Northeast Georgia Health System, Inc.

Gainesville, GA Health careNAICS 622000

Self-funded health planPlan year 2025Renews January
9,806Participants-3% vs. prior year
$23.3MEst. pharmacy spend / yrParticipants × national avg.
Jan 2027Next renewalPlan year begins January 1
#7 of 40Health care in GABy participants

Overview

Northeast Georgia Health System, Inc. sponsors a self-funded health plan that covered 9,806 participants in plan year 2025, down 3% from 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
9,806 · prior year 10,131
Plan year
Begins January 1 · next renewal January 2027
Health plans filed
Northeast Georgia Health System, Inc. Health and Welfare Benefits Plan, plan 501 (9,806 participants)
Broker compensation
$985K across insured contracts
MedicalLife insuranceDentalVisionShort-term disabilityPrepaid legalLong-term disabilityOther welfare benefits

Insurance carriers

Insured coverage reported on Schedule A. Self-funded medical claims aren't reported there.

CarrierCoverageCoveredPremiumBroker comp
Unum Life Insurance Company of AmericaShort-term disability, Long-term disability, Life9,748$8.7M$530K
Unum Insurance CompanyAccident, Critical Illness and Cancer, Hospital Indemnity2,849$1.9M$236K
Ameritas Life Insurance Corp.Vision15,648$1.5M$175K
Metropolitan General Insurance CompanyLegal1,869$375K$44K

Pharmacy benefit estimate

StreamRX estimate for a plan this size. Not based on this plan's claims.

$23.3M/ year

Estimated prescription spend: 9,806 participants × $2,371 national average per member. Usually higher once dependents are counted.

$605K–$1.5M/ year

Typical savings opportunity found in independent reviews of plans this size.

Brands with a generic available$177K–$442K
Lower-cost therapeutic alternatives$258K–$539K
Generic pricing vs. actual cost$112K–$335K
PBM contract terms$58K–$174K
The DOL's PBM fee disclosure rule first applies to this plan for the plan year beginning January 2028: semiannual PBM compensation reports and an annual audit right.

Form 5500 filing details

Filing
Form 5500 with Schedule A, plan year 2025
Plan sponsor
Northeast Georgia Health System, Inc.
Sponsor EIN
58-1694090
Plan number
501
Filed with
U.S. Department of Labor (EBSA) via EFAST2

Verify this filing: search EIN 58-1694090 in the Department of Labor's EFAST2 Form 5500 search.

Retirement plan

Plan
Northeast Georgia Health System, Inc. 401(k) Retirement Savings Plan
Type
401(k) plan
Participants
15,260

About this data

Source: Northeast Georgia Health System, 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 Northeast Georgia Health System, Inc..

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