Filings through .
History & trajectory Charts need 2 or more years. This plan has 10 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingThe primary broker changed. The plan may listen to a new pitch.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 8 contracts with Pro. Pro is free for 7 days and then costs $49 a month.
These benefits are declared on the Form 5500 main form. A ✓ means the benefit also has a Schedule A insurance contract. Without one, plan assets or a Schedule C TPA fund the benefit.
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 521 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 11 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 138 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 670 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 21 | $3K |
| Vision | VISION SERVICE PLAN | 452 | $58K |
| Life insurance | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 716 | $542K |
| Short-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 716 | $542K |
| Long-term disability | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 716 | $542K |
| Stop-loss / reinsurancereinsurance(2 contracts) | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (CIGNA) | 994 | $153K |
| Other(2 contracts, 2 carriers) | THE PRUDENTIAL INSURANCE COMPANY OF AMERICA | 716 | $560K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 994 | - |
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 instead of this filer's headcount. We show the row, but it does not count the people in this plan.
Brokers paid through Schedule A and service providers paid through Schedule C.
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO EIN 59-1031071 NONE | Participant communication; Contract Administrator; Other services; Float revenue; Named fiduciary; Direct payment from the plan; Claims processing; Non-monetary compensation Service code 12 | — | $548K |
| PRUDENTIAL INSURANCE CO OF AMERICA EIN 22-1211670 NONE | Contract Administrator; Claims processing; Other insurance fees and expenses Service code 12 | — | $18K |
| EVERNORTH CARE SOLUTIONS, INC. EIN 86-1465626 NONE | Participant communication; Contract Administrator; Employee (plan sponsor); Claims processing; Direct payment from the plan Service code 12 | — | $17K |
| VISION SERVICE PLAN EIN 06-1227840 NONE | Contract Administrator; Other insurance fees and expenses; Claims processing Service code 12 | — | $11K |
| COMPSYCH | Other insurance fees and expenses; Contract Administrator; Claims processing Service code 12 | — | $6K |
| CIGNA | Claims processing; Non-monetary compensation; Float revenue; Direct payment from the plan; Participant communication; Named fiduciary; Contract Administrator; Other services Service code 12 | — | $612 |
This section shows how the plan is funded and what that means for risk.
Welfare charges, retention and retention rate (the carrier margin on this plan) are on Pro.
4 contacts
Phone and email for the actuary are on Pro.
11 filings · 2015 to 2025