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Employer
200 East Hersheypark Drive, Hershey, PA 17033 · EIN 25-1783853 · Jan 1, 2025 to Dec 31, 2025
Plan year 2025
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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 $17,902
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 95 | Comp not disclosed Premium $262,167 |
| Dental | United Concordia Life And Health Insurance Company | — | 60 | Schedule A not provided |
| Dental | United Concordia Life And Health Insurance Company | — | 554 | Schedule A not provided |
| Vision | National Vision Administrators, LLC | Pci Insurance Agency | 113 | $828 8.5% of $9,747 |
| Life | The Guardian Life Insurance Company | Pci Insurance Agency | 114 | $10,149 30.1% of $33,666 |
| Telehealth | Allyhealth LLC | Gallagher Fiduciary Advisors, LLC | 12 | $546 20.0% of $2,728 |
| EAP | Guardian Life | — | 219 | Schedule A not provided |
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 $78,369
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Benecon Group, LLC | Broker | $60,283 | $591.01 |
| Pci (Pa Chamber Insurance) | Broker | $37,800 | $370.59 |
| Gallagher Sepa | Broker | $3,420 | $33.53 |
| Capital Bluecross | Admin | $-23,134 | $-226.80 |