J CAPTIVE

What is the COVERAGE: 

This is not a special form of coverage, but a special form of funding a health insurance plan. By bringing together similarly-minded, smaller companies, the J-Captive allows small companies to purchase captive stop-loss insurance with the leverage of a much larger company.

The captive stop-loss is a member driven stop-loss product that has been created by and will continue to be managed by AHT. Members will meet to monitor financial stability of the stop-loss and to determine as a group if and when adjustments need to be made.

The J-Captive is paired with a concierge service that has both native Japanese and native English speakers to help guide members through a system that may not be familiar to them (especially if they have never interacted with the US health system!)

COVERAGE

• Allows small- to mid-sized companies to enjoy many of the perks of self-funding while also minimizing exposure to larger claims.
• Companies can enjoy control over their insurance program.
• Offers best-in-class companies the opportunity to leave the conventional market and share risks with like-minded organizations.
• Affords companies the opportunity to control many facets of their program — including premiums, TPAs, and plan details.
• Offers best-in-class events and the opportunity to interact with other members and share best practices.
• Affords companies opportunities to improve health management strategies.
• Provides companies greater transparency into the flow of dollars and loss drivers.
• Risk/reward model that rewards members for minimizing both frequency and large claims with dividends from unused underwriting dollars.
• Provides companies the ability to stabilize their health insurance costs.

WHY SHOULD I MOVE MY INSURANCE TO A SELF-INSURED FINANCIAL MODEL?

• Members choose their own specific deductible ranging from $25,000 to $250,000
• Dividend potential.
• Members can create their own plan design and plan document.
• Participate in the sharing of population health ideas to drive down the total cost of health care.
• Aggregate stop-loss is included in the captive structure.

MY PLANS ARE ALREADY SELF-FUNDED – WHAT ARE THE BENEFITS OF USING THE AHT J-CAPTIVE?

• Most captive programs require use of Third-party administrators instead of the well-known major carriers such as Cigna or Aetna. This is critical, especially for companies with employees from outside the country. It is difficult enough to navigate medical care in the US, and many provider staffs do not recognize third-party administrator ID cards. Cigna and Aetna are both well recognized health insurers.
• The J-Captive also helps your members get the care and answers they need with the inclusion of a concierge service that is staffed with both native-Japanese and native-English speakers
• Members choose their own specific deductible ranging from $25,000 to $500,000.
• Dividend declared for each closed and profitable underwriting year.
• Members can maintain their current plan design.
• Participate in the sharing of population health ideas to drive down the total cost of health care.

WHAT IS MY COMMITMENT TO THE CAPTIVE?

• You may exit the captive upon any renewal
• Upon exit, you will no longer have access to the Cigna or Aetna networks or the specialized concierge services

WHO SHOULD CONSIDER THIS CAPTIVE?

• Groups that want to consider self-funding but are worried that they might be too small to achieve financial stability on a stand-alone basis
• Companies that have either permanent or rotational native-Japanese staff who my need additional support as they navigate the US health system and insurance coverage
• Groups who struggle with huge fluctuations in their stop-loss premiums
• Companies who want to try captive funding, but also want to offer their employees name-brand carriers (Cigna and Aetna) to make the change in funding less confusing for members

HOW DO YOU ACCESS & SUBMIT A REQUEST FOR PROPOSAL?

• The first step is to have an education session with ICS, the stop-loss administrator
• Once that is complete the attached intake form and email as instructed on the form
• An ICS representative will reach out to you to review details of your client and identify the best path forward on a case by case basis

HOW DO I GET PAID?

• You can include any PEPM commission amount you want in the policy. Typical PEPMs range from $20-$35 PEPM.
• AHT receives a separate $5 PEPM in addition to any commissions you choose to build into the policy.
• Both commissions will appear as line items on proposals – there is total transparency

ADDITIONAL RESOURCES

CONTACT THE FAMILY PROTECTION TEAM