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UNITED SECURITY LIFE AND AD&D PLAN 401k Plan overview

Plan NameUNITED SECURITY LIFE AND AD&D PLAN
Plan identification number 503

UNITED SECURITY LIFE AND AD&D PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

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

Company Name:BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC.
Employer identification number (EIN):041045815
NAIC Classification:524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNITED SECURITY LIFE AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032018-03-01

Plan Statistics for UNITED SECURITY LIFE AND AD&D PLAN

401k plan membership statisitcs for UNITED SECURITY LIFE AND AD&D PLAN

Measure Date Value
2018: UNITED SECURITY LIFE AND AD&D PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-01770
Total number of active participants reported on line 7a of the Form 55002018-03-01770
Total of all active and inactive participants2018-03-01770
Total participants2018-03-01770

Form 5500 Responses for UNITED SECURITY LIFE AND AD&D PLAN

2018: UNITED SECURITY LIFE AND AD&D PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Submission has been amendedNo
2018-03-01This submission is the final filingNo
2018-03-01This return/report is a short plan year return/report (less than 12 months)No
2018-03-01Plan is a collectively bargained planNo
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50003852
Policy instance 1
Insurance contract or identification number50003852
Number of Individuals Covered770
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,471
Commission paid to Insurance BrokerUSD $2,294
Insurance broker organization code?3

Potentially related plans

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