Form 5500 · Employee benefit plan · PROVIDENCE, RI
DELTA DENTAL OF RHODE ISLAND
The filing calls this plan DELTA DENTAL OF RHODE ISLAND WELFARE WRAP PLAN.
DELTA DENTAL OF RHODE ISLAND of PROVIDENCE, RI files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is GALLAGHER BENEFIT SRVCS. Coverage is written through BLUE CROSS BLUE SHIELD OF RHODE ISLAND and 4 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 05-0296998 · plan 501 · plan year 2025, filed Jun 29, 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: 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 14 insured contracts covering health, dental, vision, life and disability; the largest, with BLUE CROSS BLUE SHIELD OF RHODE ISLAND, covers 219 people.
Reported premium across the insured contracts is $2,605,710, with $28,936 in disclosed broker commissions — about 1.1% of premium.
The health contract's policy period ended in June, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
GALLAGHER BENEFIT SRVCS is the broker of record on 1 of the 14 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including BLUE CROSS BLUE SHIELD OF RHODE ISLAND, PRUDENTIAL INSURANCE COMPANY OF AMERICA, JOHN HANCOCK LIFE AND HEALTH INSURANCE COMPANY and DELTA DENTAL OF RHODE ISLAND. BLUE CROSS BLUE SHIELD OF RHODE ISLAND writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PRUDENTIAL INSURANCE COMPANY OF AMERICA | Life, Disability | 131 | Jan 1, 2026 | $130,841 | $24,428 |
| JOHN HANCOCK LIFE AND HEALTH INSURANCE COMPANY | — | 49 | Jan 1, 2026 | $76,847 | $1,539 |
| BLUE CROSS BLUE SHIELD OF RHODE ISLAND | Health | 219 | Jul 1, 2025 | $2,352,925 | $1,005 |
| DELTA DENTAL OF RHODE ISLAND | Vision | 100 | Jan 1, 2026 | $6,452 | $968 |
| DELTA DENTAL OF RHODE ISLAND | Vision | 74 | Jan 1, 2026 | $5,366 | $805 |
| DELTA DENTAL OF RHODE ISLAND | Vision | 18 | Jan 1, 2026 | $1,270 | $191 |
| PRUDENTIAL INSURANCE COMPANY OF AMERICA | Life | 87 | Jan 1, 2026 | $32,009 | $0 |
| ALTUS DENTAL INSURANCE COMPANY, INC. | Dental | 13 | Jan 1, 2026 | — | $0 |
| ALTUS DENTAL INSURANCE COMPANY, INC. | Dental | 1 | Jan 1, 2026 | — | $0 |
| ALTUS DENTAL INSURANCE COMPANY, INC. | Dental | 14 | Jan 1, 2026 | — | $0 |
| DELTA DENTAL OF RHODE ISLAND | Dental | 19 | Jan 1, 2026 | — | $0 |
| DELTA DENTAL OF RHODE ISLAND | Dental | 8 | Jan 1, 2026 | — | $0 |
| DELTA DENTAL OF RHODE ISLAND | Dental | 88 | Jan 1, 2026 | — | $0 |
| DELTA DENTAL OF RHODE ISLAND | Dental | 54 | Jan 1, 2026 | — | $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
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