Plan Designs

More about the different plan designs offered

Within this captive you establish your own self-funded plan. You and other participants combine your funds into a larger pool, from which all participants draw to fund their health services. Once admitted and plan established, each owner is key to keeping the plan healthy. Owners should take an active role in seeking out friendly providers - PHCS or others who are open to reference-based pricing; reviewing their claim reimbursements and and working with claims advocates when needed. Members stand to benefit from the performance of the plan in the form of more affordable premiums and healthcare each year if the group spends wisely.

Finally, plan designs are simple. Your deductible and out-of-pocket maximums are the same – once you hit your deductible, claims are paid at 100% and you meet your out-of-pocket maximum for the year.

Start by searching the PHCS network by clicking here. If your preferred provider does not appear you can use any doctor you choose. Simply provide your card to your physician’s office and have them contact the claims team to coordinate payment. Contact information will be on the back of the card, just like other insurance cards you are used to using. It's important you not pay for your healthcare services up front; if you provider doesn't want to the number on the back to verify the plan, you should insist.

Similar to ACA plans, qualified preventative services are not subject to the deductible, and are covered 100% within plan designs.

There are three plan designs to choose from when you enroll. Once contracts are signed, you must wait until renewal to select a different plan design.

As the owner of your self-funded plan for your business, you may request a change to your plan design. However, the plan designs are rated as they are now, inclusive of all their services and features; prices reflect these ratings. To request a change, you must submit a request to Vault Captive. The plan will be re-rated based on its new features, and you will be provided with a new monthly fee total.

Two of the three plan designs ($2,500 and $5,000 deductibles) are HSA eligible. There is no captive-sponsored HSA vendor, but you can set up your own individual HSA account through many sources. Your bank or credit union may offer individual HSA accounts, or use an internet-based HSA provider, such as  ConnectYourCare or HealthEquity.

Similar to ACA plans, there are no annual or lifetime limits on benefits. This is NOT a limited medical or short-term medical plan.

Depending on the plan design you choose and whether you choose to cover dependents, your deductible will vary. One of the key features of these plan designs is that the deductible and out-of-pocket maximum are the same, so once you meet your deductible, qualified benefit services are covered at the 100% level.

Prescription coverage is detailed in the plan summaries; formulary can be found here. Please read the formulary carefully.

Reference-Based Pricing is a healthcare cost containment model provided by AMPS that reviews claims, adjusts for errors, and provides fair pricing recommendations based on several benchmarks, including Medicare, cost of care, and regional cost data. This model is used to eliminate the fraud, waste, and abuse that is prevalent in the healthcare billing system today. Participating members and the Captive will benefit from this solution.

The reference-based pricing company, AMPS, starts its work when Vault Admin receives the first bill from your medical provider. They will reprice the bill based on the above factors. It's very difficult to reprice a bill if it's already been paid, so do not pay your bill at the time of service.

We recommend Members contact the AMPS Care Navigation Team to find the best facilities based on quality and cost metrics. This team, in collaboration with the Member, uses the Provider Finder to locate a “friendly” provider for medical care, based on cost, quality, location, and prior utilization. You can reach the AMPS Care Navigation Team at 800-425-9374 (this number will also be on your card).

Yes. The AMPS Care Navigation Team can facilitate access to Members’ healthcare resources by ensuring personalized services that support their healthcare needs. One of the benefits of the Vault/Captive relationship is a partnership with Edison Health. Members have preferred pricing and access at Mayo Clinics, The Cleveland Clinic and many more leading medical facilities.

Yes – we recommend the Member contact the AMPS Care Navigation team, as many providers require authorization prior to some procedures and surgeries.

Medical equipment is reimbursed at 100% after the deductible is reached. Durable Medical Equipment is defined as: able to withstand repeated use; primarily and customarily used to serve a medical purpose, and not generally useful to a person in the absence of sickness or bodily Injury.