| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BSI CORPORATE BENEFITS LLC3 | 79 W. MARKET ST, STE 400 BETHLEHEM, PA 180185749 | DELTA DENTAL OF PENNSYLVANIA | $748 | $0 | $748 | 10.00% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $502 | $345 | $847 | 16.88% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $388 | $230 | $618 | 23.86% |
| BSI CORPORATE BENEFITS LLC3 | 28411 NORTHWESTERN HWY STE 1150 SOUTHFIELD, MI 48034 | NATIONAL VISION ADMINISTRATORS NGL | $65 | $0 | $65 | 5.01% |
| BSI CORPORATE BENEFITS LLC3 | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $116 | $84 | $200 | 17.24% |
| BSI CORPORATE BENEFITS LLC3 Filed as: BSI CORPORATE BENEFITS LLC. | 79 W MARKET ST, STE 400 BETHLEHEM, PA 18018 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $65 | $98 | $163 | 24.96% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BSI CORPORATE BENEFITS EIN 51-0467698 BROKER | Insurance agents and brokers Service code 22 | — | $7K |
| THE BENECON GROUP EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $4K |
| GEISINGER HEALTH PLAN EIN 23-2815174 ADMIN | Claims processing Service code 12 | — | $4K |
| HY HOLDINGS, INC EIN 04-3705970 ADMIN | Claims processing Service code 12 | — | $2K |
| CONNECTCARE3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $889 |
| INNOVU EIN 81-1938789 OTHER | Other services Service code 49 | — | $684 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 22 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 22 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | DELTA DENTAL OF PENNSYLVANIA | 19 | $7K |
| Vision | NATIONAL VISION ADMINISTRATORS NGL | 23 | $1K |
| Life insurance | UNITED OF OMAHA LIFE INSURANCE COMPANY | 22 | $1K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 17 | $5K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 0 | $653 |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | OPTUM HEALTH (UNIMERICA INSURANCE COMPANY) | 16 | $67K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 22 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 23 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.