Form 5500 · Employee benefit plan · ROCHESTER, NY
EXCELLUS HEALTH PLAN INC
The filing calls this plan EXCELLUS GROUP TERM LIFE INSURANCE PLAN.
EXCELLUS HEALTH PLAN INC of ROCHESTER, NY is a 5,851-participant finance and insurance employer — a large group whose insured benefits are disclosed on Schedule A of its Form 5500. Coverage is written through RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 15-0329043 · plan 507 · plan year 2024, filed Jul 30, 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
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.
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
The filing discloses a single insured line, life, through RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK, covering 5,728 people.
Reported premium is $2,641,955; 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.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK | Life | 5,728 | Jan 1, 2025 | $2,641,955 | $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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