Form 5500 · Employee benefit plan · TEMECULA, CA
OPTO 22
The filing calls this plan OPTO 22 EMPLOYEE BENEFITS PLAN.
Public Form 5500 records show how OPTO 22 of TEMECULA, CA, a manufacturing employer, structures its employee benefits. Its broker of record is GALLAGHER BENEFITS SERVICES, INC.. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 2 other carriers. The plan's most recent policy period ended in August.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 95-2896389 · plan 522 · plan year 2025, filed Mar 9, 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
Also declared: death benefits.
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 3 insured contracts covering health, dental, vision, life and disability; the largest, with KAISER FOUNDATION HEALTH PLAN, INC., covers 112 people.
Reported premium across the insured contracts is $2,348,398, with $62,613 in disclosed broker commissions — about 2.7% of premium.
The most recent policy period ended in August, and the plan year ends August 31. Group contracts typically renew on that annual cycle.
GALLAGHER BENEFITS SERVICES, INC. is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN, INC., STANDARD INSURANCE COMPANY and UNITED OF OMAHA LIFE INSURANCE COMPANY. KAISER FOUNDATION HEALTH PLAN, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN, INC. | Health, Vision | 112 | Sep 1, 2025 | $2,207,268 | $41,938 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life, Disability | 133 | Sep 1, 2025 | $49,726 | $10,358 |
| STANDARD INSURANCE COMPANY | Dental | 119 | Sep 1, 2025 | $91,404 | $10,317 |
Premium and claims on this contract
STANDARD INSURANCE COMPANY, contract 160302. For the contract year on this filing, the carrier reported $91,404 in premium earned and $62,916 in claims incurred. Dividing one by the other gives 69%.
- STANDARD INSURANCE COMPANY, contract 160302 reported $28,925 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
How this plan compares
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