Form 5500 · Employee benefit plan · DETROIT, MI
BLUE CROSS BLUE SHIELD OF MICHIGAN
The filing calls this plan BLUE CROSS BLUE SHIELD OF MICHIGAN RETIREE LIFE INSURANCE PLAN.
BLUE CROSS BLUE SHIELD OF MICHIGAN of DETROIT, MI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Coverage is written through DEARBORN LIFE INSURANCE COMPANY and 1 other carrier. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 38-2069753 · plan 509 · plan year 2024, filed Oct 10, 2025
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Life: the largest of the 2 insured life contracts, with DEARBORN LIFE INSURANCE COMPANY, covers 118 of 4,426 participants (2.7%) on Schedule A.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
All 2 insured contracts are life coverage, split across DEARBORN LIFE INSURANCE COMPANY and RELIASTAR LIFE INSURANCE COMPANY.
Reported premium is $687,596; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
Two carriers split the book: DEARBORN LIFE INSURANCE COMPANY and RELIASTAR LIFE INSURANCE COMPANY.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DEARBORN LIFE INSURANCE COMPANY | Life | 118 | Jan 1, 2025 | $687,596 | $0 |
| RELIASTAR LIFE INSURANCE COMPANY | Life | 4,275 | Jan 1, 2025 | — | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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