# EMPLOYEE DISABILITY PLAN

Health and welfare plan sponsored by **BLUE CROSS BLUE SHIELD OF ARIZONA, INC.**. Form 5500 filing for plan year 2025.

| Field | Value |
|---|---|
| Sponsor | BLUE CROSS BLUE SHIELD OF ARIZONA, INC. |
| EIN | 860004538 |
| Plan number | 504 |
| Plan year | 2025 |
| Location | PHOENIX, AZ |
| Industry | Finance and Insurance |
| Funding | fully insured |
| Total premiums | $2.4M |
| Participants | 3,119 |
| Persons covered | 3,220 |

## Insurance carriers (Schedule A)

| Carrier | Coverage |
|---|---|
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | STD, LTD |
| FEDERAL INSURANCE COMPANY | Life, STD |
| DEARBORN LIFE INSURANCE COMPANY | LTD |
| HARTFORD LIFE AND ACCIDENT | LTD |
| STANDARD INSURANCE COMPANY | LTD |

## Brokers

| Broker | Placed with |
|---|---|
| BLUE CROSS BLUE SHIELD OF FLORIDA | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA |
| LOCKTON COMPANIES, LLC | EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA |
| BLUE CROSS BLUE SHIELD OF FLORIDA | EQUITABLE LIFE INSURANCE COMPANY OF AMERICA |
| LOCKTON COMPANIES, LLC | EQUITABLE LIFE INSURANCE COMPANY OF AMERICA |
| ALLIANT INSURANCE SERVICES, INC. | FEDERAL INSURANCE COMPANY |

## About this data

- Source: public Form 5500 filings from the U.S. Department of Labor (EBSA), rebuilt on each DOL release.
- Full page (charts, history, peer benchmarks, fees, contacts): https://planoptica.com/welfare/860004538-504
- Cite as: PlanOptica, https://planoptica.com/welfare/860004538-504
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