| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MID ATLANTIC INSURANCE SERVICES LLC3 | P O BOX 339 SANFORD, NC 27331 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $68K | $0 | $68K | 2.53% |
| MID ATLANTIC BENEFITS GROUP LLC Filed as: MID | — | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | — | — | $0 | 0.00% |
| MID ATLANTIC INSURANCE SERVICES LLC3 | P O BOX 339 SANFORD, NC 27331 | ANTHEM LIFE INSURANCE COMPANY | $3K | $0 | $3K | 15.44% |
| MID ATLANTIC BENEFITS GROUP LLC Filed as: MID ATLANTIC | — | ANTHEM LIFE INSURANCE COMPANY | — | — | $0 | 0.00% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM HEALTH PLANS OF VIRGINIA INC EIN 54-0357120 | Float revenue; Other fees; Claims processing; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator Service code 12 | — | $223K |
| MID ATLANTIC INSURANCE SERVIES LLC EIN 54-2025919 | Other commissions; Insurance agents and brokers; Insurance brokerage commissions and fees Service code 22 | — | $71K |
| ANTHEM LIFE INSURANCE COMPANY EIN 35-0980405 | Claims processing; Contract Administrator; Insurance services Service code 12 | — | $19K |
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 | 354 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 3 | Continuation coverage (COBRA, retiree health). |
| Total participants (= "Plan participants" tile) | 357 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 357 | $2.7M |
| Vision | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 357 | $2.7M |
| Life insurance | ANTHEM LIFE INSURANCE COMPANY | 354 | $19K |
| Prescription drug | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 357 | $2.7M |
| Stop-loss / reinsurancereinsurance | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | 357 | $2.7M |
| Other | ANTHEM LIFE INSURANCE COMPANY | 354 | $19K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 357 | — |
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."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.