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EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameEMPLOYEE HEALTH PLAN
Plan identification number 503

EMPLOYEE HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision

401k Sponsoring company profile

BLUE CROSS & BLUE SHIELD OF ARIZONA, INC. has sponsored the creation of one or more 401k plans.

Company Name:BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.
Employer identification number (EIN):860004538
NAIC Classification:524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032023-01-01
5032022-01-01
5032021-01-01
5032020-01-01
5032019-01-01
5032018-01-01
5032017-01-01GREG WELLS, CHIEF HR OFFICER
5032016-01-01GREG WELLS, VICE PRESIDENT
5032015-01-01GREG WELLS, VICE PRESIDENT
5032014-01-01GREG WELLS, VICE PRESIDENT
5032013-01-01GREG WELLS, VICE PRESIDENT
5032012-01-01GREG WELLS, VICE PRESIDENT
5032011-01-01GREG WELLS, VICE PRESIDENT
5032009-01-01GREG WELLS, VICE PRESIDENT
5032009-01-01GREG WELLS, VICE PRESIDENT

Plan Statistics for EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for EMPLOYEE HEALTH PLAN

Measure Date Value
2023: EMPLOYEE HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-012,616
Total number of active participants reported on line 7a of the Form 55002023-01-012,735
Number of retired or separated participants receiving benefits2023-01-01186
Total of all active and inactive participants2023-01-012,921
Total participants2023-01-012,921
2022: EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-012,000
Total number of active participants reported on line 7a of the Form 55002022-01-012,404
Number of retired or separated participants receiving benefits2022-01-01211
Total of all active and inactive participants2022-01-012,615
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-011
Total participants2022-01-012,616
2021: EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-012,019
Total number of active participants reported on line 7a of the Form 55002021-01-011,805
Number of retired or separated participants receiving benefits2021-01-01194
Total of all active and inactive participants2021-01-011,999
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-012,000
2020: EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,797
Total number of active participants reported on line 7a of the Form 55002020-01-011,802
Number of retired or separated participants receiving benefits2020-01-01190
Number of other retired or separated participants entitled to future benefits2020-01-0126
Total of all active and inactive participants2020-01-012,018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-011
Total participants2020-01-012,019
2019: EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,894
Total number of active participants reported on line 7a of the Form 55002019-01-011,690
Number of retired or separated participants receiving benefits2019-01-01100
Number of other retired or separated participants entitled to future benefits2019-01-017
Total of all active and inactive participants2019-01-011,797
Total participants2019-01-011,797
2018: EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-011,797
Total number of active participants reported on line 7a of the Form 55002018-01-011,413
Number of retired or separated participants receiving benefits2018-01-01463
Number of other retired or separated participants entitled to future benefits2018-01-0112
Total of all active and inactive participants2018-01-011,888
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-016
Total participants2018-01-011,894
2017: EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,777
Total number of active participants reported on line 7a of the Form 55002017-01-011,346
Number of retired or separated participants receiving benefits2017-01-01448
Total of all active and inactive participants2017-01-011,794
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-013
Total participants2017-01-011,797
2016: EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,755
Total number of active participants reported on line 7a of the Form 55002016-01-011,335
Number of retired or separated participants receiving benefits2016-01-01436
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-011,771
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-016
Total participants2016-01-011,777
2015: EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,619
Total number of active participants reported on line 7a of the Form 55002015-01-011,343
Number of retired or separated participants receiving benefits2015-01-01407
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,750
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-015
Total participants2015-01-011,755
2014: EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,613
Total number of active participants reported on line 7a of the Form 55002014-01-011,248
Number of retired or separated participants receiving benefits2014-01-01366
Total of all active and inactive participants2014-01-011,614
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-015
Total participants2014-01-011,619
2013: EMPLOYEE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,576
Total number of active participants reported on line 7a of the Form 55002013-01-011,266
Number of retired or separated participants receiving benefits2013-01-01342
Total of all active and inactive participants2013-01-011,608
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-015
Total participants2013-01-011,613
2012: EMPLOYEE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,604
Total number of active participants reported on line 7a of the Form 55002012-01-011,282
Number of retired or separated participants receiving benefits2012-01-01291
Total of all active and inactive participants2012-01-011,573
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-013
Total participants2012-01-011,576
2011: EMPLOYEE HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,678
Total number of active participants reported on line 7a of the Form 55002011-01-011,324
Number of retired or separated participants receiving benefits2011-01-01278
Total of all active and inactive participants2011-01-011,602
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-012
Total participants2011-01-011,604
2009: EMPLOYEE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,697
Total number of active participants reported on line 7a of the Form 55002009-01-011,458
Number of retired or separated participants receiving benefits2009-01-01225
Total of all active and inactive participants2009-01-011,683
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-017
Total participants2009-01-011,690

Form 5500 Responses for EMPLOYEE HEALTH PLAN

2023: EMPLOYEE HEALTH PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: EMPLOYEE HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: EMPLOYEE HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: EMPLOYEE HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: EMPLOYEE HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: EMPLOYEE HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: EMPLOYEE HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: EMPLOYEE HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: EMPLOYEE HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: EMPLOYEE HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: EMPLOYEE HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: EMPLOYEE HEALTH PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: EMPLOYEE HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: EMPLOYEE HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number007626
Policy instance 2
Insurance contract or identification number007626
Number of Individuals Covered3125
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $167,619
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,820,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered2921
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,434,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number007626
Policy instance 3
Insurance contract or identification number007626
Number of Individuals Covered2673
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $67,598
Total amount of fees paid to insurance companyUSD $56,572
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,268,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,847
Amount paid for insurance broker fees56572
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract numberYZ4 038, 039
Policy instance 2
Insurance contract or identification numberYZ4 038, 039
Number of Individuals Covered3995
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $238,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered2616
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,249,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MONY (National Association of Insurance Commissioners NAIC id number: 78077 )
Policy contract number007626
Policy instance 3
Insurance contract or identification number007626
Number of Individuals Covered2005
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $37,373
Total amount of fees paid to insurance companyUSD $48,479
Health Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $969,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees48479
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $3,294
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract numberYZ4 038, 039
Policy instance 2
Insurance contract or identification numberYZ4 038, 039
Number of Individuals Covered3017
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered2000
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,916,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered2019
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,758,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract numberYZ4 038, 039
Policy instance 2
Insurance contract or identification numberYZ4 038, 039
Number of Individuals Covered2869
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $152,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52712
Policy instance 3
Insurance contract or identification number52712
Number of Individuals Covered1945
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $19,228
Total amount of fees paid to insurance companyUSD $136
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $663,559
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees17
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $5,547
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1802
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,919,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93340 )
Policy contract numberYZ4 038, 039
Policy instance 2
Insurance contract or identification numberYZ4 038, 039
Number of Individuals Covered2699
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52712
Policy instance 3
Insurance contract or identification number52712
Number of Individuals Covered1778
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $27,673
Total amount of fees paid to insurance companyUSD $7,186
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $599,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees182
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $22,523
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1894
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,724,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52712
Policy instance 3
Insurance contract or identification number52712
Number of Individuals Covered1515
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $47,067
Total amount of fees paid to insurance companyUSD $145
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $514,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,944
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMMISSIONS
Insurance broker organization code?3
Amount paid for insurance broker fees145
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783 / 98545
Policy instance 2
Insurance contract or identification number9728783 / 98545
Number of Individuals Covered1812
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $5,258
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,258
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number402674G
Policy instance 4
Insurance contract or identification number402674G
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of fees paid to insurance companyUSD $965
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees965
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number402674G
Policy instance 4
Insurance contract or identification number402674G
Number of Individuals Covered1433
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $46
Total amount of fees paid to insurance companyUSD $10,022
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,229
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46
Insurance broker organization code?3
Amount paid for insurance broker fees10022
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameWILLIS INSURANCE SVCS OF CA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number52712
Policy instance 3
Insurance contract or identification number52712
Number of Individuals Covered1314
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $26,220
Total amount of fees paid to insurance companyUSD $134
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $451,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,220
Insurance broker organization code?3
Amount paid for insurance broker fees134
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783 / 98545
Policy instance 2
Insurance contract or identification number9728783 / 98545
Number of Individuals Covered1738
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,071
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,071
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1797
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,883,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1755
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,495,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783
Policy instance 2
Insurance contract or identification number9728783
Number of Individuals Covered1955
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,441
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,441
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number402674G
Policy instance 3
Insurance contract or identification number402674G
Number of Individuals Covered1431
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $39,707
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $539,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,707
Insurance broker organization code?3
Insurance broker nameWILLIS OF ARIZONA INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783
Policy instance 2
Insurance contract or identification number9728783
Number of Individuals Covered1864
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,541
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,541
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1619
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,578,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number402674G
Policy instance 3
Insurance contract or identification number402674G
Number of Individuals Covered1468
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $39,360
Total amount of fees paid to insurance companyUSD $12,911
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $449,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,360
Insurance broker organization code?3
Amount paid for insurance broker fees12911
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameWILLIS INSURANCE SVCS OF CA
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783
Policy instance 2
Insurance contract or identification number9728783
Number of Individuals Covered1761
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,643
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,643
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number152459
Policy instance 3
Insurance contract or identification number152459
Number of Individuals Covered1306
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $56,256
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,256
Insurance broker organization code?3
Insurance broker nameWILLIS OF AZ INC
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1613
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,114,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number152459
Policy instance 3
Insurance contract or identification number152459
Number of Individuals Covered1335
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $51,033
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,033
Insurance broker organization code?3
Insurance broker nameWILLIS OF AZ INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783
Policy instance 2
Insurance contract or identification number9728783
Number of Individuals Covered1562
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,454
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,454
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1576
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,171,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number152459
Policy instance 3
Insurance contract or identification number152459
Number of Individuals Covered1379
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $53,644
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783
Policy instance 2
Insurance contract or identification number9728783
Number of Individuals Covered1589
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,492
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1604
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,788,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number50 / 52
Policy instance 1
Insurance contract or identification number50 / 52
Number of Individuals Covered1678
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,311,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9728783
Policy instance 2
Insurance contract or identification number9728783
Number of Individuals Covered1562
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,106
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,106
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number675730-0GL
Policy instance 3
Insurance contract or identification number675730-0GL
Number of Individuals Covered1478
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $26,180
Total amount of fees paid to insurance companyUSD $1,387
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $373,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,180
Amount paid for insurance broker fees1387
Additional information about fees paid to insurance broker0 FEES
Insurance broker organization code?3
Insurance broker nameCSA GENERAL INSURANCE AGENCY, INC.

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