Kelsey-Seybold Medical Group PLLC
Overview
Kelsey-Seybold Medical Group PLLC sponsors a self-funded health plan that covered 4,057 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, short-term disability, and more.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 4,057 · prior year 4,097
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Kelsey-Seybold Medical Group PLLC Welfare Benefits Plan, plan 525 (4,057 participants)
- Broker compensation
- $119K 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 |
|---|---|---|---|---|
| Life Insurance Company of North America | Life, Short-term disability, Long-term disability | 4,157 | $3.0M | — |
| Cigna Health and Life Insurance Company | Critical Illness, Accident, Hospital | 4,157 | $793K | $119K |
| Cigna Health and Life Insurance Company and Affiliates | Dental | 9,769 | $719K | — |
| Vision Service Plan | Vision | 4,527 | $301K | — |
| United Behavioral Health DBA Optum | Employee Assistance Program | 5,921 | $46K | — |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 4,057 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
- Kelsey-Seybold Medical Group PLLC
- Sponsor EIN
- 76-0386391
- Plan number
- 525
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 76-0386391 in the Department of Labor's EFAST2 Form 5500 search.
About this data
Source: Kelsey-Seybold Medical Group PLLC'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 Kelsey-Seybold Medical Group PLLC.