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Program Details -

Health Select


 

Why Health Select?

Health Select is a unique partnership leveraging market leaders in captive programs. It provides a practical option between the extremes of purchasing a fully insured product and going fully self-funded. This turnkey solution brings together high-performing companies to provide cost stability, predictability and the accountability necessary to drive results.

Health Select offers:

  • A unique health plan solution designed for the Patient Protection and Affordable Care Act(PPACA) era health insurance marketplace
  • The benefit of banding together high-performing companies in a preferred-risk captive
  • Large-group purchasing discounts on administrative services, cost management tools and network access fees
  • Self-insurance with less volatility
  • A stop-loss component that can be structured for greater control over cost increases and renewal provisions
  • Cost savings achieved through access to industry-leading claims and health risk management tools and best practices
  • Cost stabilization through effective claims management, high-risk member intervention and eligibility for captive surplus distribution
  • The opportunity to achieve a return on a portion of Captive premium through effective high-risk management resources and good claim performance

How Health Select Works

  • You and other like-minded employers with similar risk profiles come together to form a preferred pool of self- funded benefit clients.
  • To help control healthcare costs, all participants in the pool agree to use the same benefit philosophies and cost- management tools typically available only to larger self- funded clients.
  • You each maintain your own plan, with your own benefit design, and are responsible for smaller claims your employees incur as well as the administrative fees associated with operating your own plan. When claims performance, as a result of applying cost-management tools, turns out better than expected, you keep 100 percent of the results.
  • Mid-size claims are pooled together with the rest of the group to provide a shared layer of claim protection. If the claim experience of the more predictable low-cost, high- frequency layer turns out better than expected, you get to share in the results.
  • The larger, more catastrophic claims become the responsibility of the stop-loss carrier.

Group Captive Structure

Product Information

Upsides of Self-Insurance Through a Group Captive

For some employers, the time is right to consider the advantages of a group captive, especially when comparing the performance of self-funded plans to traditional, fully insured medical plan offerings:

  • Tailored plan design across multiple state jurisdictions
  • Hand-picked, best-in-class, unbundled medical cost control vendors
  • Greater claim data transparency, reported on a monthly
  • basis
  • Lower state premium taxes/Affordable Care Act (ACA) fees
  • Tempered volatility through risk pooling, group purchasing and reinsurance protection
  • Sharing of underwriting profits on pooled risks across multiple employers

Management of Health Select

Caitlin Morgan will manage the Health Select program and provide each participant with:

  • Flexibility to choose among multiple health plan designs, including consumer-driven health plan (CDHP) and traditional plan options
  • Access to several national carrier PPO networks
  • Competitive coalition pharmacy contract with premier national Pharmacy Benefit Manager, delivering rebate transparency discount guarantees and optional trend management programs
  • Standardized Summary Plan Description and plan
  • documents for ease of administration and ERISA
  • compliance
  • Best-in-class health risk management programs, including clinical prevention services and specialized oncology medical management program
  • Easy enrollment — pick a plan, define eligibility, submit enrollment and you are off and running

Preferred Characteristics of Health Select Participant

  • 25 to 500 participating employees
  • Above average demographics and stable workforce
  • Strong corporate leadership that values employee health and embraces wellness
  • Good historical claims experience (renewals consistently
  • below trend)
  • Current fully insured accounts with a desire for transparency and desire to avoid PPACA fees
  • Current self-funded groups using a rental network through a Third Party Administrator or paying high fixed cost with a standalone carrier self-funded program