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Employer
110 Trooper Ct, York, PA 17403 · EIN 46-1126031 · 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 $42,656
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Dental + Vision | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 190 | $3,883 9.3% of $41,859 |
| Dental + Vision | Metropolitan Life Insurance Company | Gis Benefits Inc | 190 | $2,693 6.4% of $41,859 |
| Dental + Vision | Metropolitan Life Insurance Company | Plansource Benefits Administration | 190 | $203 0.5% of $41,859 |
| Dental + Vision | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 190 | $385 0.9% of $41,859 |
| Life | Hartford Life And Accident | Assured Partners (Central Pa) | 239 | $16,974 11.6% of $146,103 |
| Life | Hartford Life And Accident | Assured Partners (Central Pa) | 239 | $8,946 6.1% of $146,103 |
| EAP | Quest Behavioral Health, Inc | — | 329 | Comp not disclosed Premium $2,106 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legal Shield | David Spangler Jr | 20 | $954 24.7% of $3,863 |
| Legal Services Plan Memberships | Pre-Paid Legal Services Inc DBA Legal Shield | Murray Ins. Assoc. Inc | 20 | $752 19.5% of $3,863 |
| Accident | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 81 | $1,417 20.1% of $7,051 |
| Accident | Metropolitan Life Insurance Company | Gis Benefits Inc | 81 | $483 6.9% of $7,051 |
| Accident | Metropolitan Life Insurance Company | Plansource Benefits Administration | 81 | $26 0.4% of $7,051 |
| Accident | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 81 | $69 1.0% of $7,051 |
| Critical Illness | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 59 | $2,394 20.6% of $11,626 |
| Critical Illness | Metropolitan Life Insurance Company | Gis Benefits Inc | 59 | $825 7.1% of $11,626 |
| Critical Illness | Metropolitan Life Insurance Company | Plansource Benefits Administration | 59 | $65 0.6% of $11,626 |
| Critical Illness | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 59 | $118 1.0% of $11,626 |
| Hospital Indemnity | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 44 | $1,742 19.2% of $9,096 |
| Hospital Indemnity | Metropolitan Life Insurance Company | Gis Benefits Inc | 44 | $597 6.6% of $9,096 |
| Hospital Indemnity | Metropolitan Life Insurance Company | Plansource Benefit Admin Inc | 44 | $45 0.5% of $9,096 |
| Hospital Indemnity | Metropolitan Life Insurance Company | Assured Partners (Central Pa) | 44 | $85 0.9% of $9,096 |
| Stop-loss | Optum Health (Unimerica Insurance Company) | — | 105 | Comp not disclosed Premium $316,537 |
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 $71,941
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Assuredpartners (Central Pa) | Stop Loss Broker | $43,791 | $398.10 |
| The Benecon Group, LLC | Stop Loss Broker | $34,368 | $312.44 |
| ConnectCare3 | Patient Advocate | $7,329 | $66.63 |
| Capital Bluecross | Admin | $-13,547 | $-123.15 |