Form 5500 · Employee benefit plan · MESA, AZ
DAICEL SAFETY SYSTEMS AMERICAS, INC.
The filing calls this plan DAICEL SAFETY SYSTEMS AMERICAS, INC. EMPLOYEE BENEFITS PLAN.
DAICEL SAFETY SYSTEMS AMERICAS, INC. of MESA, AZ spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is ORION RISK MANAGEMENT INSURANCE. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in February.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 45-3640209 · plan 502 · plan year 2026, filed Sep 8, 2026
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45 other employer plans in Arizona have policy years ending in February. 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 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.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 547 people.
Reported premium across the insured contracts is $1,718,786, with $196,248 in disclosed broker commissions — about 11% of premium.
The most recent policy period ended in February, and the plan year ends February 28. Group contracts typically renew on that annual cycle.
ORION RISK MANAGEMENT INSURANCE is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including CIGNA HEALTH AND LIFE INSURANCE COMPANY, LIFE INSURANCE COMPANY OF NORTH AMERICA, STANDARD INSURANCE COMPANY and CIGNA HEALTHCARE OF CALIFORNIA. CIGNA HEALTH AND LIFE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental | 547 | Mar 1, 2026 | $1,416,891 | $164,995 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA | Life, Disability | 456 | Mar 1, 2026 | $263,055 | $26,306 |
| STANDARD INSURANCE COMPANY | Vision | 322 | Mar 1, 2026 | $34,112 | $3,678 |
| CIGNA HEALTHCARE OF CALIFORNIA | Health | 2 | Mar 1, 2026 | $4,728 | $1,269 |
Premium and claims on these contracts
CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3340782. For the contract year on this filing, the carrier reported $638,741 in premium earned and $1,250,218 in claims incurred. Dividing one by the other gives 196%.
STANDARD INSURANCE COMPANY, contract 761148. For the contract year on this filing, the carrier reported $34,112 in premium earned and $18,358 in claims incurred. Dividing one by the other gives 54%.
CIGNA HEALTHCARE OF CALIFORNIA, contract 3340782. For the contract year on this filing, the carrier reported $4,728 in premium earned and $-10,363 in claims incurred. Dividing one by the other gives -219%.
- CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3340782 reported $547,086 in retention.
- STANDARD INSURANCE COMPANY, contract 761148 reported $17,060 in retention.
- CIGNA HEALTHCARE OF CALIFORNIA, contract 3340782 reported $4,728 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.
Reported to OSHA
Reported to OSHA for 2025: 464 employees, 3 recordable cases, 0 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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