Form 5500 · Employee benefit plan · LIVERMORE, CA
FORMFACTOR, INC.
The filing calls this plan FORMFACTOR, INC. GROUP WELFARE BENEFIT PLAN.
FORMFACTOR, INC. of LIVERMORE, CA spreads its employee benefits across 9 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is USI INSURANCE SERVICES LLC. Coverage is written through CIGNA HEALTH AND LIFE INSURANCE COMPANY and 8 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 13-3711155 · plan 502 · plan year 2025, filed Aug 27, 2026
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5,257 other employer plans in California have policy years ending in December. 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
2 contracts on this filing do not say which benefits they cover, so a line above may be insured by one of them.
Also declared: prepaid legal, 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 9 insured contracts covering health, dental, life and disability; the largest, with CIGNA HEALTH AND LIFE INSURANCE COMPANY, covers 1,339 people.
The filing declares health, dental, life, disability and vision. Vision 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 one of the 2 contracts here that do not say what they cover.
Reported premium across the insured contracts is $26,122,174, with $53,675 in disclosed broker commissions — about 0.2% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in October. The plan is on a split renewal cycle.
USI INSURANCE SERVICES LLC is the broker of record on 2 of the 9 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Health, Life, Disability | 1,579 | Jan 1, 2026 | $1,620,742 | $35,446 |
| TRUSTMARK INSURANCE COMPANY | Life | 26 | Nov 1, 2025 | $42,902 | $9,067 |
| FOUR EVER LIFE INS CO. | Health | 8 | Jan 1, 2026 | $88,516 | $5,388 |
| METROPOLITAN GENERAL INSURANCE COMPANY | — | 253 | Jan 1, 2026 | $69,006 | $3,774 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | Health, Dental | 1,339 | Jan 1, 2026 | $12,425,792 | $0 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 1,338 | Jan 1, 2026 | $10,240,008 | $0 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | Health | 172 | Jan 1, 2026 | $1,381,824 | $0 |
| KAISER FOUNDATION HEALTH PLAN OF COLORADO | Health | 41 | Jan 1, 2026 | $244,887 | $0 |
| FEDERAL INSURANCE COMPANY | — | 1,579 | Jan 1, 2026 | $8,497 | $0 |
Premium and claims on this contract
CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3340216. For the contract year on this filing, the carrier reported $12,297,646 in premium earned and $12,593,819 in claims incurred. Dividing one by the other gives 102%.
- CIGNA HEALTH AND LIFE INSURANCE COMPANY, contract 3340216 reported $1,422,891 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
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