Pomona Valley Hospital Medical Center
Overview
Pomona Valley Hospital Medical Center sponsors a self-funded health plan that covered 3,591 participants in plan year 2025, about the same as the prior year. The plan year starts in January. Alongside medical, its benefits filing reports dental, vision.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 3,591 · prior year 3,642
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Pomona Valley Hospital Medical Center Associate Benefit Plan, plan 501 (3,591 participants)
- Broker compensation
- $176K 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 |
|---|---|---|---|---|
| Cigna Health and Life Insurance Company | Dental | 3,104 | $3.0M | $143K |
| United Healthcare Insurance Company | Vision | 6,508 | $411K | $33K |
| Curalinc, LLC | Employee Assistance Program | 4,057 | $55K | — |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 3,591 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
- Pomona Valley Hospital Medical Center
- Sponsor EIN
- 95-1115230
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 95-1115230 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Pomona Valley Hospital Medical Center Retirement Savings Plan
- Type
- Defined contribution plan
- Participants
- 4,994
About this data
Source: Pomona Valley Hospital Medical Center'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 Pomona Valley Hospital Medical Center.