Filings through .
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 |
|---|---|---|
Broker: Benefit Commerce Group HealthDentalVision | HealthDentalVision | |
Broker: Benefit Commerce Group LLC STDLTDLifeOther | STDLTDLifeOther |
Premium, covered lives, retention, contract number and renewal month for each carrier are on Pro.
See premium, retention and renewal dates for 6 contracts 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 | 101 | 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) | 101 | Active, retired or separated, and beneficiaries. Dependents are not counted. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 0 | $438K |
| Dental | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 0 | $438K |
| Vision | ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. | 0 | $438K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $21K |
| Short-term disability(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 110 | $63K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 31 | $23K |
| Other(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 101 | $21K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 110 | - |
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.
Commissions, fees, broker address and the carrier each broker is paid through are on Pro.
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ROCKY MOUNTAIN HOSPITAL & MEDICAL EIN 84-0747736 NOT APPLICABLE | Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Other services; Float revenue; Contract Administrator Service code 12 | — | $164K |
| BENEFIT COMMERCE GROUP | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $23K |
| DIGITAL INSURANCE LLC | Other commissions; Insurance brokerage commissions and fees; Insurance agents and brokers Service code 22 | — | $12K |
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
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