Form 5500 · Employee benefit plan · SAN JOSE, CA
BOARD OF TRUSTEES, SAN MATEO ELECTRICAL WORKERS HEALTH PLAN
The filing calls this plan SAN MATEO ELECTRICAL WORKERS HEALTH PLAN.
BOARD OF TRUSTEES, SAN MATEO ELECTRICAL WORKERS HEALTH PLAN of SAN JOSE, CA is a 1,411-participant construction employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is CAPITAL PEAK LLC. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 6 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 94-6077924 · plan 501 · plan year 2025, filed Mar 12, 2026
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323 other employer plans in California have policy years ending in May. See the full list on the renewal calendar, or ask for it in Claude or ChatGPT.
How this plan is funded
Fully insured as reported
The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
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
Schedule A lists 7 insured contracts covering health, dental, vision, life and stop-loss; the largest, with KAISER FOUNDATION HEALTH PLAN, INC., covers 796 people.
The filing declares health, dental, vision, life and disability. Disability appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
The filing lists a stop-loss contract. On its own that does not settle whether the plan pays its own claims.
Reported premium across the insured contracts is $12,638,876, with $538,256 in disclosed broker commissions — about 4.3% of premium.
The health contract's policy period ended in May, while at least one ancillary line's policy period ended in September. The plan is on a split renewal cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| SUN LIFE ASSURANCE COMPANY OF CANADA | Stop-loss | 759 | Jun 1, 2025 | $2,694,318 | $538,256 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 796 | Jun 1, 2025 | $7,667,975 | $0 |
| AMERITAS LIFE INSURANCE CORP. | Dental | 2,604 | Jun 1, 2025 | $1,367,506 | $0 |
| DELTA DENTAL PLAN OF CALIFORNIA | Dental | 0 | Oct 1, 2024 | $499,510 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY | Life | 1,041 | Sep 1, 2024 | $223,925 | $0 |
| VISION SERVICE PLAN | Vision | 938 | Jun 1, 2025 | $133,853 | $0 |
| UNITED BEHAVIORAL HEALTH DBA OPTUM | — | 994 | Jun 1, 2025 | $51,789 | $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. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
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Renewal calendar
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