Form 5500 · Employee benefit plan · NORWALK, CT
XEROX CORPORATION
The filing calls this plan XEROX MEDICAL CARE PLAN FOR RETIRED EMPLOYEES.
XEROX CORPORATION of NORWALK, CT spreads its employee benefits across 7 insurance carriers, according to its Form 5500 Schedule A. Coverage is written through KAISER FOUNDATION HEALTH PLAN, INC. and 6 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 16-0468020 · plan 511 · plan year 2024, filed Oct 15, 2025
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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
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., KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST and EXCELLUS BLUE CROSS BLUE SHIELD and others.
Reported premium is $5,807,152; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
7 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN, INC., KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, EXCELLUS BLUE CROSS BLUE SHIELD and MVP HEALTHCARE. 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 | 294 | Jan 1, 2025 | $2,298,457 | $0 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 180 | Jan 1, 2025 | $1,875,568 | $0 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | Health | 47 | Jan 1, 2025 | $458,083 | $0 |
| EXCELLUS BLUE CROSS BLUE SHIELD | Health | 160 | Jan 1, 2025 | $452,548 | $0 |
| MVP HEALTHCARE | Health | 146 | Jan 1, 2025 | $422,758 | $0 |
| KAISER FOUNDATION HEALTH PLAN OF GEORGIA, INC. | Health | 32 | Jan 1, 2025 | $231,531 | $0 |
| HEALTH NET | Health | 7 | Jan 1, 2025 | $55,289 | $0 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII | Health | 3 | Jan 1, 2025 | $12,918 | $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.
Reported to OSHA
Reported to OSHA for 2025: 590 employees, 19 recordable cases, 452 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
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