| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | PO BOX 61187 VIRGINIA BEACH, VA 23466 | VISION SERVICE PLAN | $91K | $0 | $91K | 1.27% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF TN EIN 62-0427913 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $10.0M |
| BLUECROSS BLUESHIELD OF FL EIN 59-2015694 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $2.5M |
| BLUECROSS BLUESHIELD OF AL EIN 63-0103830 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $2.2M |
| MEDPARTNERS EIN 26-3067046 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $2.0M |
| INDEPENDENCE BLUE CROSS EIN 23-2184623 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $1.1M |
| DELTA DENTAL EIN 62-0812197 CONTRACT ADMNISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $921K |
| HIGHMARK, INC. EIN 23-1294723 CONTRACT ADMNISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $532K |
| OPTUMRX EIN 33-0441200 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $239K |
| BEACON HEALTH OPTIONS EIN 54-1414194 CONTRACT ADMINISTRATOR | Insurance services Service code 23 | — | $199K |
| BUSINESSOLVER EIN 42-1503807 CONTRACT ADMINISTRATOR | Claims processing; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $160K |
| FIRST CHOICE EIN 72-1405983 CONTRACT ADMINISTRATOR | Claims processing; Contract Administrator Service code 12 | — | $150K |
| PREMIERCARE OF NORTHWEST ARKANSAS EIN 62-1682324 CONTRACT ADMINISTRATOR | Contract Administrator; Claims processing Service code 12 | — | $82K |
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 | 46,653 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1,299 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 47,952 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | VISION SERVICE PLAN | 39,113 | $7.2M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 39,113 | — |
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.