| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, INC | PO BOX 750004 PETALUMA, CA 94975 | KAISER FOUNDATION HEALTH PLAN INC | $77K | $0 | $77K | 2.68% |
| EMPLOYERS SELECT INSURANCE SERVICES3 | 5701 LONETREE BLVD. STE 305 ROCKLIN, CA 95765 | KAISER FOUNDATION HEALTH PLAN INC | $28K | $0 | $28K | 0.99% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, | PO BOX 750004 PETALUMA, CA 94975 | KAISER FOUNDATION HEALTH PLAN INC | $25K | $0 | $25K | 3.07% |
| EMPLOYERS SELECT INSURANCE SERVICES3 Filed as: EMPLOYERS SELECT INSURANCE | 5701 LONETREE BLVD. STE 305 ROCKLIN, CA 95765 | KAISER FOUNDATION HEALTH PLAN INC | $8K | $0 | $8K | 0.99% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, | PO BOX 750004 PETALUMA, CA 94975 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $20K | $0 | $20K | 4.06% |
| SSM INSURANCE SERVICES, INC.3 Filed as: SSM INSURANCE SERVICES, | PO BOX 750004 PETALUMA, CA 94975 | VISION SERVICE PLAN | $5K | $0 | $5K | 6.63% |
| SHANNON ZAJEC3 | 5701 LONETREE BLVD. STE. 305 ROCKLIN, CA 95765 | VISION SERVICE PLAN | $3K | $0 | $3K | 3.37% |
No Schedule C service providers reported on this filing.
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 | 803 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 803 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts) | KAISER FOUNDATION HEALTH PLAN INC | 628 | $3.7M |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 555 | $491K |
| Vision | VISION SERVICE PLAN | 385 | $76K |
| Other | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 555 | $491K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 628 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.