $11,134 |
| Other | Trustmark Insurance Company | Benechoice Enrollment Solutions | 70 | $5,537 12.4% of $44,708 |
| Other | Trustmark Insurance Company | Brown & Brown Of Pennsylvania | 70 | $4,859 10.9% of $44,708 |
| Other | Trustmark Insurance Company | Bsi Corporate Benefits, Inc. | 70 | $403 0.9% of $44,708 |
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 $169,043
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Bsi Corporate Benefits, LLC | Broker | $152,177 | $603.88 |
| The Benecon Group LLC | Broker | $46,460 | $184.37 |
| Innovu | Broker | $12,644 | $50.17 |
| ConnectCare3 | Patient Advocate | $16,091 | $63.85 |
| Highmark Blue Shield (Central) | Admin | $-58,329 | $-231.46 |