| Plan Name | KAISER PERMANENTE WELFARE BENEFIT PLAN |
| Plan identification number | 550 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | KAISER PERMANENTE MEDICAL CARE PROGRAM |
| Employer identification number (EIN): | 946365767 |
| NAIC Classification: | 621491 |
| NAIC Description: | HMO Medical Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 550 | 2012-01-01 | CYNTHIA GARA |
| 2012: KAISER PERMANENTE WELFARE BENEFIT PLAN 2012 form 5500 responses | ||
|---|---|---|
| 2012-01-01 | Type of plan entity | Mulitple employer plan |
| 2012-01-01 | Submission has been amended | Yes |
| 2012-01-01 | This submission is the final filing | Yes |
| 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 – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0140310 |
| Policy instance | 1 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | 0095960 |
| Policy instance | 13 |
| CONNECTICARE, INC. (National Association of Insurance Commissioners NAIC id number: 95675 ) | |
| Policy contract number | 005116 |
| Policy instance | 14 |
| GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) | |
| Policy contract number | 0124200 |
| Policy instance | 15 |
| HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 544 |
| Policy instance | 17 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0095910 |
| Policy instance | 16 |
| HAWAII DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 0000 ) | |
| Policy contract number | 1580 |
| Policy instance | 19 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0095930 |
| Policy instance | 18 |
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA INC. (National Association of Insurance Commissioners NAIC id number: 96237 ) | |
| Policy contract number | 2211-100 |
| Policy instance | 20 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) | |
| Policy contract number | 9424-001 |
| Policy instance | 21 |
| GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) | |
| Policy contract number | 1265700 |
| Policy instance | 12 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO (National Association of Insurance Commissioners NAIC id number: 95669 ) | |
| Policy contract number | 8809-001 |
| Policy instance | 11 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |
| Policy contract number | 0140410 |
| Policy instance | 2 |
| GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) | |
| Policy contract number | 0927000 |
| Policy instance | 3 |
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 5454 |
| Policy instance | 4 |
| GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) | |
| Policy contract number | 1019900 |
| Policy instance | 5 |
| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) | |
| Policy contract number | A6820 |
| Policy instance | 6 |
| GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 ) | |
| Policy contract number | 0903900 |
| Policy instance | 7 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 09599 |
| Policy instance | 8 |
| KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 ) | |
| Policy contract number | 1306-00 |
| Policy instance | 9 |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) | |
| Policy contract number | 13642-0 |
| Policy instance | 10 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 32717-001-11 |
| Policy instance | 22 |