FAQs

The safer way
to self-fund

FAQs listed below.

Self-Funding

Are other larger, independent practices 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+.

Will self-funding be more work for our staff? We’ve busy enough as it is.

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

Our health insurance rates go up every year. Can the Destiny+ solution really mitigate that trend?
Yes. To date, benchmarked against an 8% trend increase, our members have saved $10.7 million collectively over traditional fully insured plans.

How exactly does my underwriting work if I am a member of a captive? Will my practice be renewed only based on our claims history or based on the history of the group?
As a member of the captive, your underwriting will be based on your specific claims experience.

Captive

What is the captive layer of the Destiny+ model?

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.

Do members own the captive?

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”.

Do all members contribute equally to the captive?

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

What other kinds of employers are going to be in the captive with us?

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

How often does the captive return profits to members?

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.

Are there years when the captive returns nothing to members?

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

Is it possible that members might have to contribute more to the captive in a given year?

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

How is the captive regulated and where is it domiciled?

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

Does Vxtra take any profits from the captive or incorporated cell?

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

What is my maximum exposure if the captive has a bad year?

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

What happens if an employee incurs a huge claim? Aren’t we on the hook for that?

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.

What happens if another member of the captive experiences a huge claim? I don’t want to have to pay for someone else’s problems.

The captive and then the stop-loss insurance contract, if needed, would step in to 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.

When your claims analysis turns up claims expenses that can be challenged, how does Vxtra advocate for its clients?

When certain network agreements and our preferred claims administrator are selected we can achieve better pricing than usual and customary PPO discounts including dialysis, infusion therapy, and ambulance claims.

Plan Design

Do I have to share a plan design with the other members of the captive?
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.

Just how custom can the Destiny+ health plan design be? As physicians, we want more input that the average employer.
Your plan design can be as custom as you like.

Will our plan be subject to individual state mandates?
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

If we join Destiny+, what are our provider network options?
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.

If we change provider networks, can you estimate how much provider disruption our employees will experience?
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.

What retail pharmacies will our employees have access to through the pharmacy benefit?
Your employees will have access to the major retail pharmacies and a majority of local pharmacies. Our ultimate goal is to help plan members select the pharmacy program that yields the lowest net cost through transparency, rebate maximization and specialty drug programs that benefit both the practice’s health plan and your employees.

Are there pharmacy rebates? If so, how are they handled?
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.

Pharmacy costs, especially specialty pharmacy is rising at never seen before pace. How can we reign in this cost?
It is all about selecting a partner that is going to provide employers direct access to their data and tools to reduce spend. No re-pricing and repackaging games. We have full access to the claims system and will be able to help your plan members maximize the benefits from manufacturer coupons. Our programs helps leverage manufacturer coupons to benefit both the employees and employers. Lastly, detailed rebate reporting ensures that all monies that are due are tracked and accounted for.

FAQs

The safer way to self-fund

FAQs listed below.

Self-Funding

Are other larger, independent practices 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+.

Will self-funding be more work for our staff? We’ve busy enough as it is.

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

Our health insurance rates go up every year. Can the Destiny+ solution really mitigate that trend?
Yes. To date, benchmarked against an 8% trend increase, our members have saved $10.7 million collectively over traditional fully insured plans.

How exactly does my underwriting work if I am a member of a captive? Will my practice be renewed only based on our claims history or based on the history of the group?
As a member of the captive, your underwriting will be based on your specific claims experience.

Captive

What is the captive layer of the Destiny+ model?

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.

Do members own the captive?

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”.

Do all members contribute equally to the captive?

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

What other kinds of employers are going to be in the captive with us?

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

How often does the captive return profits to members?

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.

Are there years when the captive returns nothing to members?

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

Is it possible that members might have to contribute more to the captive in a given year?

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

How is the captive regulated and where is it domiciled?

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

Does Vxtra take any profits from the captive or incorporated cell?

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

What is my maximum exposure if the captive has a bad year?

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

What happens if an employee incurs a huge claim? Aren’t we on the hook for that?

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.

What happens if another member of the captive experiences a huge claim? I don’t want to have to pay for someone else’s problems.

The captive and then the stop-loss insurance contract, if needed, would step in to 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.

When your claims analysis turns up claims expenses that can be challenged, how does Vxtra advocate for its clients?

When certain network agreements and our preferred claims administrator are selected we can achieve better pricing than usual and customary PPO discounts including dialysis , infusion therapy, and ambulance claims.

Plan Design

Do I have to share a plan design with the other members of the captive?
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.

Just how custom can the Destiny+ health plan design be? As physicians, we want more input that the average employer.
Your plan design can be as custom as you like.

Will our plan be subject to individual state mandates?
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

If we join Destiny+, what are our provider network options?
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.

If we change provider networks, can you estimate how much provider disruption our employees will experience?
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.

What retail pharmacies will our employees have access to through the pharmacy benefit?
Your employees will have access to the major retail pharmacies and a majority of local pharmacies. Our ultimate goal is to help plan members select the pharmacy program that yields the lowest net cost through transparency, rebate maximization and specialty drug programs that benefit both the practice’s health plan and your employees.

Are there pharmacy rebates? If so, how are they handled?
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.

Pharmacy costs, especially specialty pharmacy is rising at never seen before pace. How can we reign in this cost?
It is all about selecting a partner that is going to provide employers direct access to their data and tools to reduce spend. No re-pricing and repackaging games. We have full access to the claims system and will be able to help your plan members maximize the benefits from manufacturer coupons. Our programs helps leverage manufacturer coupons to benefit both the employees and employers. Lastly, detailed rebate reporting ensures that all monies that are due are tracked and accounted for.