Its in the $
The approximate portion of premium attributable to outside services.
What is about 1.5%?
The document that governs what is covered and the rules of the plan, even though the employer uses stop loss for large individual claims and aggregate claim frequency.
What is the employer's plan document?
A claim arising after captive entry is paid regardless of when it occurred, but the member must meet that individual's spec deductible in the payment year; only 24/12 and 12/18 are identified as this
What does gapless mean, and which contracts allow it?
A subsidized analytics platform that turns medical and Rx claims into dashboards, insights, and Playbooks; Classic members receive Analytics and ICM members receive Intelligence.
What is Springbuk?
Re is the actual captive; Holdings sits above it, is owned by members, and owns 100% of Re, partly because some states restrict equity stakes in insurance companies.
What is the difference between Re and Holdings?
An 8% stop-loss premium decrement and 5% attachment-point decrement, paired with a general minimum specific deductible of $30,000, except where state mandates are higher.
What are the RBP discount and minimum specific deductible rules?
The party licensed and admitted in every state that collects premium and pays claims.
Who is the Carrier
A $1.50 PEPM net-of-commission aggregate premium charge that helps cash flow by allowing reimbursement above the year-to-date attachment calculation.
What is Monthly Aggregate Accommodation?
A direct-contracting program for outpatient diagnostics and surgeries with pre-negotiated, prepaid discounted rates, though geographic access gaps may apply.
What is KISx Card, or Valenz Health/KISx?
Captive claims divided by net captive premium after backing out policy expenses and excess premium for the life of the member.
What is the Inception-to-Date Loss Ratio?
13% to 16% CAGR
What has been historical growth rate on capital
A company formed solely to buy insurance, which the document says an employer absolutely cannot create to join the captive.
What is a shell company?
One costs $1.00 PEPM on aggregate premium; the other is usually an 8%-12% specific premium load; both must be purchased up front and provide up to three extra months of coverage.
What are Aggregate TLO and Specific TLO?
A Medicare-eligible participant concierge service with Passive and ICM-only Active versions, offering education, plan recommendations, and licensed-agent support in all 50 states.
What is SmartConnect?
Depends on complete data submission and carrier medical-review workload, with data requests generally in late January, April, or July for 7/1, 10/1, and 1/1 renewals respectively.
When should members expect renewals?
$3.50
Universal membership fee beginning 7/1/26 for new members and first renewal after 7/1/27 for current members
Legal documents are typically expected back within about three weeks, sold-case paperwork within seven business days, and membership is not active until subscription documents and capital payment are complete.
When are legal and sold-case documents due, and when is a member active?
A change of roughly 10% or more in enrollment, tiers, or plan elections may trigger re-underwriting.
What enrollment change may trigger re-underwriting?
The member loses access to Pareto pricing and forfeits any underperformance payments from annual reconciliation.
What happens if a member leaves the captive while using PRxC?
They are not firm actionable quotes and do not formally set lasers, even though internal underwriting may identify large claimants of concern.
What are indications at the underwriting stage?
More than $510M
Our combined New Business Premium goal for 2026
A legal and consulting bundle covering plan document drafting, compliance support, subrogation and overpayment recovery, claim negotiation, and plan defense design.
What is The Phia Group?
A specific-contract basis allowed only for currently self-funded groups that insist on it and acknowledge in writing they are giving up run-in/run-out protection; never for fully insured or level-funded takeovers.
What is a 12/12 specific contract basis?
It packages Pareto’s broader value proposition—Risk Shield for volatility protection and Savings Engine for active cost control—into a simpler, faster-to-launch path.
What is ParetoOne?
The implementation target is completion by the effective date, but movement depends heavily on receiving the PAW/admin worksheet and W-9.
What drives the implementation timeline?