| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| USI INSURANCE SERVICES LLC3 | 601 UNION STREET, SUITE 1000 SEATTLE, WA 98101 | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | $25K | $0 | $25K | 0.21% |
| USI INSURANCE SERVICES LLC3 | PO BOX 66119 VIRGINIA BEACH, VA 23466 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $167K | $0 | $167K | 2.69% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| VIA BENEFITS EIN 26-0775680 NONE | Claims processing Service code 12 | — | $164K |
| DAVIS WRIGHT TREMAINE EIN 91-0839480 NONE | Legal Service code 29 | — | $55K |
| UNITED HEALTH CARE INSURANCE CO. EIN 36-2739571 NONE | Claims processing; Other services Service code 12 | — | $54K |
| MERCER EIN 13-2834414 NONE | Actuarial Service code 11 | — | $12K |
| MILLER KAPLAN ARASE LLP EIN 95-2036255 NONE | Accounting (including auditing) Service code 10 | — | $9K |
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 | 0 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4,570 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 4,570 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 1,252 | $11.9M |
| Vision | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 1,252 | $11.9M |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 4,570 | $6.2M |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN OF WASHINGTON OPTIONS, INC. | 1,252 | $11.9M |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 4,570 | — |
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."
Total premium grew more than 20% over prior year. Renewal pain — prime candidate for re-shopping the carriers.