Eligibility: To apply and ultimately establish your plan, you must be a Business Owner, Sole Proprietor, or Independent Contractor with a federal Tax ID; complete a short health questionnaire and be accepted; and join or maintain your membership in your association if required. A federal tax ID can be from an LLC, S-corp, or other sole prop structure.
Structure: The captive is run by Vault, 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 great rated 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. As the owner of your self-funded plan, you have the right to change the design of 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 / AMPS, our claims administrator, if they do not match.
Is dental and vision offered?: Dental/vision may be included as part of the captive or separately. Check the 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.
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.
Within the last five years, has any person listed on this application been prescribed or is currently taking any of the following medications:
Cosentyx, Humira, Soliris, Otezla, Dupixent, Remicade Solr, Vyvanse, Ozempic, Descovy, Aimovig, Reyvow, Zokinvy, Myalept, Mavenclad, Ravicti, Actimmune, Oxervate, Takhzyro, Juxtapid, Gattex, Chenodal, Acthar Gel, Orladeyo, Tegsedi, Ayvakit, Qinlock, Korlym, Vitrakvi, Recorlev, Cortrophin Gel or Tibsovo, Wegovy
Are you or is any immediate family member pregnant, an expectant parent, in the process of adopting a child, or undergoing fertility treatment?
Within the last five years, has any person listed on this application received any medical or surgical advice, consultation or treatment, including medication, for:
Have you or any person proposed for coverage been diagnosed or treated by a medical professional or medically diagnosed for Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related complex? (Answer to this question "No" if you have tested positive for HIV but have not developed symptoms of the disease AIDS.)
A Captive insurance company is a privately owned insurance company whose owners come together to pool risk and form their own licensed insurance company. In this case, members who are sole proprietors, independent contractors and/or single business owners who create self-funded plans for their own businesses. This group approach provides members with the scale to cover the medical risks of participant members and potentially provide cost savings compared to the ACA marketplace and other private individual plans.
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:
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 January 1 each year.
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.