How Solo Health
Collective Works
Solo Health Collective – Nationwide PPO Health Plan
If you're self-employed, you know the frustration of sifting through a sea of healthcare options. From limited plans to short-term coverage and marketplace offerings, the choices can be overwhelming—and often frustrating and expensive. That’s where the Solo Health Collective comes in.
Designed specifically for individuals operating as a "business of one," Solo addresses the common pitfalls of traditional insurance while providing the major medical coverage and healthcare benefits to its members. If you're skeptical about whether there’s a viable healthcare option to suit your lifestyle as a self-employed individual, discover how Solo Health Collective could be the answer you've been looking for.
What a Captive Insurance Company Is (and Isn’t)
Solo operates through a captive insurance model, which is a membership structure that allows participants to collectively fund their healthcare expenses while leveraging a national PPO network. In this setup, the business—rather than the individual—is entered into the captive, making it a self-insured organization. This model is distinct from traditional insurance and provides major medical coverage, along with all the essential benefits required under the Affordable Care Act (ACA). Our captive is backed by Odyssey Reinsurance, ensuring financial strength and stability. This means Solo’s members can have full confidence knowing that claims are covered beyond standard liability limits by a globally recognized, highly rated reinsurance provider
We are a powerful alliance of organizations united by a common mission: to empower our members in their healthcare journey. Together, we create a seamless experience, streamline claims management, and champion fair pricing from medical facilities. By working collaboratively, we not only enhance the quality of care but also ensure that healthcare remains affordable for all our members. Solo is collectively a system of partners working to ensure there are no wasted dollars and total transparency of healthcare spending.
Ideal candidates are individuals who are: generally healthy with no major health concerns, operate as a business of one, and are seeking to save on monthly costs and major medical coverage without the limitations often associated with traditional plans.
Establishing your Solo Health Collective account is straightforward:
- Calculate Your Costs: Start by assessing which plan aligns with your financial and healthcare needs ($2,500, $5,000, or $10,000 deductible).
- Complete a Short Health Questionnaire: This helps determine eligibility and tailor the plan to your needs.
- Establish Your Account: Choose your plan and start date, and even contact us for a consultation.
Upon setting up their plan, new members receive an immediate order confirmation email confirming details of the plan/order. Charges begin on the member's preferred start date, which is always the first of the month and is chosen by the member during checkout. This is also when the welcome kit is delivered, containing:
- Solo Member Portal: A directory for all of your plan information and resources
- Medical ID Card: For easy access to healthcare services.
- Benefits Hero: An essential resource for understanding your benefits.
- Multiplan PHCS Access: Information on finding providers within the PPO network.
Additionally, members benefit from support provided by organizations within the collective, including Vault for claims management. Members can also expect to receive a 1095B tax document at tax season for reporting purposes.
Members can access the Multiplan PHCS network, ensuring they receive quality care. If members choose to see an out-of-network provider, they have the flexibility to choose healthcare providers outside the network, but must go through a pre-authorization process to negotiate costs. Solo's claims administrator, Vault Health Admin, can assist in facilitating fair pricing with the provider.
Claims Process
Understanding the players in the claims process is essential:
- Vault Health Admin: Solo’s claims administrator that handles all aspects of the health plan, processes claims, and provides customer support.
- Fairos: Solo’s partner that works to negotiate directly with healthcare providers to establish fair and transparent pricing for medical services.
- Establish Your Account: Choose your plan and start date, and even contact us for a consultation.
Submitting and Managing Claims
Claims are submitted through Vault, where they are evaluated and processed. Members may encounter common issues, such as needing pre-authorization for high-cost procedures or specific diagnostic tests. Clear communication with providers helps mitigate these concerns.
Financial Advantages
- Tax Deductions:
100% of monthly plan costs paid are tax-deductible, as they are considered a business expense.
- HSA Eligibility:
Our V2500 and V5000 plans are eligible for Health Savings Accounts, providing additional tax advantages.
- No Annual or Lifetime Limits:
Unlike many traditional plans, Solo members enjoy comprehensive coverage without caps.
- No Wasted Dollars:
All payments count toward the deductible, contrasting sharply with traditional plans, where co-pays might not contribute.
Speak to your tax professional about all the benefits applicable in your state and how your business can potentially write-off your monthly costs as business expenses.
- Cost Savings:
The captive model allows for more competitive pricing compared to traditional insurance, potentially leading to lower monthly costs and reduced out-of-pocket expenses via the PPO network.
- Transparency and Control:
Members have a clear understanding of how their healthcare dollars are spent and can influence the structure of their health plans.
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Access to Care:
Solo provides access to a nationwide PPO network, offering flexibility in choosing among hundreds of healthcare providers, including NYU Langone, Mayo Clinic, Ascension, and more.
- Support and Resources:
Solo offers concierge support to help you find the best in-network providers, schedule appointments, resolve billing issues, and more.
- Access to FitOn Health:
Members and their enrolled spouse will each receive 32 monthly credits to use toward in-person or virtual fitness classes and gym memberships ($100+ monthly value).
Solo encourages members to adopt healthy lifestyles, offering incentives that lead to lower healthcare costs over time, such as exclusive access to FitOn fitness programs and more. Staying healthy not only benefits individual members but also contributes to the overall financial health of the collective. Your health and success are our priorities.
Are you ready to take charge of your healthcare journey? Schedule a consultation today to learn more about how Solo can benefit you or calculate your monthly cost if you’re not ready to commit yet.