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Employer
1977 Oberlin Rd, Harrisburg, PA 17111 · EIN 23-1422644 · Jun 1, 2024 to May 31, 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 $13,941
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | Everest Reinsurance Company | — | — | Comp not disclosed Premium $493 |
| Stop-loss | Avalon Insurance Company | — | 89 | Comp not disclosed Premium $500,481 |
| Dental | United Concordia Insurance Company | — | 195 | Schedule A not provided |
| Vision | National Vision Administrators (Ngl) | Gunn Mowery, LLC | 182 | $445 5.0% of $8,901 |
| Life | Standard Insurance Company | Gunn Mowery, LLC | 98 | $1,280 9.8% of $13,064 |
| Other | Standard Insurance Company | Gunn Mowery, LLC | 63 | $2,777 13.8% of $20,108 |
| Other | Standard Insurance Company | Gunn Mowery, LLC | 98 | $2,074 7.7% of $26,925 |
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.
Visible subtotal $56,785
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Gunn-Mowery, LLC | Broker | $31,500 | $161.54 |
| The Benecon Group, LLC | Broker | $19,441 | $99.70 |
| ConnectCare3 | Patient Advocate | $4,781 | $24.52 |
| Highmark Blue Shield (Central) | Admin | $1,063 | $5.45 |