Skip to main content
Open Search
Create Account
Search for topics or resources
Enter your search below and hit enter or click the search icon.
Close Search
Create Account
Employee Benefits Captive

ELITE. Our benefits captive.

For self funded groups whose owners are done absorbing double digit renewals on a traditional plan and want to see where every dollar of their spend actually goes. Accepting submissions now.

Run the numbersBook a call

Program specs

StructureGroup captive, shared layer
Minimum enrolled26 employees
Specific deductible$25,000 and up
Captive layer$225,000, scales
Aggregate corridor125%
DomicileBermuda
Eligibility

Who fits ELITE.

The floor is real, but it is not the only question. A 40 life group with no appetite for self funding is a worse candidate than a 30 life group whose owner already understands the trade.

26
Minimum enrolled employees
This is a hard floor. Smaller groups are not a fit today.
$25K
Minimum specific deductible
Scales up with group size.
24 mo
Claims experience required
With large claimant detail included.
Self
Self funded, or ready to move
Groups on a traditional plan qualify if they are prepared to self fund at renewal.

Does the group clear the floor?

Enter the enrolled employee count.

enrolled employees
Protection

How the layers stack up.

Layer 1

The employer

Claims below the specific deductible, $25,000 and up depending on group size.

Layer 2

The captive layer

The shared layer above the deductible, scaling with group size.

Layer 3

The stop-loss carrier

Everything above the captive layer. Skyward and Great Midwest are the carriers.

The ceiling

The aggregate corridor

A 125% corridor puts a firm ceiling on total plan spend for the year.

Pharmacy

Where the savings actually come from.

On most benefits captives the pharmacy line is where the money leaks. This is the part of ELITE worth walking a prospect through slowly.

How the pharmacy program is built

  • Pharmacy carve-out structure in place
  • GLP-1s carved out with specialized pricing
  • $6 per claim, no per-script fees, no hidden PBM spreads
  • Mandatory biosimilars in place
  • Prior authorization at $350 for specialty drugs and GLP-1s
  • Every claim over $1,000 reviewed for errors and duplicates
  • Specialty drugs managed internally, no third party disconnect

What members have seen

$3.1M
Returned to members
32%
Loss ratio

Program partners

Stop-loss carrierSkyward / Great Midwest
Third Party AdministratorCAS Benefit
Pharmacy Benefit ManagerTrueScripts / Seva Rx
Captive managerSRS
Submissions

What a complete submission looks like.

Agent of record is settled by whoever first provides complete data. Incomplete submissions do not hold your place.

  • Current census with ages, zip codes, and coverage tiers
  • Twenty four months of paid claims experience
  • Large claimant report with diagnosis and prognosis
  • Current plan documents and summary of benefits
  • Current stop-loss contract, rates, and renewal date
  • Any ongoing or shock claims disclosed up front
Questions

ELITE in detail.

That is fine, and it is common. The group qualifies if the owner is prepared to self fund at renewal. What does not work is a group that wants captive economics while staying fully insured.
Twenty six is a hard floor today, so the group is not a fit for ELITE yet. It is worth tracking, because headcount moves. If the same client carries commercial property and casualty, ASCEND is often the better place to start the captive conversation.
It caps total plan spend for the year. The client knows the worst case number going in, which is usually the objection you have to answer before anything else.
Because it is where the money quietly leaves. Carved out pharmacy with transparent per claim pricing, mandatory biosimilars, and internally managed specialty drugs is most of the savings story.
Sometimes, but it has to be disclosed up front. A shock claim discovered after the fact is the fastest way to blow up a submission and damage your credibility with the client.

Have a group that is tired of the renewal?

Bring us the census, the claims experience, and the current stop-loss contract, and you will get a straight read on whether ELITE is the right home.

Run the captive calculator Book a call about an account