The 5812 Healthcare Program is a series of health plans designed specifically for companies with 500 or more employees and a minimum of 50 participants in their medical plan. It is offered to 16 industries sharing the common characteristic of employing a predominantly lower-wage hourly workforce.

Technically, no. It is a self-funded "mirror" to a healthcare Captive offered to similar but smaller companies nationwide, with identical plan designs, reinsurers, claims attachment points, level premiums, and service vendors, including specialty TPAs and actuaries. The 5812 Healthcare program is offered only to companies large enough to have credible loss data, allowing us to model the projected loss experience by extrapolating the aggregate results of our traditional Captive program.

In CBA's traditional Captive program, the Captive Sponsor retains underwriting profits generated by outperforming our actuarial assumptions. In the 5812 Healthcare Program, those profits go to the Plan Sponsor, not CBA.

Practically speaking, there is none. All level-funded premiums are quoted at the maximum possible cost to the Plan Sponsor. In other words, the rates we display are the highest possible cost a company could pay before the plan becomes fully insured. An A+-rated US-domiciled insurance company fully reinsures all costs, including claims, in excess of our quoted rates.

We offer a sequential array of up to six health insurance plans using an innovative Hybrid PPO model we created. Our plan designs are uniquely ours and well-received by hourly workers. Our plans range from preventative Minimum Essential Coverage (MEC) to a Platinum Preferred Provider Organization (PPO) with no deductible and a maximum out-of-pocket of $1,000 a year.

While our plans use traditional PPO networks for practitioners, physicians, and specialists (Cigna and PHCS), most incorporate a Limited Day Medical (LDM) plan structure coupled with a Reference-based Pricing (RBP) claims strategy to adjudicate facility and hospital claims. These key features allow us to offer our plans at an incredibly competitive price point compared to traditional group insurance plans.

An LDM plan caps certain coverages and services to a specific number of days per policy year. This includes hospital stays, physician and specialist visits, and surgical procedures. The savings realized on the catastrophic end of the claim's spectrum allow the plan to cover almost all primary care needs with either first-dollar coverage or a nominal co-pay. An LDM plan empowers employees in generally good health to dramatically lower their healthcare costs by not paying for the unlimited catastrophic protection inherent in traditional PPO plans.

RBP is a healthcare cost containment strategy that limits what a group health plan will pay for certain high-cost services, including hospital and outpatient facility charges. There are a variety of RBP strategies employers can implement. Most of our plans pay hospital and facility charges at a percentage of Medicare allowable charges (125%–175%). This strategy allows your employees to access the same hospitals used by traditional PPO networks at a fraction of the cost of most managed care models.

Yes, all our plans are 100% compliant with the ACA. All our plans provide MEC. Our Bronze, Silver, Gold, Titanium, and Platinum Plans all exceed the required 60% Minimum Value (MV) standard required by the ACA and pass the Minimum Value test as outlined in the U.S. Department of Health and Human Services (HHS) calculator.

Yes, all plans we write and all plan documents we provide are 100% ERISA compliant. ERISA governs this type of program, and every detail is addressed to assure program compliance with all federal health plan regulations, including ERISA.

There is none. Unlike traditional group insurance, which requires 40%–50% minimum employee participation, our unique plan designs dispense with this requirement. We target industries that typically have between 15%–20% participation rates in employer-sponsored medical insurance. From our perspective, any minimum participation requirement is a nonstarter, so we designed the 5812 Healthcare Program without minimum participation requirements.

Plan profitability is tracked monthly on a paid-claim basis. We prepare an annual plan performance report 15 months after plan inception. We use claims incurred during the 12-month plan year plus a modest IBNR factor (for claims that have not yet been filed or incurred but not reported). To the extent that the plan outperforms the initial actuarial assumptions, the excess premiums are returned to the plan sponsor. The estimated amount of these premiums' offsets can be viewed at various claims levels, using our program pricing spreadsheet and selecting the drop-down cell corresponding to the percentage of expected claims. As you change this variable, you will see the plan pricing drop, representing a lower employer cost for each plan.

The yearly average claims are within a few percentage points of 75% of the expected claims, set by program actuaries. These results are based on claims incurred in 12 months and paid in 15 months, the same terms as the stop-loss contracts that protect the 5812 Healthcare program.

No, they are not. These plans appeal to and are designed to benefit the 95% of hourly workers who are young and in relatively good health. In almost all circumstances, an employee who is not a heavy user of medical services and has no chronic medical conditions will have a significantly lower total annual out-of-pocket healthcare cost with one of our plans.

No, it will not. There are two excellent protections for these employees. The first is the Insurance Marketplace (.GOV), which offers individual traditional HMO and PPO plans with guaranteed issuance. Since adopting the 5812 Healthcare Program will require a 60-day Notice of Material Modifications to participants of your current health plan, all employees will have the opportunity to opt out and select a traditional On-Exchange HMO or PPO during the enrollment process. The second layer of protection is the design's top two-tier plans for managers, administrators, and executives. These benefit-rich traditional major medical plans feature zero deductibles, zero co-pays, and zero-cost drugs with a maximum annual out-of-pocket total cost of $1,000 per individual.

Since we first started writing the 5812 Healthcare Program in 2017, our total rate increase has been 4%. Nationally, over the same period, traditional health insurance rates have increased an average of 19% (Source: The Kaiser Family Foundation Annual Benefits Survey — 2019).

Turnkey means we provide all benefit design work, actuarial work, stop-loss underwriting, policy placement, benefits administration systems, benefits materials, employee communications, plan documents, open and ongoing enrollment services, call center support, program accounting and reporting, financial and insurance brokerage services, and ACA compliance and reporting.

Yes. There is a onetime setup fee of $5,000 due at contract signing. This fee covers the cost of the necessary legal work, trust setup fees and filings, plan documents, and enrollment communications. It also includes the Benefits Administration Platform's configuration, branding, and deployment.

From the acceptance of our written proposal to the initial effective date of the plan, you should allow four months' lead time to properly implement the program. This lead time is essential because the ACA requires 60 days' advance written notice to participants when making material modifications to their employer-sponsored health plan.

We require a current employee census with hire date, age, gender, and zip code. We need to know what types of current plans are offered by reviewing a Summary of Benefits or Summary of Benefits and Coverage (SOB or SBC) and receive a copy of the prior month's plan invoice showing participation and plan cost. We will provide a written formal quotation within 10 days.

The number 5812 is the four-digit Standard Industrial Classification (SIC) code for "Eating Establishments." Restaurants were the first industry group we insured in this program.

What you are missing is an effortless way to substantially improve your bottom line. The 5812 Healthcare Program will reduce a major overhead expense for your company, help you attract top talent, and significantly reduce voluntary turnover in your hourly workforce. While this FAQ format provides a high-level overview of our program, we are happy to demonstrate exactly how it will do that in a detailed written proposal for your company. All written quotations include numerous client references; you may contact them to discuss their experience with our program and company.