Who must file Form 5500 for a health plan, and the 5500-SF

Every employee welfare benefit plan covered by Title I of ERISA owes an annual report under ERISA §103 unless a regulation exempts it. The report is Form 5500, filed electronically through EFAST2 by the last day of the seventh month after the plan year ends — July 31 for a calendar-year plan, October 15 with a Form 5558 extension. Medical, dental, vision, life, disability, and health FSA coverage are all welfare plans. Governmental and church plans are outside Title I and do not file.

The filing is per plan, not per employer and not per benefit. If your plan document wraps medical, dental, and life into one ERISA plan, that is one Form 5500 with one Schedule A per insurance contract. If each benefit has its own plan document and plan number, each one is evaluated and filed on its own.

DOL Reg. 2520.104-20 exempts a welfare plan from the annual report entirely when all of the following hold:

• The plan had fewer than 100 participants at the beginning of the plan year. Growing past 100 during the year does not undo the exemption for that year; the regulation's own example is a plan with 75 on day one and 105 at year end.
• Benefits are unfunded (paid from the employer's general assets), fully insured(paid through insurance contracts or an HMO, with premiums paid from general assets or from a mix of general assets and employee contributions), or a combination of the two.
• Employee contributions are forwarded to the insurer within three months of receipt, and any refunds owed to contributing employees are returned within three months.
• The plan is not a MEWA required to file Form M-1.

The exemption covers only the annual report and its related financial disclosures; the SPD, plan document, and every other Title I duty still apply. A small plan that runs its benefits through a trust or VEBA fails the funding test and must file — that is where Form 5500-SF comes in.

The count that matters is the number of participants on the first day of the plan year, and for a welfare plan a participant is an employee or former employee, never a spouse or child. Under 29 CFR 2510.3-3(d), an individual becomes a participant on the earliest of the date the plan designates, the date the person becomes eligible for a benefit subject only to the contingency occurring, or the date the person first contributes. In practice, for a contributory medical plan where an employee must elect and pay, an eligible employee who waived coverage is not counted; an enrolled one is. For a noncontributory benefit such as employer-paid life insurance, every eligible employee is a participant whether they signed anything or not.

Include former employees still covered — COBRA qualified beneficiaries who elected, and retirees receiving coverage — because they are receiving benefits under the plan. Do not include dependents, even when they are on COBRA in their own right, and do not include the employee count from the payroll register. The 2023 change that lets retirement plans count only accounts with balances is a defined-contribution rule; it does not apply to welfare plans.

The Form 5500 instructions let a plan with between 80 and 120 participants at the start of the plan year file in the same category — small or large — that it filed in for the prior year, so a plan drifting across 100 does not flip categories every year.

The rule only works for a plan that filed last year. A fully insured plan that was exempt under 2520.104-20 at 95 participants and starts the next year at 108 has no prior-year filing category to carry forward; it must file as a large plan. Where the rule does help is at the other edge: a plan that filed as large at 110 and drops to 96 may keep filing as large rather than testing the exemption, and a small funded plan that filed on 5500-SF at 90 and grows to 115 may stay on the SF for that year.

Form 5500-SF is a two-page alternative for small plans that are simple enough not to need Schedules A, C, H, or I. For a welfare plan the current conditions in the 2025 instructions are:

• Fewer than 100 participants at the beginning of the plan year, or 100 to 120 under the 80–120 rule.
• Not required to attach an independent qualified public accountant's audit — in other words, eligible for the small-plan audit waiver.
• All plan assets invested in eligible assets with a readily determinable fair market value (cash, bank accounts, mutual funds, publicly traded securities, insurance company contracts).
• No employer securities held, and the plan is not a multiemployer plan.
• Not a MEWA required to file Form M-1.

Notice what this means in practice. A small insured or unfunded welfare plan is already exempt from filing and has no use for the SF. A small welfare plan with a trust can use it if the trust holds only eligible assets. And a plan with 100 or more participants at the start of the year — the typical reader of this site — is simply not eligible: it files the full Form 5500, with Schedule A for every insurance contract and, if it has a trust, Schedules C and H and an audit. Fully insured or unfunded large plans file the full form with Schedule A alone and skip the financial schedules under 29 CFR 2520.104-44.

A wrap document bundles separate insurance policies and self-funded benefits into a single ERISA plan with one plan number, usually 501. The payoff is one Form 5500 instead of five, one participant count (the largest benefit's enrolled employees, not the sum across benefits), and one deadline. Each insurer still produces its own Schedule A, so a wrap filing for medical, dental, vision, life, and disability attaches five Schedule As to one form. The wrap-plan filing for any employer is visible from the employer index.

• Filing one Form 5500 per benefit when a wrap document exists, or filing one wrap-style form when the benefits were never wrapped. Each separate plan with 100 or more participants needs its own filing; each un-filed one is its own penalty clock.
• Counting dependents, or counting total payroll instead of enrolled employees for a contributory plan.
• Dropping COBRA and retiree participants from the count.
• Measuring the count on the last day of the year, or on the filing date, instead of the first day of the plan year.
• Assuming a plan that first crossed 100 can use the 80–120 rule to stay exempt for another year.
• Treating a health FSA or HRA as outside ERISA. They are welfare plans and count toward the wrap plan's filing.

• Pull the enrollment roster as of the first day of the current plan year and count employees and former employees only.
• Check the plan document: is there a wrap plan, and which benefits does it name? Match your filings to it.
• Look up your own filing history on the employer index and run the Late-Filing Penalty Check for any year the count was at or above 100.
• If a year was missed, read the DFVCP cure timeline before any DOL letter arrives.