Breaking Free from Fully Insured Carrier Premium Gouging
In traditional fully insured health plans, commercial insurance carriers charge significant risk premiums and retain 100% of unspent claims dollars during low-claim years. Level-funded plans allow employers with 50+ lives to capture year-end surplus refunds while capping risk with stop-loss insurance.
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Structuring Specific & Aggregate Stop-Loss Protection
Stop-loss reinsurance protects corporate balance sheets against catastrophic medical claims. Specific stop-loss caps employer liability at a fixed dollar amount per member (e.g., $75,000), while aggregate stop-loss caps the overall plan spend at 120% of projected claims.
Unbundling Pharmacy Benefit Managers (PBMs)
Specialty prescription drugs account for over 40% of corporate healthcare inflation. We explain how fiduciary employers unbundle traditional carrier drug programs, contracting with pass-through PBMs that return 100% of manufacturer rebates directly to the employer plan.