Nicolet National Bank
Overview
Nicolet National Bank sponsors a self-funded health plan that covered 976 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
- 976 · prior year 978
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Nicolet National Bank Employee Health and Welfare Benefit Plan, plan 506 (976 participants)
- Broker compensation
- $72K 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 |
|---|---|---|---|---|
| Reliastar Life Insurance Company | Life, Short-term disability, Long-term disability | 1,329 | $624K | $63K |
| United Healthcare Insurance Company | Transplant | 644 | $79K | — |
| Metropolitan Life Insurance Company | Vision | 1,161 | $54K | — |
| Combined Insurance Company | Term Life W/ Long Term Care | 125 | $18K | $9K |
| Curalinc LLC | Employee Assistance Program | 990 | $17K | — |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 976 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
- Nicolet National Bank
- Sponsor EIN
- 39-1990426
- Plan number
- 506
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 39-1990426 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Nicolet National Bank 401(k) Plan
- Type
- 401(k) plan
- Participants
- 1,202
About this data
Source: Nicolet National Bank'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 Nicolet National Bank.