As healthcare costs continue to rise, an increasing number of small and mid-sized employers are exploring alternative solutions to first dollar coverage and traditional self-funded programs. To meet this demand, Captive Resources supports several different types of Medical Stop Loss captives that are designed to:
Read on to learn more about Medical Stop Loss group captives — including what’s driving the demand, how they benefit employers, and what captive solutions Captive Resources offers.
Below is a brief overview of some key benefits that Medical Stop Loss group captives can deliver to employers. While the list isn’t all-encompassing, it does touch on many benefits that are difficult or impossible to find with fully funded and other traditional stop-loss programs.
Members have the flexibility to determine the structure of their benefits plan — including setting deductibles, co-pays, and out-of-pocket maximums and selecting third-party administrators (TPA), networks, and other partners.
Members enjoy increased transparency into program details compared to fully funded employers. This allows them to see the flow of dollars, identify loss drivers, and manage claims more efficiently and effectively. As member-owners, employers also enjoy transparency into the performance of the captive, allowing them to see how much risk they’re sharing with their fellow captive owners.
Group captive programs focus on helping member-companies improve the overall health and well-being of their employees and plan members. Improved health outcomes lead to a happier and more productive workforce, as well as lower claims costs.
Group captives underwrite members based on individual performance rather than as part of a larger pool, which helps bend the renewal curve compared to the traditional stop-loss market. Other benefits contribute to more stable costs, including the opportunity to earn dividends and access to innovative health risk management strategies.
Members are eligible to recoup unused underwriting dollars (plus accrued investment income) in the form of dividends when excess losses are less than actuarially projected. Traditional stop-loss carriers typically retain these dollars as profit or use them to pay for other insureds’ medical claims.
Member-companies are encouraged to actively participate in the captive by regularly attending board meetings and workshops on health risk management and other relevant topics. Employers also derive significant value from collaborating with fellow members to share best practices.
Simply put, a group captive is an insurance company that provides insurance to and is controlled by its owners. Captive Resources developed our industry-leading member-owned group captive model four decades ago. This model has consistently proven to be an effective and rewarding solution for casualty insurance coverage. Since the early 2010s, we’ve been applying that collective experience and a similar model to help employers realize that potential for their health coverage.
Like the casualty group captives we support, the Medical Stop Loss captives we work with are also member-owned and controlled. These captives offer small- to mid-sized companies the opportunity to reap the benefits of self-funded health programs without having to assume all the risk on their own. The graphic and accompanying text below illustrate how the captive layer delivers additional transparency and control compared to a traditional stop-loss program.
Our Medical Stop Loss group captive model allows members to retain predictable (i.e., less severe) losses up to a specific deductible, which they select. Above the specific deductible layer, the captive takes on a layer of risk that’s decided by the individual captive program.
Watch this video for a detailed look at how Medical Stop Loss captives can help employers control costs while still providing quality coverage for their employees.
The decision to join a group captive comes down to the transition from a passive buyer of stop-loss insurance as a commodity to an active owner of a reinsurance company focused on controlling total spend for the company’s health plan. However, the best way to structure that plan can vary by employer. When it comes to Medical Stop Loss group captives, one size does not fit all. That’s why Captive Resources supports several Medical Stop Loss captives to suit employers' various needs.
A Medical Stop Loss group captive model designed for groups that are currently self-funded; strong linkage between member’s individual experience and participation in captive layer profits. TPA, provider network, and cost containment vendors are often in place.
Typically designed for employer plans of 100 to 5,000 employees.
A Medical Stop Loss group captive model designed for groups that are currently fully insured; lower captive retention to reflect the group’s transition to self-funding, utilizing a captive risk structure. TPA, provider network, and cost containment vendors are to be developed.
Designed for employer plans of 75 to 1,000 employees.
A Medical Stop Loss group captive model designed for groups that are currently self-funded or fully insured; lower volatility in a shared risk layer to insulate members from their individual claims. TPA, provider network, and cost containment vendors are to be optimized.
Designed for employer plans of 50 to 2,500 employees.
Niche, value-based group captive model focused on maximum cost containment for captive members. Structure applies dynamic cost containment strategies such as referenced-based pricing, narrow networks, and direct provider contracting. TPA, plan design, and vendor arrangements must be optimized.
Designed for employer plans of 50 to 500 employees.