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How It Works?

MediCaptive, a group captive health insurance company, is a financial and cost management structure that allows small and medium size employers to assume a portion of their healthcare risk and pool it for diversity with other similar, well-qualified employers. Assuming this risk allows businesses to access the following benefits:

  • Reduce stop loss insurance pricing.
  • Substantially mitigate annual increases.
  • Utilize claims data to help manage health care expenses (medical and pharmaceutical).
  • Tap into skilled professionals with the experience to efficiently control healthcare costs through wellness programs and provider management.
  • Retain cost savings instead of paying expensive unrecoverable premiums to large insurance companies.
  • Maintain current plans and providers, minimizing disruption to business processes.
  • Integrate seamlessly into business structure so employees can keep their physicians.

MediCaptivebreaks the total assumed healthcare risk into three layers: retention, pooled and stop loss. Breaking the total risk into layers gives employers more control over claims costs and provides a mechanism to pool risk with other employers to achieve pricing efficiencies when going to market for medical stop loss insurance.

  1. Retention

    Employers retain a portion of each employee claim submitted to the plan. The amount is flexible. Retaining a portion of each claim, usually the small and routine claims, provides employers the control – through access to claims data – to manage the costs of healthcare through wellness programs and managed care.

  2. Pooled

    Employers share claims above the retained portion, in a $250,000 layer of risk, with other employers in a group captive arrangement managed by MediCaptive.

  3. Stop Loss

    Large and catastrophic claims above the retained and pooled layers are assumed by Swiss Re, a large, third-party underwriter of medical and stop loss insurance and MediCaptive’s preferred provider.