Deriva Energy Holdco I LLC
Overview
Deriva Energy Holdco I LLC sponsors a self-funded health plan that covered 555 participants in plan year 2025, up 4% 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
- 555 · prior year 534
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Deriva Energy Holdco I LLC Health and Welfare Plan, plan 501 (555 participants)
- Broker compensation
- $73K 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 |
|---|---|---|---|---|
| Metropolitan Life Insurance Company | Life, Short-term disability, Long-term disability | 904 | $660K | $73K |
| United Behavioral Health DBA Optum | Employee Assistance Program | 566 | $13K | — |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 555 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
- Deriva Energy Holdco I LLC
- Sponsor EIN
- 93-2748361
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 93-2748361 in the Department of Labor's EFAST2 Form 5500 search.
About this data
Source: Deriva Energy Holdco I LLC'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 Deriva Energy Holdco I LLC.