Form 5500 · Employee benefit plan · SIOUX CITY, IA
HEALTH INC BENEFIT PLAN
The filing calls this plan HEALTH INC SECTION 125 CAFETERIA PLAN.
HEALTH INC BENEFIT PLAN of SIOUX CITY, IA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is GALLAGHER BENEFIT SERVICES, INC.. Coverage is written through UNITEDHEALTHCARE INSURANCE COMPANY and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 31-1712115 · plan 501 · plan year 2024, filed Jul 31, 2025
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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.
The filing carries code 4S: this plan is filing again after previously being exempt.
Benefits declared on this filing
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 7 insured contracts covering health, dental, vision, life and disability; the largest, with UNITEDHEALTHCARE INSURANCE COMPANY, covers 187 people.
Reported premium across the insured contracts is $1,860,610, with $29,078 in disclosed broker commissions — about 1.6% 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.
GALLAGHER BENEFIT SERVICES, INC. is the broker of record on 3 of the 7 contracts; the rest name a different broker or none.
5 carriers appear on the filing, including UNITEDHEALTHCARE INSURANCE COMPANY, RELIANCE STANDARD LIFE INSURANCE COMPANY, WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA and AMERICAN HERITAGE LIFE INSURANCE COMPANY. UNITEDHEALTHCARE INSURANCE COMPANY writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability | 149 | Jan 1, 2025 | $127,335 | $12,734 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life | 153 | Jan 1, 2025 | $43,298 | $4,304 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY | Disability | 95 | Jan 1, 2025 | $25,258 | $4,024 |
| WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA | Dental | 116 | Jan 1, 2025 | $96,889 | $2,836 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Disability | 153 | Jan 1, 2025 | $26,487 | $2,649 |
| FIDELITY SECURITY LIFE INSURANCE COMPANY | Vision | 195 | Jan 1, 2025 | $21,486 | $2,531 |
| UNITEDHEALTHCARE INSURANCE COMPANY | Health | 187 | Jan 1, 2025 | $1,519,857 | $0 |
Premium and claims on this contract
WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA, contract A61. For the contract year on this filing, the carrier reported $96,889 in premium earned and $87,956 in claims incurred. Dividing one by the other gives 91%.
- WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA, contract A61 reported $8,933 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.
How this plan compares
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