Stop Loss Risk
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Stop Loss Basics
  • Self Funded vs Insured
  • Brokers & Consultants
  • Placing Benefits
  • Why is Stop-Loss Needed?
  • Specific Stop Loss
  • Aggregate Stop Loss
  • Contract Types
Policy Endorsements
  • Advanced Funding
  • Plan Mirroring
  • No New Laser (NNL)
  • Rate Cap
  • Experience Refund
  • Monthly Agg Accommodation
  • Gapless Renewal
  • Terminal Liability
  • Transplant Vendor
Captives
  • What is a Captive?
  • Good Fit for a Captive?
  • Captive Reinsurance
  • Captive Structures
Stop Loss Risk
Home
Stop Loss Basics
  • Self Funded vs Insured
  • Brokers & Consultants
  • Placing Benefits
  • Why is Stop-Loss Needed?
  • Specific Stop Loss
  • Aggregate Stop Loss
  • Contract Types
Policy Endorsements
  • Advanced Funding
  • Plan Mirroring
  • No New Laser (NNL)
  • Rate Cap
  • Experience Refund
  • Monthly Agg Accommodation
  • Gapless Renewal
  • Terminal Liability
  • Transplant Vendor
Captives
  • What is a Captive?
  • Good Fit for a Captive?
  • Captive Reinsurance
  • Captive Structures
More
  • Home
  • Stop Loss Basics
    • Self Funded vs Insured
    • Brokers & Consultants
    • Placing Benefits
    • Why is Stop-Loss Needed?
    • Specific Stop Loss
    • Aggregate Stop Loss
    • Contract Types
  • Policy Endorsements
    • Advanced Funding
    • Plan Mirroring
    • No New Laser (NNL)
    • Rate Cap
    • Experience Refund
    • Monthly Agg Accommodation
    • Gapless Renewal
    • Terminal Liability
    • Transplant Vendor
  • Captives
    • What is a Captive?
    • Good Fit for a Captive?
    • Captive Reinsurance
    • Captive Structures
  • Home
  • Stop Loss Basics
    • Self Funded vs Insured
    • Brokers & Consultants
    • Placing Benefits
    • Why is Stop-Loss Needed?
    • Specific Stop Loss
    • Aggregate Stop Loss
    • Contract Types
  • Policy Endorsements
    • Advanced Funding
    • Plan Mirroring
    • No New Laser (NNL)
    • Rate Cap
    • Experience Refund
    • Monthly Agg Accommodation
    • Gapless Renewal
    • Terminal Liability
    • Transplant Vendor
  • Captives
    • What is a Captive?
    • Good Fit for a Captive?
    • Captive Reinsurance
    • Captive Structures

What is a Captive?

A stop loss / benefits captive is a structured risk-financing arrangement in which multiple employers (or sometimes a single large employer) participate in a licensed insurance company — the captive — to collectively finance and manage stop loss risk for their self-funded health plans.


Instead of purchasing traditional stop loss coverage entirely from a commercial carrier, employers share a layer of risk through the captive while still maintaining catastrophic protection through reinsurance.

The Basic Concept

In a traditional stop loss arrangement:


  • Employer pays fixed premium to a carrier
  • Carrier assumes specific and aggregate risk
  • Carrier retains underwriting profit if claims are favorable


In a stop loss captive:


  • Employers share risk within a captive insurance company
  • The captive retains a defined layer of stop loss risk
  • Reinsurance protects the captive above that layer
  • Underwriting gains (if any) are returned to participants


It blends risk sharing, risk retention, and risk transfer.

What Is a Captive?

A captive is a licensed insurance company formed to insure the risks of its owners or members.


Captives can be domiciled in places such as:


  • Vermont
  • Bermuda
  • Cayman Islands
  • Delaware


They are regulated insurance entities but designed for structured risk financing rather than traditional commercial underwriting.

How Risk Sharing Works

Each participating employer:


  • Contributes premium to the captive
  • Shares in the performance of the group
  • Is exposed to the captive layer (subject to defined limits)


If claims are favorable:


  • Surplus may be returned as dividends or premium credits.


If claims are adverse:


  • Captive funds are used to pay claims.
  • Additional assessments may be limited by agreement.


This creates a shared-risk pool among like-minded employers.

Financial Advantages

Underwriting Profit Participation


  • Instead of the carrier retaining all margin, favorable experience benefits the members.


Reduced Volatility Over Time


  • Risk is spread across multiple employers and years.


Pricing Stability


  • Captives often smooth renewal swings.


Transparency


  • Members see detailed claims and underwriting data.

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