Form 5500 · Employee benefit plan · LOS ANGELES, CA
TEAM RUBICON
The filing calls this plan TEAM RUBICON HEALTH AND WELFARE PLAN.
TEAM RUBICON of LOS ANGELES, CA files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is WORD & BROWN INS ADMINISTRATORS INC. Coverage is written through ANTHEM BLUE CROSS AND BLUE SHIELD INS. CO. and 1 other carrier. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 27-1720480 · plan 507 · plan year 2025, filed Dec 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
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.
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 2 insured contracts covering health, dental, vision, life and disability; the largest, with ANTHEM BLUE CROSS AND BLUE SHIELD INS. CO., covers 245 people.
Reported premium is $2,067,953; the filing discloses no broker commission on these contracts.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
WORD & BROWN INS ADMINISTRATORS INC is the broker of record on 1 of the 2 contracts; the rest name a different broker or none.
Two carriers split the book: ANTHEM BLUE CROSS AND BLUE SHIELD INS. CO. and HARTFORD LIFE AND ACCIDENT.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| ANTHEM BLUE CROSS AND BLUE SHIELD INS. CO. | Health, Dental, Vision | 245 | Jul 1, 2025 | $1,977,161 | $0 |
| HARTFORD LIFE AND ACCIDENT | Life, Disability | 161 | Jul 1, 2025 | $90,792 | $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.
Other plans filed by this employer
How this plan compares
Subscribers see how this compares with similar plans in California. 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 California — largest plans, brokers, carriers and renewal months.