Form 5500 · Employee benefit plan · FORT WAYNE, IN
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA, INC.
The filing calls this plan PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA, INC. MASTER WELFARE BENEFITS PLAN.
PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA, INC. of FORT WAYNE, IN files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is PHILLIPS BENEFITS ADVISORS, LLC. Coverage is written through PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC and 5 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 31-1069321 · plan 501 · plan year 2024, filed Sep 15, 2025
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
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
4 contracts on this filing do not say which benefits they cover, so a line above may be insured by one of them.
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 6 insured contracts covering health, vision, life and disability; the largest, with PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC, covers 244 people.
The filing declares health, vision, life, disability and dental. Dental 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 4 contracts here that do not say what they cover.
Reported premium across the insured contracts is $2,613,959, with $21,626 in disclosed broker commissions — about 0.8% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in January. The plan is on a split renewal cycle.
PHILLIPS BENEFITS ADVISORS, LLC is the broker of record on 1 of the 6 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Vision, Life, Disability | 148 | Jan 1, 2025 | $139,780 | $21,142 |
| ASSURITY LIFE INSURANCE COMPANY | — | 2 | Jan 1, 2025 | $2,484 | $357 |
| TRANSAMERICA LIFE INSURANCE COMPANY | — | 3 | Jan 1, 2025 | $1,016 | $127 |
| PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA INC | Health | 244 | Jan 1, 2025 | $2,462,084 | $0 |
| CROSSWINDS COUNSELING | — | 39 | Jan 1, 2025 | $6,345 | $0 |
| HARTFORD LIFE AND ACCIDENT | — | 148 | Feb 1, 2024 | $2,250 | $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. We publish company names only.
Other plans filed by this employer
How this plan compares
Subscribers see how this compares with similar plans in Indiana. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in Indiana — largest plans, brokers, carriers and renewal months.