Lucky Chances, Inc.
Overview
Lucky Chances, Inc. sponsors a self-funded health plan that covered 533 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, death benefits.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 533 · prior year 533
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Health Benefits Group LLC Health Plans, plan 501 (533 participants)
- Broker compensation
- $20K 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 | 527 | $116K | $17K |
| Vision Service Plan | Vision | 173 | $11K | $1K |
| Sun Life Assurance Company of Canada | Dental | 27 | $6K | $989 |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 533 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
- Lucky Chances, Inc.
- Sponsor EIN
- 94-3199406
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 94-3199406 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Lucky Employee 401(k) Retirement Plan
- Type
- 401(k) plan
- Participants
- 614
About this data
Source: Lucky Chances, Inc.'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 Lucky Chances, Inc..