Form 5500 · Employee benefit plan · SAN RAMON, CA
NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN
NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN of SAN RAMON, CA is a 1,435-participant construction employer — a large group whose insured benefits are disclosed on Schedule A of its Form 5500. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 3 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 77-6113549 · plan 501 · plan year 2024, filed Oct 5, 2025
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How this plan is funded
Fully insured as reported
The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.
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
Dental: NEWPORT DENTAL PLAN covers 29 of 1,435 participants (2%) on Schedule A.
Also declared: 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.
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 4 insured contracts covering health, dental, vision and stop-loss; the largest, with KAISER FOUNDATION HEALTH PLAN, INC., covers 952 people.
The filing declares health, dental, vision and life. Life appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
The filing lists a stop-loss contract. On its own that does not settle whether the plan pays its own claims.
Reported premium is $7,079,083; the filing discloses no broker commission on these contracts.
The health contract's policy period ended in August, while at least one ancillary line's policy period ended in December. The plan is on a split renewal cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 952 | Sep 1, 2024 | $6,257,121 | $0 |
| BLUE SHIELD OF CALIFORNIA LIFE HEALTH INSURANCE COMPANY | Stop-loss | 810 | Jan 1, 2025 | $622,263 | $0 |
| VISION SERVICE PLAN | Vision | 1,432 | Jan 1, 2025 | $183,851 | $0 |
| NEWPORT DENTAL PLAN | Dental | 29 | Jan 1, 2025 | $15,848 | $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.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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