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BLUE CROSS BLUE SHIELD HEALTH PLAN 401k Plan overview

Plan NameBLUE CROSS BLUE SHIELD HEALTH PLAN
Plan identification number 511

BLUE CROSS BLUE SHIELD HEALTH PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    BOSTON MUTUAL LIFE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

    Company Name:BOSTON MUTUAL LIFE INSURANCE COMPANY
    Employer identification number (EIN):041106240
    NAIC Classification:524140

    Additional information about BOSTON MUTUAL LIFE INSURANCE COMPANY

    Jurisdiction of Incorporation: Georgia Department of States Corporations Division
    Incorporation Date:
    Company Identification Number: 734335

    More information about BOSTON MUTUAL LIFE INSURANCE COMPANY

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan BLUE CROSS BLUE SHIELD HEALTH PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5112019-01-01
    5112018-01-01
    5112017-01-01CHRISTINE COUGHLIN SUSAN GARDNER2018-09-14
    5112016-01-01KIM BROSNAN CHRISTINE COUGHLIN2017-09-15
    5112015-01-01KIM BROSNAN CHRISTINE COUGHLIN2016-09-15
    5112014-01-01KIM BROSNAN CHRISTINE COUGHLIN2015-09-15
    5112013-01-01CHRISTINE COUGHLIN KIM BROSNAN2014-09-15
    5112012-01-01KIM BROSNAN CHRISTINE COUGHLIN2013-09-16
    5112011-01-01ELEANOR GRANT CHRISTINE COUGHLIN2012-09-13
    5112009-01-01ELEANOR GRANT CHRISTINE COUGHLIN2010-09-15
    5112009-01-01ELEANOR GRANT2011-01-04

    Plan Statistics for BLUE CROSS BLUE SHIELD HEALTH PLAN

    401k plan membership statisitcs for BLUE CROSS BLUE SHIELD HEALTH PLAN

    Measure Date Value
    2019
    Total participants, beginning-of-year2019-01-01209
    Total number of active participants reported on line 7a of the Form 55002019-01-01210
    Number of retired or separated participants receiving benefits2019-01-0111
    Total of all active and inactive participants2019-01-01221
    Total participants2019-01-01221
    2018
    Total participants, beginning-of-year2018-01-01218
    Total number of active participants reported on line 7a of the Form 55002018-01-01199
    Number of retired or separated participants receiving benefits2018-01-019
    Total of all active and inactive participants2018-01-01208
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-011
    Total participants2018-01-01209
    2017
    Total participants, beginning-of-year2017-01-01219
    Total number of active participants reported on line 7a of the Form 55002017-01-01214
    Number of retired or separated participants receiving benefits2017-01-014
    Total of all active and inactive participants2017-01-01218
    Total participants2017-01-01218
    2016
    Total participants, beginning-of-year2016-01-01233
    Total number of active participants reported on line 7a of the Form 55002016-01-01217
    Number of retired or separated participants receiving benefits2016-01-012
    Total of all active and inactive participants2016-01-01219
    Total participants2016-01-01219
    2015
    Total participants, beginning-of-year2015-01-01233
    Total number of active participants reported on line 7a of the Form 55002015-01-01229
    Number of retired or separated participants receiving benefits2015-01-014
    Total of all active and inactive participants2015-01-01233
    Total participants2015-01-01233
    2014
    Total participants, beginning-of-year2014-01-01219
    Total number of active participants reported on line 7a of the Form 55002014-01-01231
    Number of retired or separated participants receiving benefits2014-01-012
    Total of all active and inactive participants2014-01-01233
    Total participants2014-01-01233
    2013
    Total participants, beginning-of-year2013-01-01229
    Total number of active participants reported on line 7a of the Form 55002013-01-01216
    Number of retired or separated participants receiving benefits2013-01-013
    Total of all active and inactive participants2013-01-01219
    Total participants2013-01-01219
    2012
    Total participants, beginning-of-year2012-01-01225
    Total number of active participants reported on line 7a of the Form 55002012-01-01225
    Number of retired or separated participants receiving benefits2012-01-014
    Total of all active and inactive participants2012-01-01229
    Total participants2012-01-01229
    2011
    Total participants, beginning-of-year2011-01-01204
    Total number of active participants reported on line 7a of the Form 55002011-01-01217
    Number of retired or separated participants receiving benefits2011-01-017
    Total of all active and inactive participants2011-01-01224
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
    Total participants2011-01-01225
    2009
    Total participants, beginning-of-year2009-01-01108
    Total number of active participants reported on line 7a of the Form 55002009-01-01199
    Number of retired or separated participants receiving benefits2009-01-016
    Total of all active and inactive participants2009-01-01205
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-011
    Total participants2009-01-01206

    Form 5500 Responses

    2019
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Submission has been amendedNo
    2019-01-01This submission is the final filingNo
    2019-01-01This return/report is a short plan year return/report (less than 12 months)No
    2019-01-01Plan is a collectively bargained planNo
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2018
    2018-01-01Type of plan entitySingle employer plan
    2018-01-01Submission has been amendedNo
    2018-01-01This submission is the final filingNo
    2018-01-01This return/report is a short plan year return/report (less than 12 months)No
    2018-01-01Plan is a collectively bargained planNo
    2018-01-01Plan funding arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2017
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Submission has been amendedNo
    2017-01-01This submission is the final filingNo
    2017-01-01This return/report is a short plan year return/report (less than 12 months)No
    2017-01-01Plan is a collectively bargained planNo
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2016
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Submission has been amendedNo
    2016-01-01This submission is the final filingNo
    2016-01-01This return/report is a short plan year return/report (less than 12 months)No
    2016-01-01Plan is a collectively bargained planNo
    2016-01-01Plan funding arrangement – InsuranceYes
    2016-01-01Plan benefit arrangement – InsuranceYes
    2015
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Submission has been amendedNo
    2015-01-01This submission is the final filingNo
    2015-01-01This return/report is a short plan year return/report (less than 12 months)No
    2015-01-01Plan is a collectively bargained planNo
    2015-01-01Plan funding arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2014
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01Submission has been amendedNo
    2014-01-01This submission is the final filingNo
    2014-01-01This return/report is a short plan year return/report (less than 12 months)No
    2014-01-01Plan is a collectively bargained planNo
    2014-01-01Plan funding arrangement – InsuranceYes
    2014-01-01Plan benefit arrangement – InsuranceYes
    2013
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Submission has been amendedNo
    2013-01-01This submission is the final filingNo
    2013-01-01This return/report is a short plan year return/report (less than 12 months)No
    2013-01-01Plan is a collectively bargained planNo
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2012
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Submission has been amendedNo
    2012-01-01This submission is the final filingNo
    2012-01-01This return/report is a short plan year return/report (less than 12 months)No
    2012-01-01Plan is a collectively bargained planNo
    2012-01-01Plan funding arrangement – InsuranceYes
    2012-01-01Plan benefit arrangement – InsuranceYes
    2011
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Submission has been amendedNo
    2011-01-01This submission is the final filingNo
    2011-01-01This return/report is a short plan year return/report (less than 12 months)No
    2011-01-01Plan is a collectively bargained planNo
    2011-01-01Plan funding arrangement – InsuranceYes
    2011-01-01Plan benefit arrangement – InsuranceYes
    2009
    2009-01-01Type of plan entitySingle employer plan
    2009-01-01Submission has been amendedNo
    2009-01-01This submission is the final filingNo
    2009-01-01This return/report is a short plan year return/report (less than 12 months)No
    2009-01-01Plan is a collectively bargained planNo
    2009-01-01Plan funding arrangement – InsuranceYes
    2009-01-01Plan benefit arrangement – InsuranceYes

    Insurance Providers Used on plan

    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered472
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered450
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered479
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered516
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Are there contracts with allocated funds for individual policies?No
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered518
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Are there contracts with allocated funds for individual policies?No
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered496
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Are there contracts with allocated funds for individual policies?No
    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
    Were dividends or retroactive rate refunds paid in cash?No
    Were dividends or retroactive rate refunds paid as a credit?No
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered520
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered521
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
    Policy contract number123562
    Policy instance 1
    Insurance contract or identification number123562
    Number of Individuals Covered456
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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