| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASCENSION INSURANCE AGENCY3 | 1277 TREAT BOULEVARD, SUITE 400 WALNUT CREEK, CA 94597 | KAISER FOUNDATION HEALTH PLAN INC | $17K | — | $17K | 2.31% |
| BXA INSURANCE SERVICES3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | KAISER FOUNDATION HEALTH PLAN INC | $13K | — | $13K | 1.71% |
| ASCENISON INSURANCE AGENCY3 | 1277 TREAT BOULEVARD, SUITE 400 WALNUT CREEK, CA 94597 | UNION SECURITY INSURANCE COMPANY | $4K | — | $4K | 5.47% |
| BXA INSURANCE SERVICES3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UNION SECURITY INSURANCE COMPANY | $3K | $26 | $3K | 4.27% |
| ASCENSION INSURANCE AGENCY3 | 1277 TREAT BOULEVARD, SUITE 400 WALNUT CREEK, CA 94597 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $593 | — | $593 | 3.43% |
| BXA INSURANCE SERVICES3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | RELIANCE STANDARD LIFE INSURANCE COMPANY | $421 | $94 | $515 | 2.98% |
| ASCENSION INSURANCE AGENCY3 | 1277 TREAT BOULEVARD, SUITE 400 WALNUT CREEK, CA 94597 | UDC DENTAL OF CALIFORNIA, INC. | $509 | — | $509 | 5.84% |
| BXA INSURANCE SERVICES3 | 23716 BIRTCHER DRIVE LAKE FOREST, CA 92630 | UDC DENTAL OF CALIFORNIA, INC. | $362 | — | $362 | 4.16% |
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 | 220 | 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) | 220 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC | 143 | $738K |
| Dental(2 contracts, 2 carriers) | UNION SECURITY INSURANCE COMPANY | 77 | $80K |
| Vision | UNION SECURITY INSURANCE COMPANY | 77 | $72K |
| Life insurance(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 220 | $17K |
| Long-term disability | RELIANCE STANDARD LIFE INSURANCE COMPANY | 220 | $0 |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC | 143 | $738K |
| Other(2 contracts) | RELIANCE STANDARD LIFE INSURANCE COMPANY | 220 | $17K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 220 | — |
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.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.