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| Plan Name | HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | PRESTIGE EMPLOYEE ADMINISTRATORS, INC |
| Employer identification number (EIN): | 113448580 |
| NAIC Classification: | 561300 |
Additional information about PRESTIGE EMPLOYEE ADMINISTRATORS, INC
| Jurisdiction of Incorporation: | New York Department of State |
| Incorporation Date: | 1998-07-10 |
| Company Identification Number: | 2278064 |
| Legal Registered Office Address: |
538 BROADHOLLOW ROAD SUITE 311 MELVILLE United States of America (USA) 11747 |
More information about PRESTIGE EMPLOYEE ADMINISTRATORS, INC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-11-01 | KRISTINA FREED | |||
| 501 | 2022-11-01 | KRISTINA FREED | |||
| 501 | 2021-11-01 | ||||
| 501 | 2021-11-01 | ANDREW LUBASH | |||
| 501 | 2020-11-01 | ||||
| 501 | 2019-11-01 | ||||
| 501 | 2018-11-01 | ||||
| 501 | 2017-11-01 | ||||
| 501 | 2016-11-01 | ALAN COOPERBERG | |||
| 501 | 2015-11-01 | ALAN COOPERBERG | |||
| 501 | 2014-11-01 | ALAN COOPERBERG | |||
| 501 | 2013-11-01 | ALAN COOPERBERG | |||
| 501 | 2012-11-01 | ALAN COOPERBERG | |||
| 501 | 2011-11-01 | ALAN COOPERBERG | |||
| 501 | 2009-11-01 | ALAN COOPERBERG |
| Measure | Date | Value |
|---|---|---|
| 2021: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-11-01 | 15,059 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 22,084 |
| Number of retired or separated participants receiving benefits | 2021-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 0 |
| Total of all active and inactive participants | 2021-11-01 | 22,084 |
| 2020: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-11-01 | 14,632 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 14,780 |
| Number of retired or separated participants receiving benefits | 2020-11-01 | 279 |
| Number of other retired or separated participants entitled to future benefits | 2020-11-01 | 0 |
| Total of all active and inactive participants | 2020-11-01 | 15,059 |
| 2019: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-11-01 | 12,578 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 14,362 |
| Number of retired or separated participants receiving benefits | 2019-11-01 | 269 |
| Number of other retired or separated participants entitled to future benefits | 2019-11-01 | 0 |
| Total of all active and inactive participants | 2019-11-01 | 14,631 |
| 2018: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-11-01 | 10,293 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 12,120 |
| Number of retired or separated participants receiving benefits | 2018-11-01 | 458 |
| Number of other retired or separated participants entitled to future benefits | 2018-11-01 | 0 |
| Total of all active and inactive participants | 2018-11-01 | 12,578 |
| 2017: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-11-01 | 8,571 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 6,100 |
| Number of retired or separated participants receiving benefits | 2017-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-11-01 | 0 |
| Total of all active and inactive participants | 2017-11-01 | 6,100 |
| 2016: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-11-01 | 6,845 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 8,187 |
| Number of retired or separated participants receiving benefits | 2016-11-01 | 384 |
| Number of other retired or separated participants entitled to future benefits | 2016-11-01 | 0 |
| Total of all active and inactive participants | 2016-11-01 | 8,571 |
| 2015: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-11-01 | 5,533 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 6,656 |
| Number of retired or separated participants receiving benefits | 2015-11-01 | 189 |
| Number of other retired or separated participants entitled to future benefits | 2015-11-01 | 0 |
| Total of all active and inactive participants | 2015-11-01 | 6,845 |
| 2014: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-11-01 | 4,590 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 5,371 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 162 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 0 |
| Total of all active and inactive participants | 2014-11-01 | 5,533 |
| 2013: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-11-01 | 4,576 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 4,467 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 123 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 0 |
| Total of all active and inactive participants | 2013-11-01 | 4,590 |
| 2012: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-11-01 | 3,930 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 4,441 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 135 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 0 |
| Total of all active and inactive participants | 2012-11-01 | 4,576 |
| 2011: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-11-01 | 3,711 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 3,803 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 127 |
| Number of other retired or separated participants entitled to future benefits | 2011-11-01 | 0 |
| Total of all active and inactive participants | 2011-11-01 | 3,930 |
| 2009: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-11-01 | 3,022 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 3,407 |
| Number of retired or separated participants receiving benefits | 2009-11-01 | 224 |
| Number of other retired or separated participants entitled to future benefits | 2009-11-01 | 0 |
| Total of all active and inactive participants | 2009-11-01 | 3,631 |
| Total participants | 2009-11-01 | 3,631 |
| 2021: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2021 form 5500 responses | ||
|---|---|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Submission has been amended | No |
| 2021-11-01 | This submission is the final filing | No |
| 2021-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-11-01 | Plan is a collectively bargained plan | No |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2020 form 5500 responses | ||
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Submission has been amended | No |
| 2020-11-01 | This submission is the final filing | No |
| 2020-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-11-01 | Plan is a collectively bargained plan | No |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2019 form 5500 responses | ||
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Submission has been amended | No |
| 2019-11-01 | This submission is the final filing | No |
| 2019-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-11-01 | Plan is a collectively bargained plan | No |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2018 form 5500 responses | ||
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Submission has been amended | No |
| 2018-11-01 | This submission is the final filing | No |
| 2018-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-11-01 | Plan is a collectively bargained plan | No |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2017 form 5500 responses | ||
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Submission has been amended | No |
| 2017-11-01 | This submission is the final filing | No |
| 2017-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-11-01 | Plan is a collectively bargained plan | No |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2016 form 5500 responses | ||
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Submission has been amended | No |
| 2016-11-01 | This submission is the final filing | No |
| 2016-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-11-01 | Plan is a collectively bargained plan | No |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2015 form 5500 responses | ||
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2014 form 5500 responses | ||
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2013 form 5500 responses | ||
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2012 form 5500 responses | ||
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2011 form 5500 responses | ||
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: HEALTH AND WELFARE PLAN FOR PRESTIGE EMPLOYEE ADMINISTRATORS, INC. 2009 form 5500 responses | ||
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Submission has been amended | No |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-11-01 | Plan is a collectively bargained plan | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0281076 |
| Policy instance | 3 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5333525 |
| Policy instance | 1 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0905739 |
| Policy instance | 2 |
| SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 ) | |
| Policy contract number | 5333525 |
| Policy instance | 4 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | 5333525 |
| Policy instance | 5 |
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) | |
| Policy contract number | 9260100 |
| Policy instance | 6 |
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) | |
| Policy contract number | 0181804 |
| Policy instance | 7 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216643 |
| Policy instance | 8 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 941048 |
| Policy instance | 9 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216644 |
| Policy instance | 10 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0281076 |
| Policy instance | 3 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0905739 |
| Policy instance | 2 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | TS05333525 |
| Policy instance | 1 |
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) | |
| Policy contract number | 1140429 000 |
| Policy instance | 7 |
| SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 ) | |
| Policy contract number | TS05333525 |
| Policy instance | 4 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | TS05333525 |
| Policy instance | 5 |
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) | |
| Policy contract number | 9260100 |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216643 |
| Policy instance | 8 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 941048 |
| Policy instance | 9 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0905739 |
| Policy instance | 2 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | PE1266 |
| Policy instance | 3 |
| SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 ) | |
| Policy contract number | 5333525 |
| Policy instance | 4 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | 5333525 |
| Policy instance | 5 |
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) | |
| Policy contract number | 9260100 |
| Policy instance | 6 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216643 |
| Policy instance | 8 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216644 |
| Policy instance | 9 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5333525 |
| Policy instance | 1 |
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) | |
| Policy contract number | 1140429 000 |
| Policy instance | 7 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216644 |
| Policy instance | 12 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 1 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 5333525 |
| Policy instance | 2 |
| UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 3 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0905739 |
| Policy instance | 4 |
| UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 5 |
| UNION SECURITY DENTALCARE OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11244 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 6 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | PE1266 |
| Policy instance | 7 |
| SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 ) | |
| Policy contract number | 5333525 |
| Policy instance | 8 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | 5333525 |
| Policy instance | 9 |
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) | |
| Policy contract number | 9260100 |
| Policy instance | 10 |
| EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 ) | |
| Policy contract number | JXN,JXP |
| Policy instance | 11 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0216643 |
| Policy instance | 13 |
| UNION SECURITY DENTALCARE OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11244 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 6 |
| UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 5 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0905739 |
| Policy instance | 4 |
| UDC DENTAL OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 52031 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 3 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | TS05333525 |
| Policy instance | 2 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | PE1266 |
| Policy instance | 7 |
| SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 ) | |
| Policy contract number | TS05333525 |
| Policy instance | 8 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | TS05333525 |
| Policy instance | 9 |
| NORTH SHORE LIJ CARECONNECT HEALTH INSURANCE INC. (National Association of Insurance Commissioners NAIC id number: 15309 ) | |
| Policy contract number | L00170 |
| Policy instance | 10 |
| NORTH SHORE LIJ CARECONNECT HEALTH INSURANCE INC. (National Association of Insurance Commissioners NAIC id number: 15309 ) | |
| Policy contract number | L00171 |
| Policy instance | 11 |
| NORTH SHORE LIJ CARECONNECT HEALTH INSURANCE INC. (National Association of Insurance Commissioners NAIC id number: 15309 ) | |
| Policy contract number | L00172 |
| Policy instance | 12 |
| METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26298 ) | |
| Policy contract number | 9260100 |
| Policy instance | 13 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 0905739 |
| Policy instance | 14 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 100/5300448 |
| Policy instance | 1 |