Form 5500 · Employee benefit plan · MCLOUD, OK
KICKAPOO TRIBE OF OKLAHOMA
The filing calls this plan KICKAPOO TRIBE OF OKLAHOMA BCBS MEDICAL AND DENTAL BENEFITS PLAN.
Public Form 5500 records show how KICKAPOO TRIBE OF OKLAHOMA of MCLOUD, OK, a public administration employer, structures its employee benefits. Coverage is written through BLUECROSS BLUESHIELD OF OKLAHOMA. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 73-1018494 · plan 512 · plan year 2025, filed Jul 15, 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
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
Schedule A lists 1 insured contract covering health and dental; the largest, with BLUECROSS BLUESHIELD OF OKLAHOMA, covers 786 people.
Reported premium is $5,823,983; the filing discloses no broker commission on these contracts.
The most recent policy period ended in September, and the plan year ends September 30. 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 |
|---|---|---|---|---|---|
| BLUECROSS BLUESHIELD OF OKLAHOMA | Health, Dental | 786 | Oct 1, 2025 | $5,823,983 | $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.
Other plans filed by this employer
How this plan compares
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