PT Intermediate Holdings IV, LLC
Overview
PT Intermediate Holdings IV, LLC sponsors a self-funded health plan that covered 3,871 participants in plan year 2025, up 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
- 3,871 · prior year 3,763
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- PT Intermediate Holdings IV, LLC Welfare Plan, plan 501 (3,871 participants)
- Stop-loss carrier
- Cigna Health and Life Insurance Company
- Broker compensation
- $363K 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 | Stop-loss | 5,007 | $2.0M | — |
| Prudential Insurance Company of America | Long-term disability, MA Paid Family Leave, New York Paid Family Leave, Voluntary AD&D Insurance, Voluntary Life Insurance, VOL DEP Life Child, AD&D, Co. Paid Family Medical Leave, CT Paid Family Leave, New York DBL, Life | 3,871 | $1.7M | $60K |
| Guardian Life Insurance Company of America | Dental | 2,894 | $1.3M | $57K |
| Prudential Life Insurance Company | Voluntary DEP Life Spouse, Or Paid Family Medical Leave, Short-term disability, NJ TDB | 1,564 | $758K | — |
| Sun Life Assurance Company of Canada | Accident Insurance, Child/spouse/employe | 2,065 | $739K | $246K |
| Eyemed Vision Care | Vision | 4,656 | $290K | — |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 3,871 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
- PT Intermediate Holdings IV, LLC
- Sponsor EIN
- 88-3507312
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 88-3507312 in the Department of Labor's EFAST2 Form 5500 search.
About this data
Source: PT Intermediate Holdings IV, 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 PT Intermediate Holdings IV, LLC.