Form 5500 · Employee benefit plan · ENGLEWOOD CLIFFS, NJ
SAMSUNG ELECTRONICS AMERICA, INC.
The filing calls this plan SAMSUNG ELECTRONICS AMERICA, INC. HEALTH AND WELFARE PLAN.
Public Form 5500 records show how SAMSUNG ELECTRONICS AMERICA, INC. of ENGLEWOOD CLIFFS, NJ, a wholesale trade employer, structures its employee benefits. Its broker of record is CUSTOM BENEFITS PROGRAMS INC. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 13-2951153 · plan 501 · plan year 2024, filed Oct 15, 2025
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1,512 other employer plans in New Jersey 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
Both, as reported
The medical insurance contracts on the filing cover fewer than half the people in the plan, so the rest is paid another way.
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
Health: the largest of the 4 insured health contracts, with KAISER FOUNDATION HEALTH PLAN, INC., covers 173 of 4,855 participants (3.6%) on Schedule A.
Also declared: 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
All 8 insured contracts are health coverage, split across KAISER FOUNDATION HEALTH PLAN, INC., CIGNA HEALTH AND LIFE INSURANCE COMPANY and LYRA HEALTH, INC. and others.
Reported premium across the insured contracts is $3,916,115, with $91,727 in disclosed broker commissions — about 2.3% 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.
CUSTOM BENEFITS PROGRAMS INC is the broker of record on 3 of the 8 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN, INC., CIGNA HEALTH AND LIFE INSURANCE COMPANY, LYRA HEALTH, INC. and MCS LIFE INSURANCE COMPANY. KAISER FOUNDATION HEALTH PLAN, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | 679 | Jan 1, 2025 | $799,847 | $35,334 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | 679 | Jan 1, 2025 | $405,898 | $29,210 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY | — | 679 | Jan 1, 2025 | $518,068 | $24,617 |
| MCS LIFE INSURANCE COMPANY | Health | 0 | Jan 1, 2025 | $51,833 | $2,566 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 173 | Jan 1, 2025 | $1,221,127 | $0 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 89 | Jan 1, 2025 | $622,846 | $0 |
| LYRA HEALTH, INC. | — | 11,875 | Jan 1, 2025 | $282,652 | $0 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 1 | Jan 1, 2025 | $13,844 | $0 |
Premium and claims on this contract
MCS LIFE INSURANCE COMPANY, contract 79-860478. For the contract year on this filing, the carrier reported $51,833 in premium earned and $11,649 in claims incurred. Dividing one by the other gives 22%.
- MCS LIFE INSURANCE COMPANY, contract 79-860478 reported $2,566 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
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