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| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE CO. EIN 59-1031071 CONTRACT ADMINISTRATOR | Direct payment from the plan; Contract Administrator; Non-monetary compensation; Participant communication; Float revenue; Other services; Named fiduciary; Claims processing Service code 12 | — | $728K |
| AETNA BEHAVIORIAL HEALTH, LLC EIN 59-3269144 PLAN ADMINISTRATOR | Plan Administrator Service code 14 | 151 FARMINGTON AVE RSAA HARTFORD, CT 06156 | $25K |
| ADVANTAGE CONSULTANTS AGENCY, INC. EIN 34-1865335 BROKER | Insurance agents and brokers Service code 22 | — | $0 |
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 | 2,078 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 185 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 2,263 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | HAWAII MEDICAL SVC ASSOC | 172 | $2.3M |
| Dental | METROPOLITAN LIFE INS CO | 1,129 | $818K |
| Vision(2 contracts, 2 carriers) | HAWAII MEDICAL SVC ASSOC | 1,126 | $1.4M |
| Life insurance | METROPOLITAN LIFE INS CO | 1,979 | $664K |
| Long-term disability | METROPOLITAN LIFE INS CO | 693 | $252K |
| Prescription drug(4 contracts, 4 carriers) | CAREMARK RX PLAN | 1,294 | $5.7M |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | MEDICAL MUTUAL OF OHIO | 1,435 | $1.6M |
| Other(4 contracts, 3 carriers) | MEDICAL MUTUAL OF OHIO | 2,078 | $906K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 2,078 | — |
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."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.