Filings through .
History & trajectory Charts need 2 or more years. This plan has 4 years on file. Pro shows premium, premium per covered life, covered lives and carrier and broker share for every year.
See pricingThe top carrier holds over 85% of premium. A rate increase from that carrier moves the whole plan.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
DentalHMOIndemnityOther | DentalHMOIndemnityOther |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 1 contract 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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 814 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 814 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 41 | $12K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 41 | $12K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 41 | - |
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.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| HEALTH CARE SERVICE CORP EIN 36-1236610 CONTRACT ADMINSTRATOR | Contract Administrator Service code 13 | — | $447K |
| OPTUMRX EIN 11-2581812 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $163K |
| ALIGHT SOLUTIONS LLC EIN 82-1061233 CONTRACT ADMINISTRATOR | Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 15 | — | $130K |
| CONSTELLATION ENERGY GENERATION LLC EIN 23-3064219 ADMINISTRATOR | Plan Administrator Service code 14 | — | $114K |
| NISA INVESTMENT ADVISORS LLC EIN 48-1140940 INVESTMENT MANAGER | Investment management; Investment management fees paid directly by plan Service code 28 | — | $63K |
| WILLIS TOWERS WATSON EIN 53-0181291 ACTUARY | Actuarial Service code 11 | — | $39K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CONTRACT ADMINSTRATOR | Contract Administrator Service code 13 | — | $30K |
| INDEPENDENCE BLUE CROSS EIN 23-0370720 CONTRACT ADMINISTRATOR | Contract Administrator Service code 13 | — | $28K |
| MITCHELL & TITUS EIN 13-2781641 AUDITOR | Accounting (including auditing) Service code 10 | — | $25K |
| BLACKROCK FINANCIAL MANAGEMENT EIN 94-3112180 INVESTMENT MANAGER | Investment management fees paid directly by plan; Direct payment from the plan; Investment management; Trustee (bank, trust company, or similar financial institution); Trustee (discretionary) Service code 21 | — | $17K |
| PLANTE MORAN CONSULTING | Consulting fees; Consulting (general) Service code 16 | 10 S RIVERSIDE PLAZA CHICAGO, IL 60606 | $12K |
| NRAC LLC CONTRACT ADMINISTRATOR | Consulting (general); Contract Administrator; Consulting fees Service code 13 | 601 TERESA STREET OXNARD, CA 93030 | $10K |
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.
4 filings · 2022 to 2025