FAQs

Self-Funding

Market leaders in multiple sub-specialty medical practices are turning to self-funding. Our members are highly influential and entrepreneurial leaders in radiology, cardiology, urology, orthopedics, OB/GYN, etc. Here’s what some of our members have to say about their experience with Destiny+.

Yes. Vxtra supports the industry’s leading brokers and consultants in bringing clients an unbeatable combination of of financial controls, claims management, big data analytics, personalized service, and individual support. Read more about how we work with brokers and consultants here.

In the beginning, as we transition you into self-funding and the captive, the process will require some time commitment from your staff. However, once the transition is complete, we work with you to ensure the routine has a minimal impact on your workload.

You will need to devote time to weekly banking activity, as well as reviewing reports and analytics that identify the options and opportunities that can lead to a more cost efficient health benefits strategy.

Renewal Rates and Underwriting

Yes. To date, benchmarked against an 8% trend increase, our members have saved $10.7 million collectively over traditional fully insured plans.

Captive

The captive layer is funded based on a portion of each member’s stop-loss premium. Vxtra pools those funds to create a “shock absorber” that pays for high-cost claims – claims that go beyond the practice level in tier one of our model. See more about our model here.

No. Members participate in the captive to create underwriting efficiencies and to potentially participate in profit distributions, but they are not owners of the captive. Vxtra owns the "INCORPORATED CELL".

Members each contribute an equal percentage of their stop-loss premium to the captive.

Only other, independent medical practices will be in the captive with you.

The captive returns profits to members annually, once all incurred but not reported claims have been reconciled. Historically, the profit distribution (if available) is made mid-year, following the close of prior year. The captive may hold back a small amount of the allocated distribution through the end of the year to cover any unexpected claims. If unused, those monies are returned to members as well.

Yes, that is possible if the captive experiences an unexpected number of large claims in that year.

No; that’s when the stop-loss insurance would step in. The job of the stop-loss insurance is the cover any claims above the captive limit.

The captive, officially known as the DESTINY+ INCORPORATED CELL, is registered with the Vermont Department of Insurance and domiciled in the State of Vermont.

No. The incorporated cell serves merely as a administrative, contracting, and regulatory agent on behalf of the captive.

If the overall claims experience causes the captive layer to be depleted, then tier three -- the stop-loss insurance -- kicks in. A portion (or all) of each member's non-premium funding may be used to offset unusual claim costs. The amount of exposure is limited to the amount of the non-premium funding, as defined in each member's stop-loss contract.

Claims

Yes, but any amount beyond your practice level coverage will be paid through the captive, or if needed, the stop-loss layer. You will never have to pay a huge claim all by yourself.

The captive and then the stop-loss insurance contract, if needed, would step in the pay the claim. You won’t owe anything more to the captive; the contributions you would have already paid, and potentially the non-premium funding within the stop-loss insurance, would cover the claims. Think about the reverse situation: if it’s your employee with the shock claim, the captive would work to protect you.

Our team will perform a complete audit of the claim, starting with the pre-certification and eligibility and working through the list bill from the hospital. If needed, we will enlist an independent audit company for clinical review. We will then contest, on behalf of our client, the disputed amount with the claims administrator who has the contract with the provider. We work on behalf of our Destiny+ clients to ensure that charges paid are fair both for our groups and the provider.

Plan Design

No. However, you will have the benefit of our community’s experiences. You may want to try what’s working well for other members with issues similar to yours, based on meaningful data and experience.

When you are self-insured, you are the fiduciary of your plan and you have the opportunity to determine – within federal guidelines – what is included in your plan design.

Provider and Pharmacy Networks

You can either (1) remain with a carrier-based Administrative Services Only (ASO) contract and access their network of providers, or (2) use our high-performance Third Party Administrator (TPA) that has access to either Aetna, CIGNA or MultiPlan networks. Or, we can work with you to build and administer a custom network.

Yes. We will analyze the disruption so you can understand exactly where the differences will be. However, you can expect an extremely high overlap of in-network providers.

You will have access to more than 65,000 retail pharmacies, including all the major pharmacy chains.

Different pharmacy vendors handle pharmacy rebates differently. If there are pharmacy rebates, we pass those directly through to you. Our preferred pharmacy vendor is responsible for issuing rebates and mailing checks directly to our members.