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BLUE CROSS BLUE SHEILD OF NORTH CAROLINA 401k Plan overview

Plan NameBLUE CROSS BLUE SHEILD OF NORTH CAROLINA
Plan identification number 502

BLUE CROSS BLUE SHEILD OF NORTH CAROLINA Benefits

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

401k Sponsoring company profile

PRIMARY HEALTH CHOICE, INC. has sponsored the creation of one or more 401k plans.

Company Name:PRIMARY HEALTH CHOICE, INC.
Employer identification number (EIN):562384240
NAIC Classification:621330
NAIC Description:Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CROSS BLUE SHEILD OF NORTH CAROLINA

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01
5022020-01-01

Plan Statistics for BLUE CROSS BLUE SHEILD OF NORTH CAROLINA

401k plan membership statisitcs for BLUE CROSS BLUE SHEILD OF NORTH CAROLINA

Measure Date Value
2021: BLUE CROSS BLUE SHEILD OF NORTH CAROLINA 2021 401k membership
Total participants, beginning-of-year2021-01-013
Total number of active participants reported on line 7a of the Form 55002021-01-013
Total of all active and inactive participants2021-01-013
Total participants2021-01-013
2020: BLUE CROSS BLUE SHEILD OF NORTH CAROLINA 2020 401k membership
Total participants, beginning-of-year2020-01-012
Total number of active participants reported on line 7a of the Form 55002020-01-012
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-012
Total participants2020-01-012
Number of employers contributing to the scheme2020-01-010

Form 5500 Responses for BLUE CROSS BLUE SHEILD OF NORTH CAROLINA

2021: BLUE CROSS BLUE SHEILD OF NORTH CAROLINA 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: BLUE CROSS BLUE SHEILD OF NORTH CAROLINA 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01First time form 5500 has been submittedYes
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14159615-1001
Policy instance 1
Insurance contract or identification number14159615-1001
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $273
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedWELLNESS, POS CONTRACT
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 $20,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $273
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14159615-1001
Policy instance 1
Insurance contract or identification number14159615-1001
Number of Individuals Covered2
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $269
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedWELLNESS POS CONTRACT
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 $22,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $269
Amount paid for insurance broker fees0

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