No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| EMPIRE BLUECROSS BLUESHIELD EIN 23-7391136 PPO PROVIDER | Contract Administrator Service code 13 | 165 BROADWAY NEW YORK, NY 10006 | $92K |
| DICKINSON GROUP, LLC EIN 20-1241472 CONTRACT ADMINISTRATOR | Claims processing Service code 12 | 50 CHARLES LINDBERGH BLVD SUITE 207 UNIONDALE, NY 11553 | $80K |
| MY BENEFIT ADVISOR, LLC EIN 20-5335092 INSURANCE AGENTS. BROKERS | Insurance agents and brokers Service code 22 | 669 RIVER DRIVE CENTER II SUITE 305 ELMWOOD PARK, NJ 07407 | $54K |
| AMERICAN HEALTH HOLDING INC. EIN 31-1368946 CASE MANAGEMENT | Claims processing Service code 12 | 7400 WEST CAMPUS ROAD, F-510 NEW ALBANY, OH 43054 | $13K |
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 | 95 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 95 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 30 | $10K |
| Other | METROPOLITAN LIFE INSURANCE COMPANY | 30 | $10K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 30 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.