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November 21, 2024

The Captive Vernacular: Defining the Common Parties Involved in Medical Stop Loss Captives

Who is Responsible for Medical Stop loss Captives? 

Captive Managers, Program Managers, and Benefit Advisors: Understanding Their Distinct Roles 

Captive health plans have gained significant traction as an alternative risk structure strategy among groups of all sizes. However, different roles within this landscape often lead to confusion. We are going to look at three key players: Captive Managers, Program Managers, and Captive Advisors and discuss how their functions contribute to the unique medical stop loss captive experience. 

Captive Managers: Captive Managers traditionally oversee the day-to-day operations of a captive insurance company. You will often find them handling administrative tasks, ensuring regulatory compliance is met, providing necessary financial reporting, and even performing the physical claims management of a plan. You can expect the Captive Manager to make sure the captive operates smoothly and efficiently and aligns with the captive's goals and regulatory obligations. It’s not uncommon to see the state regulatory agency require a Captive Manager to be involved in any new captive concept.

Program Managers: Program Managers often focus their efforts on designing, implementing, and managing insurance programs tailored to specific risks within an organization. This means that Program Managers are involved in the details, particularly for those high-cost members that can greatly impact the group’s and the captive’s expenses. Your relationship with your Program Manager is a valuable one. It means that you have someone in your corner to assess the risk profile of the group, manage stop loss policies, pre-configure and integrate health plan operations, monitor for value-add opportunities, and ultimately create the highest performing insurance structures. When partnering with a Program Manager, you have a partner who will collaborate with Captive Managers, or sometimes act as both. They will work to integrate captive solutions into your organization’s complete insurance strategy. 

Benefit Advisors: Benefit Advisors often function as the strategic guide for an organization that may be considering a captive. These individuals are often industry experts who share their insights on the feasibility, benefits, and risks associated with captives. A true Captive Advisor can help an organization, or benefit advisor, determine if a captive plan is the right idea, help  navigate any legal requirements, assist with regulatory information, and even optimize captive performance. Benefit advisors often have preferred relationships with Program Managers and Captive Managers, largely due to experience and existing business relationships.

As you consider a captive, make sure you have the right players performing the right duties. In summary, Captive Managers handle operational and regulatory intricacies, Program Managers develop tailored insurance solutions, and Benefit Advisors offer strategic insights. These roles can traditionally be found working together to maximize the potential of captives, enhancing risk management and financial strategies for organizations. Understanding their respective roles empowers you to make informed decisions in the ever-evolving landscape of captive insurance.

ClearPoint Health is proud to be one of the most knowledgeable and creative Captive Program Managers in the business. Through our industry-leading ClearPoint Health Platform, we bring options to our partners designed to drive significant benefit savings for those companies that need it the most: small to mid-sized employers (SMBs). 

Contact us today to find out more information and to learn how we can devise a benefit strategy with your advisor for maximized savings. 

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