Polyglass USA, Inc.
Overview
Polyglass USA, Inc. sponsors a self-funded health plan that covered 645 participants in plan year 2025, up 9% 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
- 645 · prior year 594
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Polyglass USA, Inc. Health and Welfare Plan, plan 501 (645 participants)
- Broker compensation
- $253K 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 |
|---|---|---|---|---|
| Life Insurance Company of North America | Life, Accidental Death and Dismemberment, Short-term disability, Long-term disability | 639 | $736K | $98K |
| Delta Dental Insurance Company | Dental | 1,459 | $470K | $47K |
| Prudential Insurance Company of America | Accident, Critical Illness, Hospital Ind | 227 | $172K | $91K |
| Fidelity Security Life Insurance Company | Vision | 1,310 | $89K | $9K |
| Pre-Paid Legal Services Inc. DBA Legalshield | Legal | 82 | $17K | $2K |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 645 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
- Polyglass USA, Inc.
- Sponsor EIN
- 88-0267816
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 88-0267816 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Polyglass USA, Inc. 401(k) Plan
- Type
- 401(k) plan
- Participants
- 755
About this data
Source: Polyglass USA, 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 Polyglass USA, Inc..