Form 5500 · Employee benefit plan · MILPITAS, CA
SEMI
The filing calls this plan SEMI HEALTH & WELFARE PLAN.
Public Form 5500 records show how SEMI of MILPITAS, CA, a professional services employer, structures its employee benefits. Its broker of record is ACRISURE WEST INSURANCE SERVICES LL. Coverage is written through ANTHEM BLUE CROSS and 6 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 94-1751440 · plan 501 · plan year 2025, filed May 27, 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: 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 8 insured contracts covering health, dental, vision, life and disability; the largest, with ANTHEM BLUE CROSS, covers 127 people.
Reported premium across the insured contracts is $2,560,672, with $135,947 in disclosed broker commissions — about 5.3% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in August. The plan is on a split renewal cycle.
ACRISURE WEST INSURANCE SERVICES LL is the broker of record on 1 of the 8 contracts; the rest name a different broker or none.
7 carriers appear on the filing, including ANTHEM BLUE CROSS, KAISER FOUNDATION HEALTH PLAN, INC., UNUM LIFE INSURANCE COMPANY OF AMERICA and VISION SERVICE PLAN. ANTHEM BLUE CROSS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS | Health | 127 | Jan 1, 2026 | $1,427,056 | $58,024 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 71 | Jan 1, 2026 | $874,810 | $52,436 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 127 | Jan 1, 2026 | $163,608 | $16,124 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | — | 32 | Jan 1, 2026 | $27,777 | $5,383 |
| VISION SERVICE PLAN | Vision | 120 | Jan 1, 2026 | $44,209 | $3,701 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental | 120 | Jan 1, 2026 | $9,315 | $279 |
| CONCERN EAP | — | 117 | Sep 1, 2025 | $8,697 | $0 |
| CONCERN EAP | — | 124 | Jan 1, 2026 | $5,200 | $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
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