How a Captive + Care Navigation
Drives Down Claims
Go beyond the renewal rate. See how claims funding, stop-loss — individual and aggregate — captive risk-sharing,
and care navigation work together to manage healthcare cost and risk in a more predictable way.
How Risk Is Structured
See what the employer retains, shares, and transfers through stop-loss.
You Retain
Captive Layer (Shared)
Stop-Loss Carrier
Small claims stay with you
Mid-layer pooled with other employers
Catastrophic claims transfer out
What Happens When Claims Hit
Two large-claim quarters. Variable costs. Here's how the year actually played out.
| Year 2 | Fully Insured | Captive + Care Navigation |
|---|
| Q1 | $737.5K | $575K |
| Q2 — Large Claim | $737.5K | $790K |
| Q3 | $737.5K | $560K |
| Q4 — Large Claim | $737.5K | $800K |
| Full Year | $2.95M | $2.725M |
| Difference | — | $225K lower |
$225K lower for the year in this illustrative example — same two large-claim quarters, same group, different structure underneath.
Go Behind the Claims
Go Beyond Standard Carrier Reporting. With enhanced plan performance reporting, you can identify cost drivers, emerging risks, gaps in care, and opportunities for targeted intervention to improve outcomes and control costs.
Care Navigation in Action
See how targeted clinical guidance directs members to appropriate, cost-effective care, closes utilization gaps, and intercepts cost drivers before they escalate into high-dollar claims.
From Risk Protection to Cost Management
See where the risk sits, what drives the numbers, and what can be influenced before the next renewal.
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