LAC Courte Oreilles Band of Lake Superior Chippe
Overview
LAC Courte Oreilles Band of Lake Superior Chippe sponsors a self-funded health plan that covered 868 participants in plan year 2024. The plan year starts in October. Alongside medical, its benefits filing reports life insurance, dental, short-term disability, long-term disability, and more.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 868
- Plan year
- Begins October 1 · next renewal October 2027
- Health plans filed
- LAC Courte Oreilles Tribal Governing Board Employee Benefit Health & Welfare Plan, plan 501 (868 participants)
- Broker compensation
- $50K 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 |
|---|---|---|---|---|
| Unum Life Insurance Company of America | Life, Short-term disability, Long-term disability | 879 | $507K | $32K |
| Delta Dental of Wisconsin | Dental | 575 | $389K | $13K |
| Wyssta Insurance Company Inc. | Vision | 428 | $50K | $4K |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 868 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
- LAC Courte Oreilles Band of Lake Superior Chippe
- Sponsor EIN
- 39-1165322
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 39-1165322 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- LCO 401(k) Plan
- Type
- 401(k) plan
- Participants
- 1,342
About this data
Source: LAC Courte Oreilles Band of Lake Superior Chippe'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 LAC Courte Oreilles Band of Lake Superior Chippe.