edHEALTH’s coalition of member educational institutions provides purchasing clout that helps drive down healthcare costs. By coming together, the members of edHEALTH realize lower costs than fully insured plans or go-it-alone self-insured options:

• Larger group = better pricing and less volatility
• Low negotiated third-party administrator (TPA) fees
• Transparent advisor payments
• No payments of profits to TPAs on top of claims (unlike fully insured plans)
• Reduced Affordable Care Act (ACA) taxes

Healthcare costs put a significant strain on college, university, private, and charter school budgets, which drives up tuition costs. Our member-owned collaborative approach gives your school, its faculty and staff access to affordable, quality healthcare. Through edHEALTH, your educational institution will play a proactive role in your institution’s healthcare, gain control over plan design, and receive valuable data insights into your trends and cost drivers.

Most programs and services are identical between a fully insured and self-insured healthcare arrangement. The difference is in the funding and potential savings. With a fully insured arrangement, the employer pays an insurance company a negotiated premium that includes expected claims payments based on the employer’s risk pool, plan design, and claims history; broker fees; net profits; and administrative fees. With edHEALTH, each school is individually self-insured and co-owner of a medical stop-loss captive. With self-insurance, you choose your risk tolerance. You pay the actual cost of claims, stop-loss premiums, and a group-negotiated administrative fee, but don’t pay broker commissions and administrator profits. Bottom line — you have the opportunity to pay substantially lower employee healthcare costs.

A captive is an insurance company that is wholly owned and controlled by its members to insure the risks of its member owners. Additionally, you may have an opportunity to share in surplus earned by the captive.

Member-owned captives like edHEALTH offer educational institutions five distinct advantages:

• Profits go back to the member-owner schools– money saved can go directly back to focusing on a school's mission of educating students
• Member-owner schools can keep their preferred health benefits advisor and have them participate alongside the school's Human Resources and Finance teams
• Schools are part of all key decision-making processes, which include the direction of plan designs and new program offerings, with representation from an institution's Finance and Human Resources departments
• There is complete transparency in all claims and services provided on behalf of a school's healthcare program
• Schools are part of a like-minded educational institution consortium, which offers a strong network of industry colleagues with whom to consult and collaborate to improve healthcare experiences for faculty, staff, and their family members

"When we meet with schools interested in learning more about edHEALTH, they often ask if they can continue to work with their current advisor. We reassure them that because we are advisor-neutral, they can continue that relationship. We have a positive working relationship with all of our schools' advisors and invite them to sit at the table." – Nancy McConaghy, Vice President of edHEALTH

The captive structure, including external stop-loss, pooled risk, and individual member funding (self-insured retention) provides protection for 100% of the risk. edHEALTH works with each member institution to determine their risk tolerance and provides protection to minimize it.

Each member chooses their own self-insured retention rate based on their risk tolerance, philosophy, financial status, and experience. This allows each school to determine how much risk they are comfortable with for a specific claim. Any claims above the institution’s self-insured retention rate (SIR) are paid by the captive.

edHEALTH’s purchasing power allows us to negotiate low third-party administrator (TPA) fees. Each member selects its own TPA and plan design from our suite of healthcare options. We underwrite your institution’s rates based on your school’s plan design, claims experience, census data, and the self-insured retention rate you’ve selected.

Our member-centric approach to rising healthcare costs provides valuable savings benefits, ownership, transparency, and innovation.

• Savings – Through our purchasing clout, we consistently negotiate lower administrative fees and enjoy less healthcare cost volatility than schools can realize on their own. Our pharmacy carve-out has saved member institutions approximately $80M between 2017 and 2023. Person-centric clinical health initiatives help us improve the quality of care and reduce costs for the employees and family members who need it most. Our results show that our innovative approach is working. The ten-year average health insurance premium increase is 3.7%, well below the industry average of 7.9%. Employee satisfaction, high quality of care, and valuable savings you can pass along to students and families are all benefits of being a member-owner of edHEALTH.
• Ownership – edHEALTH is a member-owned consortium run by and for its educational institutions. As a member, you share in the savings generated by the group. To date, edHEALTH has awarded dividends of $6.7 million. Member-owners control and have a meaningful say in the decision-making process, along with direct access to plan administrators. edHEALTH provides multiple forums for member-owners to share and learn from one another. Collaboration is a key benefit of belonging to edHEALTH.
• Transparency – Health insurance works when employers have the data they need to make informed decisions. edHEALTH’s transparent approach means member educational institutions are apprised of all rate components. And our collaborative approach enables colleges and universities to compare cost, utilization, trends, and best practices with other member schools.
• Innovation – edHEALTH is the innovative healthcare solution for higher education institutions and secondary schools, along with their faculty, staff, and family members. Our self-insured healthcare offerings are tailored to meet the needs of our members. Through data analysis, advanced, person-centric programs, and decision support, we help educational institutions select programs that meet their needs while containing rising healthcare costs.

Here’s what to know about obtaining a working rate.

edHEALTH charges prospective members a nominal non-refundable working rate quote fee. This amount is applied to your capital contribution upon joining. The fee represents the actuarial cost to calculate the working rate, including a breakdown of all expected costs for the plan year.

Additionally, below highlights the steps taken to receive a working rate based on a January 1 effective date. Educational institutions may join edHEALTH at any time, in which case the actual dates below will change.

Once a school joins edHEALTH, we provide a more detailed timeline and work with its staff and advisor every step of the way.

While it varies by state, the minimum number that a school should have to receive a working rate quote is between 100 and 150 benefit-eligible employees.

As edHEALTH welcomes a new school, we work closely with its Finance and Human Resources staff and the school’s advisor to ensure a smooth onboarding for faculty and staff alike.

The following chart provides key onboarding dates based on a January 1 effective date. Educational institutions may join edHEALTH at any time, in which case the actual dates below will change.

Once a school joins edHEALTH, we provide a more detailed timeline and work with its staff and advisor every step of the way.

No. There are no fees to join edHEALTH. When a school joins edHEALTH, the State of Vermont requires a new member-owner to make a capital contribution, which remains an asset to the institution.

Member-owners can access the following reports on the edHEALTH portal:

• High-cost claims report
• Quarterly actuarial report
• Prescription drug rebate information
• Important owner information
• Plan design minutes and presentations
• Member services guide