Form 5500 · Employee benefit plan · HAUPPAUGE, NY
CLEARVISION OPTICAL COMPANY, INC.
The filing calls this plan CLEARVISION OPTICAL HEALTH AND WELFARE PLAN.
CLEARVISION OPTICAL COMPANY, INC. of HAUPPAUGE, NY insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 11-1868628 · plan 501 · plan year 2025, filed Aug 18, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
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 5 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 110 people.
Reported premium across the insured contracts is $956,666, with $11,195 in disclosed broker commissions — about 1.2% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES LLC is the broker of record on 3 of the 5 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK, AFLAC and AMERITAS LIFE INSURANCE CORP. OF NEW YORK. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| LINCOLN LIFE & ANNUITY COMPANY OF NEW YORK | Life, Disability | 123 | Jan 1, 2026 | $73,127 | $4,478 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental | 69 | Jan 1, 2026 | $50,383 | $3,681 |
| AFLAC | Disability | 20 | Jan 1, 2026 | $24,640 | $2,652 |
| AMERITAS LIFE INSURANCE CORP. OF NEW YORK | Vision | 123 | Jan 1, 2026 | $7,674 | $384 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health | 110 | Jan 1, 2026 | $800,842 | $0 |
Premium and claims on this contract
CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 635380. For the contract year on this filing, the carrier reported $675,959 in premium earned and $1,002,941 in claims incurred. Dividing one by the other gives 148%.
- CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 635380 reported $48,637 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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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