How can we help you?

Your business is establishing a self-funded health plan and your business is joining the Captive as a class member. All participating companies combine funds into a larger pool, from which all participants draw to fund their health services. Each owner is key to keeping the plan healthy. Owners should take an active role in seeking out friendly providers, providers in the PHCS network, or others who are open to reference-based pricing, reviewing their claim reimbursements and working with claims advocates when necessary. 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. Plan designs are simple. Your deductible and out-of-pocket maximums are the same – once you hit your deductible, claims are paid at 100% with the exception of Pharmacy Tier 2 and above.

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 Vault captive 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 inclusive of all their services and features; prices reflect these ratings. To request a change, you must submit a request to Vault Health Captive. The plan will be re-rated based on its new features, and you will be provided with a new monthly fee total subject to approval.

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.

The three model plan designs show the annual out of pocket maximum which is the same as the members deductible and these vary by tier. Once you meet your deductible, qualified benefit services are covered at the 100% level with the exception of copays that apply for Pharmacy Benefits at Tier 2 and above.

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 Fairos 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. The reference-based pricing company, Fairos, starts its work when Vault Admin Services receives the first bill from your medical provider. Fairos will reprice the bill based on the above factors.

We recommend Members contact the Fairos 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 Fairos Care Navigation Team at (855) 426-1100.

Yes. The Vault Admin Services team can facilitate access to Members’ healthcare resources by ensuring personalized services that support their healthcare needs. In addition, Members have access to Edison Health Care. Members have access to the Edison Health second opinion program and concierge medicine program.

Yes – we recommend the Member contact Vault Admin Services, as many providers require authorization prior to some procedures and surgeries.

Yes – we recommend the member contact Vault Admin Services to discuss your unique situation.