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Employer
1007 East Spring Street, Titusville, PA 16354 · EIN 13-3550228 · 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 $136,933
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Medical | Aetna Life Insurance Company | Total Benefits Solutions LLC | 31 | $31,590 2.7% of $1,184,407 |
| Medical | Kaiser Foundation Health Plan Inc | Nfp Corporate Services (Ny) LLC | 50 | $32,447 5.4% of $601,782 |
| Medical | Selecthealth | Nfp Coporate Services Ny LLC | 261 | $38,216 2.7% of $1,412,594 |
| Medical | Blue Cross & Blue Shield Of Mississipppi | — | 55 | Comp not disclosed Premium $186,553 |
| Vision | Vision Service Plan | — | 356 | Comp not disclosed Premium $40,164 |
| Life | Sunlife Assurance Company Of Canada | Nfp Corporate Services (Ny) LLC | 394 | $33,075 8.2% of $403,085 |
| Life | Sunlife Assurance Company Of Canada | Nfp Insurance Services Inc | 394 | $420 0.1% of $403,085 |
| Other | Provident Life And Accident Insurance Company | Nfp Corporate Services (Ny) LLC | 1 | $261 17.3% of $1,507 |
| Other | Provident Life And Accident Insurance Company | Nfp Insurance Services Inc | 1 | $30 2.0% of $1,507 |
| Other | Provident Life And Accident Insurance Company | Nfp Corporate Services (Ny) LLC | 3 | $539 17.4% of $3,094 |
| Other | Provident Life And Accident Insurance Company | Nfp Insurance Services Inc | 3 | $62 2.0% of $3,094 |
| EAP | Great American Assurance Company | — | 88 | Comp not disclosed Premium $5,185 |
| EAP | Telus Health (Us) Ltd | — | — | Schedule A not provided |
| Mba Coverage | Cigna Health And Life Insurance Company | Nfp Corporate Services (Ny) LLC | 1 | $293 10.0% of $2,925 |
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.