401k Plan data: CHUBBCHOICE FLEXIBLE BENEFIT PLAN plan

CHUBBCHOICE FLEXIBLE BENEFIT PLAN 401k Plan overview

Plan Name	CHUBBCHOICE FLEXIBLE BENEFIT PLAN
Plan identification number	508

CHUBBCHOICE FLEXIBLE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

CHUBB & SON, A DIVISION OF FEDERAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: CHUBB & SON, A DIVISION OF FEDERAL INSURANCE COMPANY

Employer identification number (EIN): 131963496

NAIC Classification: 524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHUBBCHOICE FLEXIBLE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2017-01-01
508 2016-01-01
508 2015-01-01 CAROLYN KENNEDY
508 2014-01-01 CAROLYN KENNEDY
508 2013-01-01 CAROLYN KENNEDY
508 2012-01-01 JOHN ROWLAND
508 2011-01-01 ROBERT WEINMAN
508 2010-01-01 ROBERT WEINMAN
508 2009-01-01 ROBERT WEINMAN ROBERT WEINMAN 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
508	2017-01-01
508	2016-01-01
508	2015-01-01	CAROLYN KENNEDY
508	2014-01-01	CAROLYN KENNEDY
508	2013-01-01	CAROLYN KENNEDY
508	2012-01-01	JOHN ROWLAND
508	2011-01-01	ROBERT WEINMAN
508	2010-01-01	ROBERT WEINMAN
508	2009-01-01	ROBERT WEINMAN	ROBERT WEINMAN	2010-10-15

Plan Statistics for CHUBBCHOICE FLEXIBLE BENEFIT PLAN

401k plan membership statisitcs for CHUBBCHOICE FLEXIBLE BENEFIT PLAN

Measure Date Value
2017: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 22,784
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 7,198
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 6,144
Number of retired or separated participants receiving benefits 2016-01-01 2,105
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 8,249
2015: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 6,364
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 6,264
Number of retired or separated participants receiving benefits 2015-01-01 2,058
Total of all active and inactive participants 2015-01-01 8,322
Total participants 2015-01-01 8,322
2014: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 7,421
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 6,350
Number of retired or separated participants receiving benefits 2014-01-01 1,940
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 8,290
2013: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 7,441
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 7,380
Number of retired or separated participants receiving benefits 2013-01-01 41
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 7,421
2012: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8,209
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 7,331
Number of retired or separated participants receiving benefits 2012-01-01 110
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 7,441
2011: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10,047
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6,551
Number of retired or separated participants receiving benefits 2011-01-01 1,658
Total of all active and inactive participants 2011-01-01 8,209
2010: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 8,665
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7,458
Number of retired or separated participants receiving benefits 2010-01-01 2,589
Total of all active and inactive participants 2010-01-01 10,047
2009: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9,559
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 6,939
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1,726
Total of all active and inactive participants 2009-01-01 8,665

Measure	Date	Value
2017: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	22,784
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	7,198
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	6,144
Number of retired or separated participants receiving benefits	2016-01-01	2,105
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	8,249
2015: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	6,364
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	6,264
Number of retired or separated participants receiving benefits	2015-01-01	2,058
Total of all active and inactive participants	2015-01-01	8,322
Total participants	2015-01-01	8,322
2014: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	7,421
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	6,350
Number of retired or separated participants receiving benefits	2014-01-01	1,940
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	8,290
2013: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	7,441
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	7,380
Number of retired or separated participants receiving benefits	2013-01-01	41
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	7,421
2012: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8,209
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	7,331
Number of retired or separated participants receiving benefits	2012-01-01	110
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	7,441
2011: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10,047
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6,551
Number of retired or separated participants receiving benefits	2011-01-01	1,658
Total of all active and inactive participants	2011-01-01	8,209
2010: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	8,665
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7,458
Number of retired or separated participants receiving benefits	2010-01-01	2,589
Total of all active and inactive participants	2010-01-01	10,047
2009: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9,559
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	6,939
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1,726
Total of all active and inactive participants	2009-01-01	8,665

Form 5500 Responses for CHUBBCHOICE FLEXIBLE BENEFIT PLAN

2017: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	This submission is the final filing	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CHUBBCHOICE FLEXIBLE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number	10082741001
Policy instance	15
AETNA EMPLOYEE ASSISTANCE PLAN (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	556755
Policy instance	16
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0177128
Policy instance	3
TRIPLE-S, VIDA, INC. (National Association of Insurance Commissioners NAIC id number: 73814 )
Policy contract number	GLIF418888
Policy instance	2
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0177132
Policy instance	4
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0174612
Policy instance	5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	526291
Policy instance	6
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	0868331
Policy instance	7
AETNA GLOBAL BENEFITS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	0299552
Policy instance	8
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number	10082001001
Policy instance	14
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	233321
Policy instance	13
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	605349
Policy instance	12
MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 )
Policy contract number	79790502
Policy instance	11
HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	556757
Policy instance	10
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	499681
Policy instance	9
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763*COBRA
Policy instance	6
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763
Policy instance	5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	4
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	149475
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	50119
Policy instance	2
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12008861
Policy instance	1
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 54199 )
Policy contract number	CHUC0-001
Policy instance	9
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00181B
Policy instance	7
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00181A
Policy instance	8
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0000372
Policy instance	10
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	16465
Policy instance	11
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	00181A
Policy instance	12
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number	ERLL15100740003
Policy instance	13
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	000064047702
Policy instance	14
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	102213
Policy instance	15
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0000372
Policy instance	9
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	00181A
Policy instance	11
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	12
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64047702
Policy instance	13
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	50119
Policy instance	14
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	102213
Policy instance	10
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number	ERLL14100740002
Policy instance	8
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	16465
Policy instance	7
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763*COBRA
Policy instance	1
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763
Policy instance	2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00181B
Policy instance	3
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 54199 )
Policy contract number	CHUC0-001
Policy instance	4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12008861
Policy instance	5
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00181A
Policy instance	6
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP0000372
Policy instance	6
CIGNA HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	00181A
Policy instance	5
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763
Policy instance	4
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 54199 )
Policy contract number	CHUC0001
Policy instance	3
OXFORD HEALTH PLANS NJ, INC. (National Association of Insurance Commissioners NAIC id number: 95506 )
Policy contract number	CS34455
Policy instance	2
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	00181A
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	50119
Policy instance	11
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	102213
Policy instance	7
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	061958
Policy instance	8
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181B
Policy instance	15
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12008861
Policy instance	14
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	13
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	16465
Policy instance	12
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number	ERLL13100740001
Policy instance	10
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64047702
Policy instance	9
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181B
Policy instance	11
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64047702
Policy instance	12
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	061958
Policy instance	14
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 54199 )
Policy contract number	CHUC0001
Policy instance	13
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12008861
Policy instance	15
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763*COBRA
Policy instance	8
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	102213
Policy instance	16
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763
Policy instance	10
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	50119
Policy instance	9
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181A
Policy instance	7
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	6
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	16465
Policy instance	4
CIGNA WORLDWIDE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181A
Policy instance	2
OXFORD HEALTH PLANS NJ, INC. (National Association of Insurance Commissioners NAIC id number: 95506 )
Policy contract number	CS34455
Policy instance	3
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number	75864
Policy instance	5
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	SP000037
Policy instance	1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	11
OXFORD HEALTH PLANS NJ, INC. (National Association of Insurance Commissioners NAIC id number: 95506 )
Policy contract number	CS34455
Policy instance	12
CIGNA WORLDWIDE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181A
Policy instance	13
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181B
Policy instance	14
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	50119
Policy instance	15
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 54199 )
Policy contract number	CHUC0001
Policy instance	6
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12008861
Policy instance	10
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	64047702
Policy instance	9
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181A
Policy instance	7
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	102213
Policy instance	16
TRIPLE S (National Association of Insurance Commissioners NAIC id number: 55816 )
Policy contract number	109368/SP000037
Policy instance	1
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number	75864
Policy instance	2
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	061958
Policy instance	3
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763
Policy instance	4
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763*COBRA
Policy instance	5
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	16465
Policy instance	8
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number	061958
Policy instance	3
OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number	2763
Policy instance	2
HEALTH NET OF CT (National Association of Insurance Commissioners NAIC id number: 95968 )
Policy contract number	0B8295
Policy instance	4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	102213
Policy instance	6
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	16465
Policy instance	7
MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 54199 )
Policy contract number	CHUC0001
Policy instance	8
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181B
Policy instance	13
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number	0113090
Policy instance	9
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12008861
Policy instance	10
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 )
Policy contract number	75864
Policy instance	11
CIGNA WORLDWIDE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	00181A
Policy instance	12
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	50119
Policy instance	14
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 95351 )
Policy contract number	035126
Policy instance	5
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number	000064047702
Policy instance	1

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Company Name:	CHUBB & SON, A DIVISION OF FEDERAL INSURANCE COMPANY
Employer identification number (EIN):	131963496
NAIC Classification:	524150