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| Plan Name | WELLBOX HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WELLBOX |
| Employer identification number (EIN): | 371801961 |
| NAIC Classification: | 561110 |
| NAIC Description: | Office Administrative Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-05-01 | ROSEMARY KELLY | 2023-11-16 | ||
| 501 | 2021-05-01 | ROSEMARY KELLY | 2022-11-01 |
| 2022: WELLBOX HEALTH AND WELFARE BENEFIT PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-05-01 | Type of plan entity | Single employer plan |
| 2022-05-01 | Plan funding arrangement – Insurance | Yes |
| 2022-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: WELLBOX HEALTH AND WELFARE BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-05-01 | Type of plan entity | Single employer plan |
| 2021-05-01 | Plan funding arrangement – Insurance | Yes |
| 2021-05-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | J7729 |
| Policy instance | 1 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 945745 |
| Policy instance | 2 |
| METROPOLITAN FAMILY SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | EAP |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 945745 |
| Policy instance | 2 |
| METROPOLITAN FAMILY SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | EAP |
| Policy instance | 3 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | J7729 |
| Policy instance | 1 |
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