Capital Blue Cross
Overview
Capital Blue Cross sponsors a self-funded health plan that covered 2,248 participants in plan year 2025, about the same as the prior year. The plan year starts in January. Alongside medical, its benefits filing reports life insurance, dental, vision, long-term disability, and more.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 2,248 · prior year 2,282
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Capital Blue Cross Welfare Benefit Plan, plan 510 (2,248 participants); Capital Blue Cross Retiree Medical Plan, plan 512 (1,441 participants); Capital Blue Cross Medical and Life Insurance Plan for Disabled Former Employees, plan 511 (28 participants)
- Broker compensation
- $36K across insured contracts
Insurance carriers
Insured coverage reported on Schedule A. Self-funded medical claims aren't reported there.
| Carrier | Coverage | Covered | Premium | Broker comp |
|---|---|---|---|---|
| Dearborn Life Insurance Company | Life | 2,147 | $707K | $35K |
| Unum Life Insurance Company of America | Long-term disability | 2,035 | $410K | — |
| Unum Insurance Company | Short-term disability | 468 | $226K | — |
| Zurich American Insurance Company | AD&D | 2,001 | $3K | $405 |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 2,248 participants × $2,371 national average per member. Usually higher once dependents are counted.
Typical savings opportunity found in independent reviews of plans this size.
Form 5500 filing details
- Filing
- Form 5500 with Schedule A, plan year 2025
- Plan sponsor
- Capital Blue Cross
- Sponsor EIN
- 23-0455154
- Plan numbers
- 510, 512, 511
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 23-0455154 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Capital Blue Cross Employee Savings Plan
- Type
- 401(k) plan
- Participants
- 2,883
About this data
Source: Capital Blue Cross's Form 5500 filing for plan year 2025 and its Schedule A insurance reports, published by the U.S. Department of Labor. "Self-funded" means the filing reports benefits paid from employer assets or a trust, with no medical insurance contract or with a stop-loss contract. Pharmacy figures are StreamRX estimates based on national averages. StreamRX is not affiliated with Capital Blue Cross.