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Employer
800 Waterfront Drive, Pittsburgh, PA 15222 · EIN 25-1053485 · 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 $32,810
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental | The Guardian Life Insurance Company | Dmc Benefits Inc | 173 | $4,234 5.0% of $84,675 |
| Dental | The Guardian Life Insurance Company | The Dbj Group Inc | 173 | $3,202 3.8% of $84,675 |
| Vision | Vision Benefits Of America | The Dbj Group Inc | 175 | $975 5.2% of $18,700 |
| Life | Hartford Life And Accident | The Dbj Group Inc | 180 | $517 5.2% of $9,928 |
| Life | Hartford Life And Accident | High Street Insurance Partners, Inc | 180 | $513 5.2% of $9,928 |
| Life | United Of Omaha Life Insurance Company | The Dbj Group Inc | 186 | $3,365 9.0% of $37,305 |
| Life | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 186 | $2,611 7.0% of $37,305 |
| AD&D | United Of Omaha Life Insurance Company | The Dbj Group Inc | 62 | $2,799 15.0% of $18,660 |
| AD&D | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 62 | $1,306 7.0% of $18,660 |
| EAP | Life Solutions | — | — | Schedule A not provided |
| Other | United Of Omaha Life Insurance Company | The Dbj Group Inc | 186 | $4,024 9.9% of $40,484 |
| Other | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 186 | $2,834 7.0% of $40,484 |
| Other | United Of Omaha Life Insurance Company | The Dbj Group Inc | 186 | $3,554 8.7% of $41,078 |
| Other | United Of Omaha Life Insurance Company | Dmc Benefits Inc | 186 | $2,876 7.0% of $41,078 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 171 | Comp not disclosed Premium $482,444 |
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 $70,402
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| The Djb Group | Broker | $65,056 | $376.05 |
| The Benecon Group | Broker | $32,955 | $190.49 |
| ConnectCare3 | Patient Advocate | $11,425 | $66.04 |
| Upmc Benefit Management Services | Admin | $-39,034 | $-225.63 |