FAQ

Eligibility: To establish your plan, you must be:

1. "Business of One", Business Owner, Sole Proprietor, Independent Contractor or Gig Worker.
2. Have an Employer Identification Number (EIN #). Visit the IRS website to obtain and complete a short questionnaire to receive an EIN #.
3. An EIN# can be for an LLC, S-Corp, or other sole prop structure.

Structure: Vault Health is a Captive Insurance Company. Vault Captive, is a captive insurance company domiciled and regulated by the North Carolina Department of Insurance, a Captive Division and available in all 50 states. You will establish a self-funded plan for your "business of one", which means you are an owner of the captive and are represented by its Advisory Board.

Medical Plan Design Options: There are three Major Medical plan designs. $2500 Deductible HSA Compatible, $5,000 Deductible HSA Compatible, $10,000 Deductible.

Unlike the ACA, the deductibles are also the out-of- pocket maximums. As the owner of your self-funded plan, you have the right to change the design of your selected plan design; however, Vault, as administrator, must approve. Plan design change will result in re-rating and can change the payment amount.

Network: Access to a nationwide PPO, PHCS Practitioner and Ancillary network. To locate an in-network PHCS provider, please copy the link and follow the instructions on the website.

Claims: Compare explanation of benefits (EOB)to the provider bill and contact Vault Admin Services / AMPS, the claims administrator, if they do not match. Call AMPS at 800-425-9374.

Establishing your medical plan is simple and secure via an online portal.

Answer medical questions, get accepted, see your rates choose your plan.

Sign contracts, enter your credit card information for your premium payment.

A captive harness the size and scale of its membership to create an innovative structure that locks in savings for its members and their families in good health.

The first step is to screen for healthy applicants.

It’s a fact, 80% of all medical claims come from 20% of the population. If you are young, healthy, smart and insured today, you are most likely subsidizing the un-healthy people in the larger group. In essence, most of the premium you pay goes to fund the others!

The second step is to have each member use the correct Network for care.

The third step is to review your provider bills and claims for reimbursement.

If you have questions call the number on your insurance card. Call AMPS at 800-425-9374.

None

The captive is reinsured by OdysseyRE, an A rated reinsurer.

If claims exceed expected levels, they are paid by the reinsurer and Vault. There is NO maximum coverage limit.

In addition, the captive structure is filed and meets all requirements set forth by the North Carolina Department of Insurance, a Captive Division available in all 50 states.

"Business of One", Business Owner, Sole Proprietor, Independent Contractor With an Employer Identification Number

Instructions for obtaining an EIN#

An Approved Health Questionnaire from the Business Owner and their dependents.

There is no individual medical underwriting. Applicants must complete and pass a short health questionnaire.

The client support team will not request nor view your medical history. Your health questionnaire will not be used for any other purpose than determining your eligibility and will not be shared with or released to any other entity.

Health Questions

Within the last five years, has any person listed on this application been prescribed or is currently taking any of the following medications?

Cosentyx, Humira, Soliris, Otezla, Dupixent, Remicade Solr, Vyvanse, Ozempic, Descovy, Aimovig, Reyvow, Zokinvy, Myalept, Mavenclad, Ravicti, Actimmune, Oxervate, Takhzyro, Juxtapid, Gattex, Chenodal, Acthar Gel, Orladeyo, Tagxedo, Ayvakit, Qinlock, Korlym, Vitrakvi, Recorlev, Cortrophin Gel, Tibsovo, Wegovy, Blincyto, Brineura, Danyelza, Folotyn, Kimmtrak, Luxturna, Mounjaro, Tegsedi, Zolgensma

Are you or is any immediate family member pregnant, in the process of adopting a child, or undergoing fertility treatment?

Within the last five years, has any person listed on this application received any medical or surgical advice, consultation or treatment, including medication for:

Heart disorder or heart disease, including but not limited to heart attack, coronary artery disease, circulatory system disorder, by-pass surgery, stent surgery or carotid artery disease/surgery?

Stroke, seizure disorder, or other neurological disorder apart from ADHD?

Cancer or tumor including taking medication to prevent recurrence of cancer or tumorous growth apart from Basal Cell Carcinoma or Squamous Cell Carcinoma?

Emphysema, chronic bronchitis or COPD (chronic obstructive pulmonary disease)?

Liver disease, Kidney disorder other than stones?

Degenerative arthritis (degenerative disc disease, herniated disc, osteo, rheumatoid or psoriatic arthritis or degenerative joint disease?

Alcohol, drug abuse, dependency or chemical dependency (treated or untreated)?

Stem cell treatment or transplant Paraplegia, quadriplegia or multiple sclerosis?

Diabetes with any insulin treatment?

Alzheimer’s?

Any auto-immune disorders or diseases including but not limited to: Autism, Lupus, Multiple Sclerosis, Addison's Disease, Celiac Disease or Graves’ Disease?

Have you or any person proposed for coverage been diagnosed or treated by a medical professional or medically diagnosed for Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related complex? (Answer this question "No" if you have tested positive for HIV but have not developed symptoms of the disease AIDS.)

A Captive insurance company is a privately owned insurance company whose owners come together to pool risk and form their own licensed insurance company. In this case, members who are sole proprietors, independent contractors, single business owners or Gig worker create self-funded plans for their own businesses. This group approach provides members with the scale to cover the medical risks of participating members and potentially provide cost savings compared to the ACA marketplace and other private individual insurance plans.

Vault Health Captive is owned by its participating members’ business a "business of one". Each member /participant has its own self-funded plan.

Vault Health Holdings is the captive manager.

Vault Admin Services is the plan Administrator.

OdysseyRe is the captive’s reinsurer and an A rated company. OdysseyRe will cover all claims exceeding the target loss ratio. There is no coverage limit or reinsurance cap.

Joinder to the Captive Operating Agreement which describes, among other things, how the captive will operate and communicate with members as well as to the Administrative Services and Managed Care Agreement Plan Document for your self-funded plan.

Medical Reimbursement Policy Certificate - issued by the Captive.

An Attestation that you agree by specific tenets of the Captive.

Disclosure Agreement

Solo Health Plan Summary of Benefits

Potential savings vs. the ACA Exchange

Access to a nationwide PPO, PHCS Practitioner and Ancillary network. Copy link https://www.multiplan.com/webcenter/portal/ProviderSearch

Two HSA compatible plan designs $2,500 and $5,000 (always confirm with tax professional)

Three major medical plan design options $2,500, $5,000 and $10,000

Monthly fees are guaranteed through the end of the calendar year. The 2023 plan year begins on January 1, 2023, through December 31, 2023.

The captive is re-insured by OdysseyRE, an A rated insurance company. If claim amounts exceed claim fund resources, overages are paid by the re-insurer. There is NO maximum coverage limit.

You may not be admitted based on the results of your health questionnaire or if you do not meet other eligibility requirements.

The structure, (Captive), plan designs and health questionnaire are all components designed to allow the captive to remain healthy now and in the long run. However, the cost of healthcare continues to increase. As members of the captive, members choose how to control costs by adjusting participation requirements, plan benefits, using the Network and monitoring claims.

Regardless of when you establish your plan and participate in the captive, any changes to monthly fees, details or plan designs will occur on January 1 each year. In early November, each member will have the opportunity to review their options for the next calendar year.

NO, this plan is only available to businesses of one and sole proprietors.

You can proceed from viewing your estimate to signing documents in a matter of minutes.

No. You will get an instant pass or fail.

The $2,500 and $5,000 deductible plan designs are HSA compatible (always confirm with a tax professional).

Credit Card or ACH deduction from checking account. You will need to provide your credit card information or your Banking information including checking and routing numbers.

Premium payments will be paid between the First and the Fifth of month. All members have the same monthly draft date.

If you establish and confirm your plan at least two weeks prior to your effective date, the goal is to have your physical cards to you by your effective date. You will receive an email from claims@AMPS.com within 48-72 hours after your first payment is drawn. This email is important, as it contains a link and instructions on how to create your member account within the Vault Admin Services/AMPS member portal. Within your account you will be able to access your virtual ID card(s), eligibility record, claims, documents, and other important information regarding your healthcare.

Network: Access to a nationwide PPO, PHCS Practitioner and Ancillary network. To locate an in-network PHCS provider, please copy the link and follow the instructions on the website.

Claims: Your card will provide Vault Admin Services information, powered by AMPS. You can reach AMPS at 800-425-9374 for questions about your claims and billing.

Solo Support Team: The Solo Support team is available to help and answer your questions about the plan. The team can be reached by phone or text: (888)-655-4053 or email: support@hbgnow.com.

Your business is participating in a self-funded health plan. Your business is joining the Captive as a member/participant. All participating businesses combine the funds into a larger pool, from which all participants draw to fund their health services. Each owner is key to keeping the plan healthy.

Participants should stay in the PHCS Network. Please copy the link and follow the instructions on the website.

Owners should seek out providers from the PHCS Network, or others who are open to reference-based pricing, reviewing their claim reimbursements and working with claims advocates when necessary. Members stand to benefit from the performance of the plan in the form of more affordable premiums and healthcare each year if the group spends wisely.

Plan designs are simple. Your deductible and out-of-pocket maximums are the same – once you hit your deductible, claims are paid at 100% except for co-pay's that apply for Pharmacy Benefits at Tier 2 and above.

Start by searching the PHCS network: please copy the link and follow the instructions on the website.

If your preferred provider does not appear you can use any doctor you choose except for HMO providers. Simply provide your card to your physician’s office and have them contact the claims team to coordinate payment. Contact information will be on the back of the card. It's important you DO not pay for your healthcare services up front; if you provider doesn't want to use the number on the back to verify the plan, you should insist.

Yes. Like ACA plans, qualified preventative services are not subject to the deductible, and are covered 100% within plan designs.

There are three plan designs to choose from when you enroll; $2500, $5000 or $10,000 deductible options.

Once contracts are signed, you must wait until renewal to select a different plan design.

As the owner of your self-funded plan for your business, you may request a change to your plan design. However, the plan designs are rated inclusive of all their services and features; prices reflect these ratings. To request a change, you must submit a request to Vault Health Captive. The plan will be re-rated based on its new features, and you will be provided with a new monthly fee subject to approval.

YES. Two of the three plan designs ($2,500 and $5,000 deductibles) are HSA compatible. Members can set up your own individual HSA account through many sources. Your bank or credit union may offer individual HSA accounts or use an internet-based HSA provider. HBG Solo Support can assist in setting up an HAS account.

NO. Like ACA plans, there are no annual or lifetime limits on benefits. This is NOT a limited medical or short-term medical plan.

Plan designs show the annual out of pocket maximum which is the members deductible, and these vary by tier. Once you meet your deductible, qualified benefit services are covered at the 100% except for co-pay's that apply for Pharmacy Benefits at Tier 2 and above.

Prescription coverage is detailed in the plan summaries; formulary can be found here. Please read the formulary carefully.

Reference-Based Pricing is a healthcare cost containment model provided by AMPS that reviews claims, adjusts for errors, and provides fair pricing recommendations based on several benchmarks, including Medicare, cost of care, and regional cost data. This model is used to eliminate the fraud, waste, and abuse that is prevalent in the healthcare billing system today.

The reference-based pricing company, AMPS, starts its work when Vault receives the first bill from your medical provider. AMPS will reprice the bill based on the above factors.

We recommend Members contact the AMPS Care Navigation Team to find the best facilities based on quality and cost metrics. This team, in collaboration with the Member, uses the Provider Finder to locate a friendly provider for medical care, based on cost, quality, location, and prior utilization. You can reach the AMPS Care Navigation Team at 800-425-9374 (this number will also be on your card).

The AMPS Care Navigation Team can facilitate access to members healthcare resources by ensuring personalized services that support their healthcare needs. In addition, Members have access to Edison Health Care. Edison Health Care is a second opinion program and concierge medicine program.

Yes – we recommend the Member contact the AMPS Care Navigation team, as many providers require authorization prior to procedures and surgeries. Call AMPS at 800-425-9374

Medical equipment is reimbursed at 100% after the deductible is reached. Durable Medical Equipment is defined as: able to withstand repeated use, primarily and customarily used to serve a medical purpose, and not generally useful to a person in the absence of sickness or bodily Injury.

Eligible members can establish their self-funded plan at any time during the calendar year with effective dates on the 1st of each month.

The decision as to when to establish your plan can only be made by you. Considerations are the cost of a self-funded plan being offered, versus your current plan and where you are with regard to your current plan year deductible.

Once you have confirmed your effective date of your new plan and paid the premium for your new plan you can then cancel your old plan. You are responsible for proactively cancelling your current plan.

A captive insurance company is a company that shares in the insured risk of its owners and is controlled by its participants, in this case, the owner/members. Participating members both technically own the majority of the company through B-shares (shares do not come with actual value attached to them) and reap the rewards of any annual profits (generally, future savings). Distribution of any annual profits is determined by a Captive Advisory Board. Typically, an Advisory Board decides to lower prices or keep prices stable by directing reserve funds to benefit the owner/members.

Participating companies sign the Joinder Agreement of the Captive to become a member.

The role of the Advisory Board is to be the voice of the owner/members and to represent their interests. The Advisory Board will review annual audits and have access into captive financials. The Advisory Board will also make decisions on how to manage annual profits of the captive, such as allowing them to build and grow in a reserve fund, or to apply them to reduce or stabilize monthly costs.

A reserve fund is money that accumulates from any profits realized. Funds grow when medical costs are lower than the amount taken in from members/owners. The monthly payments collected from each member should cover 100% of anticipated claims. Therefore, if claims are only 80% for the year, the captive would keep the remaining 20% for a reserve fund, or other purposes, as decided by the Advisors Board.

You can schedule a meeting/call with a representative by clicking this scheduling here.

You must make this decision on your own, or in consultation with your tax professional. Our partners are here to help you establish your plan, answer any questions and ensure your claims are paid in a timely manner. But we cannot help you choose a plan design.

You will need to ask a tax professional to verify tax deductibility of your healthcare fees.

You will call Vault Admin Services, powered by AMPS, our carrier claims administrator. The number to call is (800) 425-9374. This contact information will also be available on your Member Services page and on your medical card.

AMPS support hours are Monday-Friday 8 am to 7 pm EST.

If you want to change your payment information, please call HBG Support (888)-655-4053 or email support@hbgnow.com for assistance.