This document discusses strategies for controlling escalating medical insurance costs through greater employer control and participation in alternative insurance models like captives. It outlines how traditional insurance results in annual double-digit cost increases and minimal transparency or control. A captive insurance program places employers in a group that shares risks and returns, gaining stability, transparency and the ability to retain underwriting profits and investment returns to offset premiums. The document provides an overview of captive definitions, design considerations, and underwriting guidelines to establish a captive program.
Strategies for controlling medical insurance costs
1. Strategies for Controlling Medical
Insurance Costs
How to stop the annual rate increase of 15% for medical
insurance coverage.
2. Traditional vs. Captive
Participants
Moderator:
Michael A. Schroeder – President, Roundstone Management, Ltd.
Panelists:
David Reynolds – President, Chief Executive Officer,
Capitol Administrators
Bernie Tillotson ‐ Managing Director, Employee Benefits Division,
Andreini & Company
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3. Traditional vs. Captive
Program Outline
• Stabilize escalating premiums with greater control
over the delivery of insurance
• Standard Stop Loss coverage issued by an A rated
insurer along with Captive participation
• Premium savings through investment and
underwriting return
• Medical Stop Loss Advantage Program
requirements
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4. Traditional vs. Captive
The Standard Market
The Standard Market = Minimal Control, No Transparency
• Unanticipated rate increases
• Burdensome plan marketing
• Available responses
– Change carrier
– Change benefit levels
– Change contribution schedule
Today’s annual cost increases will double premium in 6 years
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5. Captive Definitions
Average Annual Premiums
Average Annual Premiums
for Single and Family Coverage, 1999‐2009
1999 2,196
5,791
2000 2,471
6,438
2001 2,689
7,061
2002 3,083
8,003
2003 3,383
9,068
2004 3,695
9,950 Single
2005 4,024
Family
10,880
2006 4,242
11,480
2007 4,479
12,106
2008 4,704
12,680
2009 4,824
13,375
‐ 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
Source: Kaiser/HRET Survey of Employer – Sponsored Health Benefits, 1999 – 2009.
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6. Traditional vs. Captive
Larger Employers – Self Fund
Percentage of Covered Workers
in Partially or Completely Self‐Funded Plans, by Firm Size, 1999‐2000
Source: Kaiser/HRET Survey of Employer – Sponsored Health Benefits, 1999 – 2009.
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7. Traditional vs. Captive
Why Large Employers Self Fund
• Control over benefit plan and claims
administration
• Complete data and cost transparency
• National plan consistency, no state mandates
• Cash flow benefits (“pay as you go”)
• Custom designed best in class wellness/behavioral
programs
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8. Why Don’t Mid‐Size Employers
Traditional vs. CaptiveSelf Fund?
Volatility – employers’ costs can vary significantly due
to large claims or an aggregation of smaller claims
Turnkey Program – Running a self insurance program
can be intimidating. Plan design, TPA/Network selection,
stop loss contract negotiations
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9. Traditional vs. Captive
Opportunity
Stop Loss Group Captive
Capture underwriting and investment income
by combining Best in Class Companies into a
medical benefit group captive.
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10. Captive Definitions
Captive Definitions
Captive
An insurance company that provides insurance to and is
controlled by its owners.
Group Captive
A group captive is an insurance facility formed by companies
joining together to share risk. Each have a desire to control
their own risk. Member companies maintain good loss
histories and effective risk management programs.
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11. Traditional vs. Captive
The Captive Difference
Traditional Program Captive Stop Loss Program
Cycle driven Smoothes Cycles and Cash Flow
Transaction driven Relationship driven with Transparent
Communication
No alignment of interests Skin in the Game for all Participants
Generic services Specialized Services
No Return on Investment Retain U/W Profit and Investment
Income 10
12. Program Design
Program Design
• All participants committed with a capital
investment (collateral) in the form of cash
• Participants’ exposure is limited to premium and
collateral
• Participants take ownership in growth and
economic success
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13. Traditional vs. Captive Market
Claimants Claims Payments
A B C D E
Stop Loss Stop Loss
Premiums Reimbursements
Reinsurance
Policy Issuing Carrier Group Captive Facility
Stop Loss
Reimbursements
U/W Profit and
Collateral
Investment Returns
Captive Participants
A B C D E
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14. Reinsurance Structure
Group Aggregate for Captive
Aggregate available for Participant’s
Deductible exposure
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15. Risk Sharing
Heterogeneous Risk Sharing
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The Hierarchy of Loss Application
Participant Loss Fund
1. Loss Fund of each Participant
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2. Then, the Indemnity Collateral of
each Participant Participant Indemnity Collateral
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3. Then, the Loss Fund of all
Participants proportional with their Proportional Share of All
Participants’ Loss Fund
Assumed Premiums
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4. Then, the Indemnity Collateral of all Proportional Share of All
Participants’ proportional with their Participants’ Indemnity Collateral
Assumed Premiums. 5
5. Aggregate Reinsurer Aggregate Reinsurer
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16. Risk Sharing
Association Risk Sharing
The Hierarchy of Loss Application
1. Losses shared Pro Rata of each 1
Participants Assumed Premiums Proportional Share of All
Participants’ Loss Fund
2. Then, the Pro Rata Indemnity
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Collateral of all Participants’
proportional with their Assumed Proportional Share of All
Premiums. Participants’ Collateral
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3. Aggregate Reinsurer
Aggregate Reinsurer
*Individual employer aggregates can be
reinsured via the Group Captive layer
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17. Group Captive
Start Up Considerations
• TPA/Network Selection
• Deductible Levels
• Employer Aggregate Issues
• Wellness/Behavioral Programs
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18. Group Captive
Group Captive Benefits
Reduce operating costs over time with the best overall price
Realize underwriting profits and investment income
Stabilize an unpredictable and cyclical marketplace
Control claims, coverage, loss control, frictional costs
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19. Underwriting Guidelines &
Submission Requirements
Underwriting Guidelines
• 50+ employee Groups
• Minimum of $20,000 Deductible
• Support culture of health and wellness
Submission Requirements
• Completed Application or RFP outlining criteria
• Current Detailed Census
• 3 Years Stop Loss Premium and Detailed Claims History
• Copy of Current Policy
• Copy of the Current Plan, Proposed Plan(s) and
accompanying documents
• Identity of the current and/or proposed TPA 18