Form 5500 · Employee benefit plan · LAWRENCEVILLE, GA
NATIONAL VISION INC.
The filing calls this plan NATIONAL VISION INC. HEALTHCARE PLAN.
Public Form 5500 records show how NATIONAL VISION INC. of LAWRENCEVILLE, GA, a retail employer, structures its employee benefits. Its broker of record is MARSH AND MCLENNAN AGENCY. Coverage is written through AETNA LIFE INSURANCE COMPANY and 5 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 58-1910859 · plan 501 · plan year 2025, filed Jul 30, 2026
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1,626 other employer plans in Georgia 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
Self-funded as reported
The filing reports a stop-loss contract and no medical premium, which is what a plan that pays its own claims reports.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
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 dental, life, disability and stop-loss; the largest, with AETNA LIFE INSURANCE COMPANY, covers 1,294 people.
The filing declares dental, life, disability and health. Health 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.
The only insured piece of the health benefit is stop-loss coverage, and the filing reports the plan paying its own claims. The 2 stop-loss contracts report $13,355,556 in premium and $0 in commission. The rest of the premium and commission above is on the plan's other insured lines, and none of it is medical premium.
Reported premium across the insured contracts is $17,420,852, with $368,333 in disclosed broker commissions — about 2.1% 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.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 3,518 | Jan 1, 2026 | $1,672,825 | $139,814 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 1,775 | Jan 1, 2026 | $1,019,454 | $102,007 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Disability | 3,304 | Jan 1, 2026 | $834,286 | $70,014 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 8,602 | Jan 1, 2026 | $449,859 | $45,230 |
| PREPAID LEGAL SERVICES INC DBA LEGAL SHIELD | — | 697 | Jan 1, 2026 | $86,515 | $11,192 |
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | — | 2 | Jan 1, 2026 | $2,357 | $76 |
| AETNA LIFE INSURANCE COMPANY | Stop-loss | 1,294 | Jan 1, 2026 | $10,766,645 | $0 |
| SYMETRA LIFE INSURANCE COMPANY | Stop-loss | 4,216 | Jan 1, 2026 | $2,588,911 | $0 |
| DELTA DENTAL INSURANCE COMPANY | Dental | 7,581 | 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. The service providers are named on Schedule C of this filing. We publish company names only.
Other plans filed by this employer
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Renewal calendar
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