/// By Paul Clark and Evan Macedo
Squeezed between the perpetually rising cost of health care and the increasing demand for good benefits to attract and retain talent—American businesses are struggling to find the right balance to stay afloat and remain competitive. More and more companies are looking for ways to cut costs of employee benefits without sacrificing quality. This has led to the rise in the Group Captive insurance program, which is a self-funded health insurance pool formed by companies joining together as a means to reduce costs of their collective medical benefit spend while taking on the risk traditionally assumed by insurance companies in the fixed premium model.
Such programs can be particularly beneficial for mid-sized groups, between 50-2000 participants. As they are self-funded and selected programs comprised of individual businesses with third party administrators, every captive has its own distinct “personality.” By leaving a fully insured, traditional, premium basis health plan to pool employers together in this self-insurance approach, participants take full control of the benefit plan design and can expect to save on average between 12%-15% on costs in the first year alone. But as with all things, not all Group Captives are created equally, and some key differentiators can have a significant impact on success.
While all Captive plans offer greater transparency and flexibility in design, administration, and customization, and a more equitable system of only paying for what claims are actually used—they also transfer fiduciary responsibility to the group, which comes with some inherent risk.
The InCap® captive insurance program, designed by Clark & Lavey Benefits Solutions and a Hilb Group product since November 2021, is a proven plan for mid-sized groups that provides some unique benefits for participant businesses—including an administration system that works to mitigate assumed fiduciary risks and an annual profit sharing distribution to member companies. Unlike most captives, with the InCap® program, the TPA assumes the fiduciary responsibility on behalf of their clients on day one.
Key differentiators of the InCap® Group Captive Program:
- COBRA included in program structure
- Individual concierge medical practitioners that work with each member to help navigate the healthcare system for optimized results
- A prescription benefit management (PBM) partnership with Southern Scripts that provides a pass through to give manufacturer rebates on medications back to the clients
- Scrubs claims—watching the value and till to ensure only actual claims are properly processed—to eliminate “golden toilets in ivory towers,” resulting in a huge savings in maintaining low premium costs
- Full transparency with quarterly meetings for clients to review their direct data and trust the metrics to control controllable elements
- Running 25% below the national TPA medical loss ratio
- Flexible plan anniversary date, proven to benefit staff renewals
- Immediate profit sharing for plan participants with above industry average rates of return that are among the highest in the country over the last three years
Client Example: One InCap® Captive Group Program participant with an enrollment of 325 participants all over the country, has saved $7.2 million since joining the plan and received over $1 million in profit sharing over the last 10 years.
Contact us to learn more about our group health captive program and see if your business would be a good fit for this dynamic, industry leading plan.
Evan Macedo
Treasurer &Vice President /
Finance & Operations
Sapers & Wallack Inc
Paul E. Clark
Managing Partner /
National Health Care Captive Practice Leader
Clark & Lavey Benefits, A Hilb Group Company