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Employer
846 Jefferson Ave, Scranton, PA 18510 · EIN 24-0829843 · 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 $48,917
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | Metropolitan Life Insurance Company | One Digital Premier Services LLC | 203 | $613 4.2% of $14,715 |
| Dental | Metropolitan Life Insurance Company | Kistler Tiffany Benefits Co | 203 | $466 3.2% of $14,715 |
| Vision | Highmark, Inc | Onedigital (Philadelphia) | 140 | $42 6.2% of $682 |
| Stop-loss | HM Life Insurance Company | — | 92 | Comp not disclosed Premium $45,230 |
| Stop-loss | HM Life Insurance Company | — | 100 | Comp not disclosed Premium $610,635 |
| Medical | Principal Life Insurance Company | Kistler Tiffany Benefits Co | 192 | $39,771 22.8% of $174,276 |
| Medical | Principal Life Insurance Company | Onedigital Premier Services | 192 | $7,513 4.3% of $174,276 |
| Vision | Highmark, Inc | Joseph Francis Dowd | 153 | $512 6.0% of $8,544 |
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 $46,940
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Cummings Insurance Agency | Broker | $2,760 | $30.00 |
| The Benecon Group | Broker | $1,780 | $19.35 |
| ConnectCare3 | Patient Advocate | $502 | $5.46 |
| Highmark Bcbs Nepa | Admin | $138 | $1.50 |
| Cummings Insurance Agency | Broker | $33,720 | $337.20 |
| The Benecon Group | Broker | $22,398 | $223.98 |
| ConnectCare3 | Patient Advocate | $6,316 | $63.16 |
| Highmark Bcbs Nepa | Admin | $-20,674 | $-206.74 |