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Employer
247 Empire Drive, Mifflintown, PA 17059 · EIN 20-3061216 · Jul 1, 2024 to Jun 30, 2025
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 $23,311
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Reliance Standard Life Insurance Company | — | — | Schedule A not provided |
| Vision | Vision Service Plan | — | — | Schedule A not provided |
| Stop-loss | Optum Health Unimerica Insurance Company | — | 276 | Comp not disclosed Premium $52,282 |
| Vision | Vision Service Plan | Onedigital (Philadelphia) | 247 | $2,950 9.8% of $29,990 |
| Vision | Vision Service Plan | Lockton Companies, LLC | 247 | $-4,500 -15.0% of $29,990 |
| Life | Reliance Standard Life Insurance Company | Onedigital (Philadelphia) | 447 | $7,830 10.0% of $78,296 |
| AD&D | Reliance Standard Life Insurance Company | Onedigital (Philadelphia) | 133 | $243 10.0% of $2,429 |
| Other | Reliance Standard Life Insurance Company | Onedigital (Philadelphia) | 573 | $7,291 10.0% of $72,911 |
| Other | Reliance Standard Life Insurance Company | Onedigital (Philadelphia) | 447 | $6,816 100.0% of $6,816 |
| Voluntary Accident Insurance | Reliance Standard Life Insurance Company | Onedigital (Philadelphia) | 19 | $1,060 25.0% of $4,239 |
| Voluntary Critical Illness | Reliance Standard Life Insurance Company | Kistler Tiffany Benefits Co | 31 | $1,621 25.0% of $6,484 |
| Stop-loss | Optum Health Unimerica Insurance Company | — | — | Comp not disclosed Premium $542 |
| Stop-loss | HM Life Insurance Company | — | 254 | Comp not disclosed Premium $716,770 |
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 $269,028
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Kistler Tiffany Benefits General | Broker | $5,223 | $9.12 |
| Delta Dental Of Pennsylvania | Admin | $28,277 | $49.35 |
| Onedigital Philadelphia | Broker | $9,660 | $35.00 |
| The Benecon Group, LLC | Broker | $3,577 | $12.96 |
| Connectcare 3 | Patient Advocate | $1,242 | $4.50 |
| Capital Blue Cross | Admin | Comp not disclosed | — |
| Kistler Tiffany Benefits General | Broker | $4,937 | $8.62 |
| Delta Dental Of Pennsylvania | Admin | $27,597 | $48.16 |
| Onedigital Philadelphia | Broker | $122,478 | $443.76 |
| The Benecon Group, LLC | Broker | $66,037 | $239.26 |