Filings through .
The top carrier holds over 85% of premium. A rate increase from that carrier moves the whole plan.
Schedule A changed between filings. The plan moved between insured and self-funded, or contracts were added or removed. The plan is in a transition year.
The Schedule A insurance contracts show who carries the risk, for which benefits and for how many people.
| Carrier | Coverage | Premium |
|---|---|---|
HealthStop-loss | HealthStop-loss |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 1 contract 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 | 18 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 18 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | FIDELITY SECURITY LIFE INSURANCE COMPANY | 18 | $150K |
| Stop-loss / reinsurancereinsurance | FIDELITY SECURITY LIFE INSURANCE COMPANY | 18 | $150K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 18 | - |
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.
No brokers reported on this filing.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ORCHESTRATEHR EIN 27-4567072 TPA/CLAIMS ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $15K |
| EBENCONCEPTS COMPANY EIN 75-2966596 CONSULTANT | Consulting fees; Consulting (general) Service code 16 | — | $5K |
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 06-0303370 CLAIMS ADMINSTRATOR | Claims processing; Contract Administrator Service code 12 | — | $4K |
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.
1 contact
1 filing