From “bellybutton” to “captive” the health benefits lexicon is chock full of terms that have wildly different meanings in other contexts. Another example? Lasers. You may know them as the weapon of choice for futuristic villains in cinema, but what are lasers in the context of medical stop loss? What role do they play and how does ClearPoint Health approach them? We explain below.
Lasers in Medical Stop Loss
Medical stop loss insurance protects self-funded employers from exceptionally high healthcare claims by reimbursing them when claim costs exceed a predetermined amount. In this type of insurance plan, lasering refers to assigning a higher deductible to employees with known, serious medical conditions that are expected to result in significant costs. Conditions that might cause someone to fall within this category include cancers, kidney failure, premature births, severe injuries, and conditions treated with organ transplants. Lasers isolate these types of expected risks from the general insured population.
Lasers in ClearPoint Health’s Captive
For small to midsize businesses (SMBs), joining a group captive is often the best way to benefit from the protection of medical stop loss coverage. In a group captive, like-minded employers band together to self-fund their healthcare costs, with each employer purchasing their own medical stop loss policy. This approach empowers SMBs to gain more control over their health plan costs as they spread risk across a larger group to reduce volatility.
ClearPoint Health elevates the standard captive model by promoting a culture of accountability through our proprietary Member Engagement Index (MEI), which ranks employer members as Focused, Engaged, and Passive. Upon entering a ClearPoint Health Captive, each employer member is given a playbook of cost management recommendations tailored to their unique situation. A Focused employer member follows the playbook closely, maximizing employee participation in vitality and wellness initiatives, provider-benefit navigation, cost management, Rx strategies, and other programs — achieving minimum expense on the continuum of expected employer cost. A Passive employer member does not take the actions outlined in their custom MEI navigation playbook, which translates to the maximum expense. Engaged employer members fall in the middle of the spectrum, with their ranking tied to expected expense.
The MEI rewards Focused and Engaged employer members with financial incentives, including a no new lasers (NLL) policy. This means that, come renewal time, Engaged and Focused employer members can rest assured that the plan will not take on any new lasers in addition to those already accounted for.
Participation in a ClearPoint Health Captive comes with the added bonus of access to the ClearPoint Health Alternative Funding Center of Excellence (COE). As medical stop loss protects employer members from unavoidable risk, the COE connects them with best-in-class vendors and clinical point solutions that meet our high standard of Sustainability, Accountability, Fairness, and Efficiency (SAFE) and are designed to reduce addressable and avoidable costs.
ClearPoint Health’s approach to captive design and cost management is indicative of the thread of empathy and accountability that runs through our digital alternative funding marketplace. Contact us today to partner!
