Intro to Self-Funding: What Is a Captive?

This blog was inspired by the webinar Intro to Self-Funding: What Is a Captive?, now available on demand. Watch it here.

Highlights  

• Knowing what a captive insurance plan is and how it works can help you gain better control over your company’s healthcare costs.

• Unlike traditional insurance, a group captive gives you design flexibility and data transparency that you can use to tailor a plan for your employees.

• Group captives allow you to spread financial risk through pooled stop-loss insurance.
• With a Roundstone group captive plan, you customize your coverages from the ground up, choose your own TPA, and get all unused premiums back in your pocket at the end of the year.

Many businesses recognize that traditional health insurance is no longer adequate in today’s financial climate, especially with premiums rising by 7% in 2023 and medication prices increasing by 15.2%. For small to medium-sized businesses (SMBs), out-of-control plans without flexibility or data transparency are simply unaffordable.

If you’re looking for a new way to provide affordable health insurance to your employees, switching to a group captive health plan as part of a self-funding approach can help keep costs down and give you more control.

But what is a captive? It’s an insurance arrangement that lets you pool your resources with others, helping you get better-quality coverage at lower prices. If you’re looking for an affordable health benefits alternative, a captive can be a great solution.

Learn more about self-funding vs. traditional insurance and how joining a Roundstone group captive can mean happier employees, higher-quality care, and lower costs overall.

Differences Between Self-Insurance and Fully Insured Plans

A group captive is sometimes known as a stop-loss captive. The best way to understand how a group captive works with self-funded insurance is to compare it to fully insured plans. With traditional plans, 100% of the costs are fixed, and you don’t have control of increases or coverages. This means no insight into claims data, no making changes based on coverage needs, and sticking with the network, pharmacies, and vendors the carrier uses.

Self-insurance offers more control over costs and benefits compared to fully insured models. About 40% of the costs are fixed in a standard self-funded plan, with only 60% being variable. However, these plans are usually only available to major corporations with lots of financial resources and backing.

A group medical captive is a subset of self-funding, where multiple SMBs join with each other to pool resources while maintaining their own self-insurance plans. Roundstone’s captives have fixed costs as low as 15%.

As a member of a group captive, you share the risks and rewards of this model; when managed effectively, it can lead to more stable premiums and potential financial returns year over year.

Roundstone consistently returns unused stop loss premium funding back to members in in the form of a cash distribution. Last year, we distributed $8 million pro rata back to businesses in the stop-loss captive.

Benefits of a Group Medical Captive

The benefits of group captives for SMBs have to do with three major areas of healthcare management: information, control, and cost-savings. A captive is a practical, safe solution for employers to provide their employees with affordable health insurance. Here’s a closer look at the advantages of a group medical captive:

• Lower fixed costs and higher variable costs. With only 15% fixed costs, you only pay for actual claims, not coverages you don’t use. Because 85% of the costs are variable, you have control over them and can use plan data to optimize your plan and further increase the savings of your healthcare.
• Control over health plan design. With a group captive, you have complete control over your plan design year-round. You can tailor coverage options, implement wellness programs, or change vendors for more customized healthcare management.
• Cost-savings through profit distributions. You receive dividends or premium refunds based on captive performance, boosting financial outcomes for your company. As a Roundstone captive member, you get back 100% of unused premiums in a distribution check pro rata. Distributions are based on the overall performance of the captive – not one company’s performance. You are still entitled to a refund even if you had a bad claims year.

Management and Operation

In the Roundstone group captive model, you (the employer) are at the center of the arrangement, with your advisor acting as the direct link between you and the operator. A turnkey operator (Roundstone) handles daily operations and management of a group captive and manages essential functions like underwriting, claims management, and risk pooling through stop-loss insurance.

There is little heavy lifting or management of the plan required on your part. Your Third-Party Administrator (TPA) manages daily operations, focusing on claims processing and plan administration. They collaborate with your provider network and Pharmacy Benefits Manager (PBM) to ensure efficient claims processing and benefits application.

As a captive member, you and your TPA get detailed reports and analytics the captive manager provides. These insights into claim data help you better understand spending patterns and manage costs more effectively, leading to more affordable health insurance expenses over time.

Educating Employees and Managing Change in a Self-Funded Health Insurance Plan

A successful group captive as part of a self-funded benefits plan thrives on engaged, educated employees. When you first make the change, maintaining open communication, explaining plan benefits, and encouraging participation help boost cost saving utilization and satisfaction.

Tips for managing the transition to self-funded health insurance include:

• Simplify the information for employees. Focus on explaining how their participation affects their out-of-pocket costs rather than the complex details of self-funding. Ensure they understand the importance of their involvement in the plan.
• Promote cost-effective treatment options. Encourage employees to seek care from providers who offer the best value, are high-quality, and are cost-efficient. This will save on costs and support better health outcomes.
• Encourage questions. Make it easy for employees to ask their TPA questions about the plan and its benefits to better understand and feel comfortable with the new system.
• Communicate using digital tools. Provide accessible, engaging, and informative content through pre-recorded webinars or emails to explain plan changes and benefits. This helps educate employees at their convenience and keeps them informed about their options.
• Work with the right partners. For plan success, collaborate with an experienced TPA and advisors. They help analyze data and implement cost containment solutions tailored to your company’s specific needs and benchmarks. This ensures an efficiently managed plan with the potential for maximum savings, thereby increasing the affordability of your health insurance plan.

Common Misconceptions of Self-Funding Under a Stop-Loss Captive

Two primary misconceptions might hold you back from switching to a group captive solution for your SMB. These typically have to do with concerns about additional administrative burdens and managing data privacy.

Although you have more control over your budget and coverages with a group captive, this doesn’t mean more responsibility for plan administration. Like a traditional fully insured plan, you won’t have to hire additional staff, process claims on your own, or worry about legal compliance on your own. Your TPA handles these issues, allowing you to focus on other areas, like growing your company or serving clients.

Regarding claims data, you gain access to detailed HIPAA-compliant information without running the risk of privacy violations. For instance, you will be able to tell how many employees are using a specific medication but not who they are or other identifying information. This ensures employee data is kept safe and in line with healthcare privacy standards. You can use this data to implement cost savings measures, increasing the affordability of your benefits plan.

Switch to a Roundstone Group Captive Plan Today

Roundstone is an innovative employee health benefits company. We help small and midsize businesses offer competitive benefits at a lower cost by self-funding health insurance through our group medical captive. The Roundstone Captive enables companies to self-insure safely by pooling hundreds of employers together to share risk and save money.

With easy onboarding and personalized support every step of the way, the Captive offers control, flexibility, and transparency and returns all savings back to employers where they belong. We believe in always aligning with the employers’ best interests and remain committed to our mission — quality, affordable healthcare and a better life for all.

Speak with an advisor today to discuss concerns with your current healthcare insurance plan and learn how we can save you thousands in a medical group captive self-funded solution.