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Eligibility: To establish your plan, you must be an independent, self-employed business owner with NO employees. The business must have its own federal Tax ID.; Complete a short health questionnaire and be accepted. A federal tax ID can be from an LLC, S-corp, or other business structure.

Structure: Vault Health Captive, a captive insurance company domiciled and regulated by the North Carolina Department of Insurance. You will establish a self-funded plan for your 'business of one', which means you are an owner of the captive and are represented by its Advisory Board.

Plan Design Options: There are three model plan designs for the business. Those plan levels offer deductibles of $2,500, $5,000, and $10,000 – and, unlike the ACA, the deductibles are also the out-of- pocket maximums, with the exception of co-pays for tier 2 and above pharmacy benefits (once the annual deductible is satisfied). As the owner of your self-funded plan, you have the right to request changes to your selected plan design; however, Vault, as administrator, must approve. Plan design change will result in re-rating and change to monthly payment.

Network and Claims: You also have access to a nationwide PPO, PHCS Physician. Check their doctor list here. Be sure to compare your explanation of benefits to the provider bill and contact Vault Admin Services, our claims administrator, if they do not match.

Benefits of the Plan Designs: The structure, plan designs and application of a health questionnaire are all components designed to allow the captive to remain healthy now and in the long run. As the cost of healthcare continues to increase, the captive will choose how to control costs by adjusting participation requirements or plan benefits. Other benefits may include:

• Potential savings vs. the ACA Exchange
• Access to a national physician PPO network or go to any doctor of your choice
• Two HSA eligible plan design options with business tax deductible premiums (always confirm with tax professional)
• Three major medical plan design options

Are dental and vision offered?: Dental/vision are offered separately. Check your specific website and your plan design options for details.

Plan Establishment: Creating your plan is simple and secure via an online portal. Review the plan design options and monthly fees, complete and pass a medical questionnaire and select your plan design, sign final contracts, enter bank information, and you’re done.

Participation Requirements: You must meet the following requirements to establish your health plan:

• Individual business owners / independent contractors with a federal Tax ID (the policy is issued to the business).
• Complete a health questionnaire on behalf of primary and dependents and be accepted based on the answers.
• Join and/or maintain your annual group membership if it is required by the sponsoring organization.
• Your federal tax ID can represent an LLC, S-corp, or other legal business structure.

If you do not pass the medical questionnaire, your business will not be allowed to establish your plan within the captive (information on the next page). You may not be admitted based on the results of your health questionnaire or if you do not meet other eligibility requirements.

Information on Monthly Fees: Regardless of when you establish your plan and participate in the captive, any changes to monthly fees, details or plan designs will occur January 1 each year. In early November, each plan will have the opportunity to renew for the next calendar year and all plans must be renewed.

Monthly fees are guaranteed through the end of the calendar year. The 2024 plan year begins on January 1, 2024 through December 31, 2024.

A captive harnesses the size and scale of its membership to create an innovative structure that locks in savings for its members and their families in good health. The first step is to screen for healthy applicants. About 5% of people drive 95% of healthcare costs. By allowing the remaining 95% of applicants to participate, the chance of larger claims is reduced.

The second step is to ensure each captive member maintains its responsibility to other participants, including seeking friendly providers via PPO, Care Navigation or other means, reviewing claims reimbursements and provider bills, and working with claims advocates when needed.

The captive is reinsured by OdysseyRE, an A rated reinsurer. If claims exceed expected levels, they are paid by the re-insurer and Vault. There is NO maximum coverage limit. In addition, the captive structure is filed with, and meets all requirements set forth by, the North Carolina Department of Insurance.

You will need to apply and pass a medical questionnaire on behalf of yourself and any dependents you wish to cover, your business will not be allowed to establish a plan in the captive.

You must meet the following requirements:

• Individual business owners / independent  contractors with a federal Tax ID (the policy issued to the business) and their dependents.

• Complete a health questionnaire on behalf of primary and dependents and be accepted based on the answers.

• Join and/or maintain your annual group membership if it is required by the sponsoring organization.

Your federal tax ID can represent an LLC, S-corp, or other legal sole prop structure.

There is no individual medical underwriting but applicants must complete a short health questionnaire to qualify.

The client support team will not request nor view your medical history. Your health questionnaire will not be used for any other purpose than determining your eligibility and will not be shared with or released to any other entity.

There is no individual medical underwriting, but applicants must complete a short health questionnaire. The client support team will not request nor view your medical history. Your health questionnaire will not be used for any purpose other than determining your eligibility. It will not be shared with or released to any other entity.

The captive is owned by participating member businesses. Each member participant is its own self-funded plan. Vault Health Holdings is the captive manager and Vault Admin Services is the plan Administrator. The captive secures a re-insurance contract to cover claims exceeding the target loss ratio (if the captive does exceed the loss ratio. Re-insurance provided by OdysseyRE does not have a “specific” or “aggregate” paid claim limit, meaning that there is  no coverage limit, or re-insurance cap.

Because you are creating your own self-funded plan as part of the captive, there are four documents required that are not typical of a group insurance enrollment process. You will have to sign:

• A  joinder to the captive operating agreement which describes, among other things, how the captive will operate and communicate with members.
• A plan document for your self-funded plan
• Medical Reimbursement Contract with the Captive
• An attestation that you agree by specific tenets of the captive

• Potential savings vs. the ACA Exchange
• Access to a  national physician PPO or go to any doctor of your choice
• Two HSA eligible plan design options with tax deductible premiums (always confirm with tax professional)
• Three major medical plan design options

The structure, plan designs and application of a health questionnaire are all components designed to allow the captive to remain healthy now and in the long run. However, the cost of healthcare continues to increase. But, as members of the captive, members choose how to control costs by adjusting participation requirements or plan benefits.

Regardless of when you establish your plan and participate in the captive, any changes to monthly fees, details or plan designs will occur in November and December for a new plan year beginning January 1.

Only independent, self-employed business owners with NO employees may establish self-funded plans for their business. The business should have its own federal Tax ID.