DYI Dollars
Owns the plan and has primary responsibility for claims payment in self insured
what is the Employer
In a medical group captive, employers band together to share this.
What is Risk
Founded in 2011, Pareto Health now has more than this many member companies.
What is over 3,500
These are the two main types of stop loss coverage: one for an individual claim and one for the entire group.
What is specific and aggregate stop loss?
who has responsibility for processing claims, eligibility and providing a network?
What is a TPA or Third Party Administrator
Unlike traditional stop loss, medical group captives allow employers to also share in this if claims are favorable.
What are underwriting profits / surplus distributions?
Pareto Health’s model is designed to bend this unsustainable curve for American employers.
What is Medical Trend?
These common contract types—12/12, 12/15, 24/12—refer to how this is applied.
What are contract periods for paid vs. incurred claims?
Employers often purchase this type of insurance to protect against catastrophic claims in a self-funded plan.
What is stop loss?
In a group captive, each employer is responsible for their own claims up to this retention level.
What is a specific deductible?
Risk Shield is designed to ensure this never happens to members—something traditional stop-loss carriers often impose after a big claim.
What are Lasers?
This stop-loss feature provides cash flow relief to an employer when a large individual claim hits before they can pay it out.
What is specific advance?
A major advantage of self-funded plans is reducing this kind of state-mandated tax or premium fee.
What are state premium taxes?
One major reason employers join a captive is to avoid rising costs from this type of health plan.
What is Fully Insured plans?
Pareto’s Savings Engine saves employers an average of this percentage by year three compared to fully insured models.
What is 16.5%
This feature advances funds when cumulative claims approach this type of limit before year-end.
What is aggregate accomodation?
Unlike fully insured plans, self-funded plans are regulated primarily under this federal law.
What is ERISA?
Captives are typically controlled by these entities, giving members a say in decisions.
What are member-owned boards or committees?
Beyond no lasers, Risk Shield also caps this at a predictable level to reduce volatility year to year.
What is premium increase cap of 30%?
What type of plan offered by Insurance Carriers provides monthly maximums and a chance to get savings returned?
What are level funded plans