Table Mountain Rancheria Band of Indians
Overview
Table Mountain Rancheria Band of Indians sponsors a self-funded health plan that covered 1,007 participants in plan year 2025, about the same as the prior year. The plan year starts in January. Alongside medical, its benefits filing reports life insurance, dental, vision, short-term disability.
- Plan type
- ERISA welfare benefit plan, self-funded (benefits paid from employer assets or a trust)
- Participants
- 1,007 · prior year 996
- Plan year
- Begins January 1 · next renewal January 2027
- Health plans filed
- Table Mountain Rancheria Welfare Benefit Plan, plan 501 (1,007 participants)
- Stop-loss carrier
- Symetra Life Insurance Company
- Broker compensation
- $364K 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 |
|---|---|---|---|---|
| Symetra Life Insurance Company | Stop-loss | 981 | $1.7M | $197K |
| Metropolitan Life Insurance Company | AD&D, Life | 1,235 | $717K | $117K |
| Unum Life Insurance Company of America | Flex STD | 340 | $228K | $8K |
| Metropoliatan Life Insurance Company | Life | 1,235 | $148K | $24K |
| Provident Life and Accident Insurance Company | Accident, Crit Illness, Iswl Stnd, Term | 491 | $138K | $17K |
Pharmacy benefit estimate
StreamRX estimate for a plan this size. Not based on this plan's claims.
Estimated prescription spend: 1,007 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
- Table Mountain Rancheria Band of Indians
- Sponsor EIN
- 77-0212451
- Plan number
- 501
- Filed with
- U.S. Department of Labor (EBSA) via EFAST2
Verify this filing: search EIN 77-0212451 in the Department of Labor's EFAST2 Form 5500 search.
Retirement plan
- Plan
- Table Mountain Rancheria 401(k) Plan
- Type
- 401(k) plan
- Participants
- 1,449
About this data
Source: Table Mountain Rancheria Band of Indians'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 Table Mountain Rancheria Band of Indians.