Frequently Asked Questions
Can we keep our current TPA/Carrier and Network?
Yes. Each group can maintain their current TPA/Carrier and related network going forward provided Carriers agree to provide ASO services. There will be no mandated consolidation of TPAs/Networks.
Can we maintain our current Plan Design?
Yes. Each group can maintain or change Plan Design. There is no mandated consolidation of Plan Designs.
Can we maintain current HSA/HRA banks and services?
Yes.
If self-insured, will our Specific & Aggregate Deductibles change?
Your Choice. Each group will have a deductible level quoted specific to that group. Deductible level will be a group by group individual decision.
If Collateral is established as Letter of Credit, how would it be used if needed?
In the event every captive employer member experiences a high utilization year resulting in a spend greater than their aggregate deductible, prior to Berkley Accident & Health assuming responsibilities for those costs, the letter of credit would be cashed. This would occur ONLY if ALL members of the captive experience a high utilization year. The statistical probability of that occurring is small.
How are Distributions Calculated?
Distributions from the Captive are made pro rata based on each group’s percent contribution to the total Captive funding. Distributions are made to groups active at time of distribution.
What if my company has good claims experience, is my company burdened by sub-optimal utilization trends of others?
No. Individualized base-line underwriting depends on each company’s claims experience and utilization.
What happens if our group has a high cost claims year?
This is where the Captive has a strong balancing effect for participating groups. A high cost year for a group is supported by the overall performance of the Captive, which is likely to be profitable and therefore able to help hold down overall costs for any specific group.
What is the criteria for membership?
The optimal company size is 150-800 employees. Membership is determined solely on the underwriting of each employers 2-year utilization history and current claims experience. Membership is data-driven.