Carilion Clinic

Roanoke, VA Health careNAICS 622000

Self-funded health planPlan year 2025Renews January
12,954Participants+3% vs. prior year
$30.7MEst. pharmacy spend / yrParticipants × national avg.
Jan 2027Next renewalPlan year begins January 1
#3 of 34Health care in VABy participants

Overview

Carilion Clinic sponsors a self-funded health plan that covered 12,954 participants in plan year 2025, up 3% from the prior year. The plan year starts in January. Alongside medical, its benefits filing reports life insurance, dental, vision, short-term disability, and more.

Plan type
ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
Participants
12,954 · prior year 12,565
Plan year
Begins January 1 · next renewal January 2027
Health plans filed
Carilion Clinic Welfare Benefit Plan, plan 544 (12,954 participants)
Broker compensation
$817K across insured contracts
MedicalLife insuranceDentalVisionShort-term disabilityLong-term disability

Insurance carriers

Insured coverage reported on Schedule A. Self-funded medical claims aren't reported there.

CarrierCoverageCoveredPremiumBroker comp
Life Insurance Company of North AmericaLong-term disability, Short-term disability, Life12,872$10.2M$390K
Delta Dental of VirginiaDental19,831$5.8M—
Aetna Life Insurance CompanyVision8,836$3.5M$423K

Pharmacy benefit estimate

StreamRX estimate for a plan this size. Not based on this plan's claims.

$30.7M/ year

Estimated prescription spend: 12,954 participants × $2,371 national average per member. Usually higher once dependents are counted.

$799K–$2.0M/ year

Typical savings opportunity found in independent reviews of plans this size.

Brands with a generic available$233K–$584K
Lower-cost therapeutic alternatives$341K–$713K
Generic pricing vs. actual cost$147K–$442K
PBM contract terms$77K–$230K
The DOL's PBM fee disclosure rule first applies to this plan for the plan year beginning January 2028: semiannual PBM compensation reports and an annual audit right.

Form 5500 filing details

Filing
Form 5500 with Schedule A, plan year 2025
Plan sponsor
Carilion Clinic
Sponsor EIN
54-1190771
Plan number
544
Filed with
U.S. Department of Labor (EBSA) via EFAST2

Verify this filing: search EIN 54-1190771 in the Department of Labor's EFAST2 Form 5500 search.

Retirement plan

Plan
Carilion Clinic 403(b) Retirement Savings Plan
Type
Defined contribution plan
Participants
18,178

About this data

Source: Carilion Clinic'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 Carilion Clinic.

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