Pre-65 Retiree Medical Solution

National Seniors Coalition (NSC) has built a captive solution that allows employers, municipalities, and unions to exit the group sponsorship role while still maintaining a group benefits plan for their Pre-65 Retirees. We believe this is a more economically efficient strategy compared to staying self-funded with a traditional TPA/PPO network or using an Individual Private Exchange. Key components of this offering include:

Employers have the choice to remain the ERISA Plan Sponsor or transfer the plan sponsorship role to an NSC Sponsored Trust.

  • NSC Sponsored Trust Model was created in 2008 and is being utilized by employers today for their Post-65 Retirees.
  • Flexible funding options based on each employer’s unique needs.

Each employer receives a stop-loss policy for their Pre-65 Retiree

Medical Plans from either Nationwide Insurance Company or American National Insurance Company.

  • Both are A-rated, size XV insurance carrier partners.

Pre-65 retiree costs benchmarked off of Medicare.

  • Targeting 140-150% reimbursement for facilities and 120-130% reimbursement for physicians.
  • Leveraging an Open-Platform Model to include your current TPA and a choice of Reference Based Pricing, (RBP) Venders.
  • Estimated claims costs will be approximately 20-25% lower than any commercial PPO network arrangement.
  • Can customize or duplicate current benefit plans to avoid disruption.
  • No networks so members can choose any doctor or hospital.

Same self-funding principals apply:

  • Benefits of paying claims at cost, with no markup, below stop-loss deductibles.
  • Transfer catastrophic risk via a stop-loss policy to either Nationwide Insurance Company or American National Insurance Company.
  • Ability to cross state lines and avoid many of the ACA regulations.

Plus the benefits of a group captive…

  • Allow participating employers to share in captive’s underwriting gains.
  • Unlocks a significant portion of stop-loss premiums and converts them into a variable expense.
  • Pooling in the captive layer rewards participants in good years and protects participants in bad years.