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BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 401k Plan overview

Plan NameBLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN
Plan identification number 502

BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

BLUE CROSS BLUE SHIELD OF TENNESSEE has sponsored the creation of one or more 401k plans.

Company Name:BLUE CROSS BLUE SHIELD OF TENNESSEE
Employer identification number (EIN):620427913
NAIC Classification:524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022024-01-01DANIEL GREGORY
5022023-01-01
5022023-01-01DANIEL GREGORY
5022022-01-01
5022022-01-01DANIEL GREGORY
5022021-01-01
5022021-01-01DANIEL GREGORY
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01TREY WHITE
5022016-01-01TREY WHITE
5022015-01-01TREY WHITE
5022014-01-01TREY WHITE
5022013-01-01TREY WHITE TREY WHITE2014-10-02
5022012-01-01RALPH WOODARD
5022011-01-01RALPH WOODARD
5022010-01-01RALPH WOODARD
5022009-01-01RALPH WOODARD

Plan Statistics for BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN

401k plan membership statisitcs for BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN

Measure Date Value
2023: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-016,861
Total number of active participants reported on line 7a of the Form 55002023-01-016,621
Number of retired or separated participants receiving benefits2023-01-01569
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-017,190
2022: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-016,850
Total number of active participants reported on line 7a of the Form 55002022-01-016,281
Number of retired or separated participants receiving benefits2022-01-01580
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-016,861
2021: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-017,411
Total number of active participants reported on line 7a of the Form 55002021-01-016,256
Number of retired or separated participants receiving benefits2021-01-01594
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-016,850
2020: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-017,216
Total number of active participants reported on line 7a of the Form 55002020-01-016,791
Number of retired or separated participants receiving benefits2020-01-01620
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-017,411
2019: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-017,024
Total number of active participants reported on line 7a of the Form 55002019-01-016,604
Number of retired or separated participants receiving benefits2019-01-01612
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-017,216
2018: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-016,703
Total number of active participants reported on line 7a of the Form 55002018-01-016,364
Number of retired or separated participants receiving benefits2018-01-01660
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-017,024
2017: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-016,567
Total number of active participants reported on line 7a of the Form 55002017-01-016,056
Number of retired or separated participants receiving benefits2017-01-01647
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-016,703
2016: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-016,476
Total number of active participants reported on line 7a of the Form 55002016-01-015,955
Number of retired or separated participants receiving benefits2016-01-01612
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-016,567
2015: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-016,006
Total number of active participants reported on line 7a of the Form 55002015-01-015,850
Number of retired or separated participants receiving benefits2015-01-01621
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-016,471
Total participants2015-01-016,471
2014: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-015,755
Total number of active participants reported on line 7a of the Form 55002014-01-015,374
Number of retired or separated participants receiving benefits2014-01-01632
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-016,006
Total participants2014-01-016,006
2013: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-015,861
Total number of active participants reported on line 7a of the Form 55002013-01-015,118
Number of retired or separated participants receiving benefits2013-01-01725
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-015,843
2012: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-015,276
Total number of active participants reported on line 7a of the Form 55002012-01-015,155
Number of retired or separated participants receiving benefits2012-01-01637
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-015,792
2011: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-015,916
Total number of active participants reported on line 7a of the Form 55002011-01-015,276
Number of retired or separated participants receiving benefits2011-01-01691
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-015,967
2010: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-015,767
Total number of active participants reported on line 7a of the Form 55002010-01-015,422
Number of retired or separated participants receiving benefits2010-01-01459
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-015,881
Total participants2010-01-015,881
2009: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-015,284
Total number of active participants reported on line 7a of the Form 55002009-01-015,316
Number of retired or separated participants receiving benefits2009-01-01439
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-015,755

Form 5500 Responses for BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN

2023: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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
2019: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2019 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2018 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2017 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2016 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2015 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2014 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2013 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2012 form 5500 responses
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: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2011 form 5500 responses
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
2010: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: BLUECROSS BLUESHIELD OF TENNESSEE LIFE AND AD&D PLAN 2009 form 5500 responses
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

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
Insurance contract or identification number50000608
Number of Individuals Covered4428
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $31,999
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 BenefitNo
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 providedVOLUNTARY AD&D
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 $336,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
Insurance contract or identification number50000608
Number of Individuals Covered6847
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $186,037
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, DEPENDENT LIFE, GROUP TERM LIFE
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 $1,958,293
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230180
Policy instance 7
Insurance contract or identification number0230180
Number of Individuals Covered1628
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $45,990
Total amount of fees paid to insurance companyUSD $4,136
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 providedHOSPITAL
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 $230,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
Insurance contract or identification number50000608
Number of Individuals Covered6055
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $219,473
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
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 $2,310,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract numberGS0000009
Policy instance 4
Insurance contract or identification numberGS0000009
Number of Individuals Covered0
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedUNIVERSAL LIFE
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 $288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230178
Policy instance 5
Insurance contract or identification number0230178
Number of Individuals Covered2667
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $55,204
Total amount of fees paid to insurance companyUSD $9,266
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 providedCRITICAL ILLNESS
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 $524,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230179
Policy instance 6
Insurance contract or identification number0230179
Number of Individuals Covered2609
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $32,391
Total amount of fees paid to insurance companyUSD $2,891
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 providedACCIDENT
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 $162,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
Insurance contract or identification number50000608
Number of Individuals Covered6696
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $183,042
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, DEPENDENT LIFE, GROUP TERM LIFE
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 $1,926,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
Insurance contract or identification number50000608
Number of Individuals Covered3725
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $26,457
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 BenefitNo
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 providedVOLUNTARY AD&D
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 $278,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
Insurance contract or identification number50000608
Number of Individuals Covered5170
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $190,279
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY GROUP TERM LIFE
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 $2,002,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230178
Policy instance 5
Insurance contract or identification number0230178
Number of Individuals Covered2772
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $114,381
Total amount of fees paid to insurance companyUSD $10,836
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 providedCRITICAL ILLNESS
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 $537,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230179
Policy instance 6
Insurance contract or identification number0230179
Number of Individuals Covered2668
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $33,223
Total amount of fees paid to insurance companyUSD $3,310
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 providedACCIDENT
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 $166,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230180
Policy instance 7
Insurance contract or identification number0230180
Number of Individuals Covered1716
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $49,067
Total amount of fees paid to insurance companyUSD $4,806
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 providedHOSPITAL
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 $247,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract numberGS0000009
Policy instance 4
Insurance contract or identification numberGS0000009
Number of Individuals Covered1
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedUNIVERSAL LIFE
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 $288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401I
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401I
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract numberGS0000009
Policy instance 7
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230178
Policy instance 8
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230179
Policy instance 9
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0230180
Policy instance 10
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401I
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 7
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 7
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 7
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 7
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 7
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 5
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 6
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number110984401
Policy instance 8
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 2
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 3
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 4
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number50000608
Policy instance 1

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