Georgia ADS

Georgia ADS, LLC

Georgia ADS offers a mechanism to reimburse participating members for high cost claimants covered under their self-funded health benefits plans and now is the most penetrated company in Phoenix Health Care Management Services, Inc. serving 18 of 19 stockholders.

Founded in 1991 by four VHA Georgia members, this program was developed through the use of insurance consulting services, claim loss forecasting, and actuarial services.  The program objectives include optimizing resources by promoting and leveraging economies of scale, minimizing the risk of health claim liability and maximizing the value of the insurance dollar spent.

The program consists of four components:

1. Self Insured Deductible – Participants self insure up their own claims up to $150,000.

2. Shared Financing Layer – Participants fund or finance each other’s claims between $150,000 and $500,000.   Each participant is assigned an actuarially determined percent as their share of the total claims for the group.  Percentages are recalculated annually and move up or down based on utilization of the program.  Cumulative statements designate whether a participant is a lender or borrower to the program.

3.  Reinsurance – After $500,000, participants group purchase reinsurance at a much lower rate than they would pay individually due to their combined number of lives. Including the previous layers, claims are covered up to $1M.

4. Excess Coverage - Georgia ADS’ highest tier offers additional coverage up to $4M purchased in $1M blocks.  A participant based on individual circumstances could increase coverage by an additional $1M, $2M, $3M or $4M for relatively inexpensive costs due to the purchasing power of the larger group. 

Program advantages include:

• Actual reflection of experience of a defined and homogenous group in participant’s loss financing
• Improved cash flow management through claims payments only if they occur
• Improved cash retention for investment income
• Reduced cost of reinsurance through risk sharing, retention and economies of scale

Since the program’s inception, members have participated together in financing nearly $80 million of claims and have saved more than $55 million in premium costs.

For more information on Georgia ADS, contact 770-850-7400.