Oxbow Carbon LLC
Overview
Oxbow Carbon LLC sponsors a self-funded health plan that covered 563 participants in plan year 2025, up 11% from the prior year. The plan year starts in January. Alongside medical, its benefits filing reports life insurance, dental, vision, long-term disability, and more.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 563 · prior year 507
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Oxbow Affiliated Companies Health and Welfare Plan, plan 501 (563 participants)
- Stop-loss carrier
- Reliastar Life Insurance Company
- Broker compensation
- $94K 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 | Stop-loss | 1,045 | $2.0M | $73K |
| Metropolitan Life Insurance Company | Dental | 947 | $482K | $8K |
| Prudential Insurance Company of America | Life, Long-term disability | 554 | $475K | — |
| American Heritage Life Insurance Company | Accident, Hospital Indemnity, Accident, Critical Illness | 67 | $80K | $12K |
| Vision Service Plan | Vision | 309 | $65K | — |
| Arag Insurance Company | Legal | 114 | $14K | $1K |
| New Directions Behavioral Health | Employee Assistance Program | 4,765 | $5K | — |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 563 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
- Oxbow Carbon LLC
- Sponsor EIN
- 04-2800610
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 04-2800610 in the Department of Labor's EFAST2 Form 5500 search.
About this data
Source: Oxbow Carbon LLC'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 Oxbow Carbon LLC.