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 pricingNo prospect flags tripped on this filing.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
Broker: Willis Towers Watson Midwest, Inc. Stop-loss | Stop-loss | |
Broker: Willis Towers Watson Northeast Inc HealthRxHMO | HealthRxHMO | |
HealthRx | HealthRx |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 5 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 | 1,645 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 47 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 23 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 1,715 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 62 | $894K |
| Prescription drug(4 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN, INC. | 62 | $894K |
| Stop-loss / reinsurancereinsurance | HCC LIFE INSURANCE COMPANY | 1,371 | $1.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 1,371 | - |
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.
| Broker | Commissions |
|---|---|
Carrier: HCC Life Insurance Company | |
Carrier: Kaiser Foundation Health Plan, Inc. |
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BL. CR. LF AND HLTH INS. CO. EIN 95-4331852 CONTRACT ADMNSTRTR | Other services; Float revenue; Direct payment from the plan; Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $1.2M |
| TOKIO MARINE EIN 35-1817054 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $1.2M |
| EMPYREAN BENEFIT SOLUTIONS, INC. EIN 20-3029813 CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan Service code 13 | — | $182K |
| DELTA DENTAL OF CALIFORNIA EIN 94-1461312 CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan; Claims processing Service code 12 | — | $90K |
| BAKER TILLY US, LLP EIN 30-1413443 AUDITOR | Accounting (including auditing); Direct payment from the plan Service code 10 | — | $57K |
| FNAI ADMIN SVCS EIN 46-4314843 CONTRACT ADMNSTRTR | Contract Administrator; Direct payment from the plan Service code 13 | — | $53K |
| VISION SERVICE PLAN EIN 94-1632821 CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | — | $35K |
| HEALTH ADVOCATE CONTRACT ADMNSTRTR | Direct payment from the plan; Contract Administrator Service code 13 | 3043 WALTON ROAD SUITE 150 PLYMOUTH MEETING, PA 19462 | $20K |
| OG LAW EIN 92-3715595 ATTORNEY | Plan Administrator; Direct payment from the plan Service code 14 | — | $12K |
| U.S. BANK NATIONAL ASSOCIATION EIN 31-0841368 TRUSTEE | Direct payment from the plan; Trustee (bank, trust company, or similar financial institution) Service code 21 | — | $11K |
| HEALTH EQUITY EIN 52-2383166 CONTRACT ADMNSTRTR | Plan Administrator; Direct payment from the plan Service code 14 | — | $9K |
| ALIGHT SOLUTIONS LLC EIN 36-2235791 CONSULTANT | Consulting (general); Direct payment from the plan Service code 16 | — | $8K |
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.
3 contacts
11 filings · 2015 to 2025