AST Risk

In small group level-funded insurance, third-party administrators (TPA) aim to offer employers a health plan that is competitively priced and delivers tangible value. Designing a smart insurance solution demands a keen understanding of pricing intricacies and the ability to optimize cost-containment measures.

AST Risk, a specialized managing general underwriter (MGU) and actuarial partner, empowers TPAs to gain a competitive edge in the market. Integrating their services and distribution channels with its proprietary stop-loss process, the company delivers high-value health plans.

Drawing on its underwriting expertise within the self-insurance ecosystem, it offers comprehensive guidance and training across all facets of level-funding administration, creating an environment for TPAs to excel.

“We support our clients with custom health plan designs on a collaborative and consultative basis without locking them into a limited range of traditional insurance options,” says Bryan Sautters, president.

When engaging with traditional MGUs, TPAs often face a “black box” scenario, where understanding the rationale behind the pricing strategies in the underwriting process proves challenging.

AST Risk fosters open communication, providing them with insights to build and maintain a high-performing small group-level-funded block. TPAs become active participants in the underwriting process, gaining complete transparency and a seat at the decision-making table during group renewals.

Another challenge for TPAs is the lack of acknowledgment from stop-loss providers when implementing cost-containment strategies for managing health benefit plan costs for small employers.

Through regular check-ins, AST Risk ensures TPAs receive due recognition and pricing adjustments for their efforts, analyzing their cost containment models such as reference-based pricing or concierge medical management service. The company also leverages the expertise of one of its owners, Highmark Insurance Group, as a back-office support for handling claims cost containment functions.

Central to AST Risk’s ethos is its consultative approach. Rather than dictating plan designs, it works hand in hand with TPAs to create custom plans and rates through its actuarial arm. It ensures that plan costs accurately reflect each TPA’s distinct strategies and objectives.

It typically conducts face-to-face meetings with clients and program calls approximately every six weeks and more frequently during the initial stages of program launch. Together, they review the effectiveness of implemented plans and assess the competitiveness of quotes in the market to ensure proper credit.

A differentiating aspect is the company encourages TPAs to become adept program managers, taking ownership of their level-funded business. It expands their business opportunities, enabling them to independently conduct initial underwriting while maintaining healthy and cost-effective programs.

A case in point is a TPA initially using a national preferred provider organization (PPO) network as its primary provider. It faced higher-than-expected claims costs. AST Risk helped redesign its products, resulting in a transition to local providers and direct contracts. This shift contributed to addressing the client’s claims cost concerns through a collaborative effort.

Another client sought to transition from a PPO network to reference-based pricing. This transition required careful consideration of administrative mechanics and plan constructs. AST Risk provided valuable support in seamlessly migrating the client to the preferred pricing model, guaranteeing continued effectiveness in managing costs.

Clients’ feedback underscores the value they place on its distinctive partnership approach. It has prioritized being more consultative, investing more time in understanding their needs and optimizing offerings to enhance their sales potential.

AST Risk’s diverse and seasoned team brings formidable industry insights and leadership to the table. At the forefront are Sautters, whose expertise lies in stop-loss operations, Co-founder and Principal Bernon Erickson, known for his actuarial acumen, and Principal Bill Ashley, with decades of small group tenure.

Its consulting expertise as a strategic stop-loss provider equips TPAs to dominate in delivering exceptional value and competitive pricing, setting new standards in small group level-funded insurance space.