| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD EXECUTIVE PLAZA III, SUITE 120 HUNT VALLEY, MD 21031 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | $69K | $3K | $72K | 2.75% |
| KELLY & ASSOCIATES INSURANCE GROUP3 Filed as: KELLY AND ASSOCIATES INS. GROUP INC | 1 KELLY WAY SPARKS, MD 21152 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | $10K | $0 | $10K | 0.39% |
| EBCA3 Filed as: EBCA GENERAL AGENCY | 1430 SPRING HILL ROAD, SUITE 320 MCLEAN, VA 22102 | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | -$2K | $0 | -$2K | -0.09% |
| USI INSURANCE SERVICES LLC3 | PO BOX 61007 VIRGINIA BEACH, VA 23466 | UNITEDHEALTHCARE INSURANCE COMPANY | $25K | $47K | $72K | 3.63% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, SUITE 1200 HUNT VALLEY, MD 21031 | UNITEDHEALTHCARE INSURANCE COMPANY | $31K | $0 | $31K | 1.57% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | ANTHEM HEALTH PLANS OF VIRGINIA, INC. | $4K | $0 | $4K | 1.80% |
| USI INSURANCE SERVICES LLC3 | 4840 COX ROAD, SUITE 150 GLEN ALLEN, VA 23060 | AMERITAS LIFE INSURANCE CORP. | $10K | $0 | $10K | 5.00% |
| USI INSURANCE SERVICES LLC3 | 11350 MCCORMICK ROAD, SUITE 1203 HUNT VALLEY, MD 21031 | AMERITAS LIFE INSURANCE CORP. | $0 | $5K | $5K | 2.62% |
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 | 617 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 617 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 740 | $4.8M |
| Dental(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 740 | $2.2M |
| Vision(2 contracts, 2 carriers) | UNITEDHEALTHCARE INSURANCE COMPANY | 740 | $2.2M |
| Life insurance | UNITEDHEALTHCARE INSURANCE COMPANY | 740 | $2.0M |
| Short-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 740 | $2.0M |
| Long-term disability | UNITEDHEALTHCARE INSURANCE COMPANY | 740 | $2.0M |
| Prescription drug(3 contracts, 3 carriers) | KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. | 740 | $4.8M |
| Other | UNITEDHEALTHCARE INSURANCE COMPANY | 740 | $2.0M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 740 | — |
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."
No prospect flags tripped on this filing.