Missouri Jack LLC
Overview
Missouri Jack LLC sponsors a self-funded health plan that covered 834 participants in plan year 2024. 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
- 834
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Missouri Jack Employee Health & Welfare Plan, plan 501 (834 participants)
- Broker compensation
- $6K 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 |
|---|---|---|---|---|
| The Lincoln National Life Insurance Company | Life | 768 | $21K | $3K |
| Healthy Alliance Life Insurance Company | Dental, Vision | 99 | $17K | $953 |
| Delta Dental | Dental | 116 | $15K | $1K |
| Advantica Insurance Company | Vision | 115 | $2K | $185 |
| Anthem Life Insurance Company | Life | 768 | $1K | $149 |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 834 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
- Missouri Jack LLC
- Sponsor EIN
- 45-2037521
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 45-2037521 in the Department of Labor's EFAST2 Form 5500 search.
About this data
Source: Missouri Jack LLC'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 Missouri Jack LLC.