| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| CUSTOM BENEFIT CONSULTANTS INC.3 | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | KAISER FOUNDATION HEALTH PLAN OF HAWAII | $14K | $0 | $14K | 1.97% |
| CUSTOM BENEFIT CONSULTANTS INC.3 | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | BLUE CROSS OF CALIFORNIA | $43K | $78 | $43K | 6.42% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 7660 W CHEYENNE SUITE 109 LAS VEGAS, NV 89129 | BLUE CROSS OF CALIFORNIA | $2K | $0 | $2K | 0.36% |
| ROBERTO VELAZQUEZ3 Filed as: ROBERTO VELASQUEZ | 7 REATA RANCHO SANTA MARGARITA, CA 92688 | BLUE CROSS OF CALIFORNIA | $0 | $205 | $205 | 0.03% |
| BENEFIT MALL3 | 5090 N 40TH STREET SUITE 100 PHOENIX, AZ 85018 | PARTNERRE AMERICA INSURANCE COMPANY (PRAIC) | $0 | $22K | $22K | 5.36% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $11K | $0 | $11K | 10.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 300 S 4TH STREET SUITE 704 LAS VEGAS, NC 89101 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $7K | $0 | $7K | 10.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $6K | $0 | $6K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $5K | $0 | $5K | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $2K | $0 | $2K | 10.09% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS, INC. | 300 S. 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | HYATT LEGAL PLANS | $929 | $0 | $929 | 10.24% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 300 S 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $679 | $0 | $679 | 15.00% |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT CONSULTANTS | 7660 W CHEYENNE LAS VEGAS, NV 89129 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | -$1 | $0 | -$1 | — |
| CUSTOM BENEFIT CONSULTANTS INC.3 Filed as: CUSTOM BENEFIT | 300 SOUTH 4TH STREET SUITE 704 LAS VEGAS, NV 89101 | ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY | -$6 | $0 | -$6 | — |
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 | 698 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 5 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 703 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 741 | $1.5M |
| Dental(2 contracts, 2 carriers) | BLUE CROSS OF CALIFORNIA | 292 | $721K |
| Vision(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 741 | $728K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 150 | $150K |
| Short-term disability(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 158 | $52K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 0 | $68K |
| Prescription drug(2 contracts, 2 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 292 | $1.4M |
| Stop-loss / reinsurancereinsurance | PARTNERRE AMERICA INSURANCE COMPANY (PRAIC) | 370 | $412K |
| Other(5 contracts, 4 carriers) | KAISER FOUNDATION HEALTH PLAN OF HAWAII | 117 | $880K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 741 | — |
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."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.