Country Supplier
Overview
Country Supplier sponsors a self-funded health plan that covered 845 participants in plan year 2024. The plan year starts in June. 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
- 845
- Plan year
- Begins June 1 · next renewal June 2027
- Health plans filed
- Country Supplier Health and Welfare Benefits Plan, plan 501 (845 participants)
- Broker compensation
- $166K 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 |
|---|---|---|---|---|
| United of Omaha Life Insurance Company | Life, Short-term disability, Long-term disability | 845 | $409K | $85K |
| Ameritas Life Insurance Corp. | Dental, Vision | 1,287 | $370K | $68K |
| First Stop Health, LLC | Telehealth | 509 | $63K | — |
| Trustmark Insurance Company | Long Term Care | 62 | $13K | $13K |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 845 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 2024
- Plan sponsor
- Country Supplier
- Sponsor EIN
- 92-1096110
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 92-1096110 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Country Supplier 401(k) Savings Plan
- Type
- 401(k) plan
- Participants
- 1,452
About this data
Source: Country Supplier's Form 5500 filing for plan year 2024 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 Country Supplier.