A plan structure for every workforce.
CGS Health builds health plans the way they should be built — designed around your people, integrated end to end, and administered by a team that owns every piece.
Maximum flexibility. Maximum savings.
For employers ready to take control. You fund claims directly, keep what you don't spend, and get full transparency into where every dollar goes. We handle administration, networks, pharmacy, and stop-loss.
- ✓ Custom plan design and benefit structure
- ✓ Choice of national PPO networks, plus custom regional, tiered, and reference-based pricing (RBP) solutions
- ✓ Stop-loss your way — bring your own, place it through our panel, or integrate it through Litchfield
- ✓ Connectivity to any pharmacy, or full pharmacy benefits through CAPSL Rx
- ✓ Quarterly utilization reporting
Predictable monthly costs. Real upside.
Fixed payments cover claims, admin, and stop-loss. If claims come in under budget, you get money back. The protection of fully-insured with the economics of self-funding.
- ✓ Fixed, predictable monthly payments
- ✓ Year-end refund of unused claim funds
- ✓ Aggregate and specific stop-loss built in
- ✓ Lower-risk entry point to self-funding
Transparent prescription benefits.
Pass-through pricing, no hidden rebates kept by the PBM, and a formulary built for outcomes. CAPSL Rx is the integrated pharmacy benefit manager inside the CGS Health platform.
Risk protection that holds up.
A-rated carrier partnerships, custom-structured specific and aggregate coverage, and underwriting that understands self-funded risk because that's all we do. Litchfield also underwrites excess, level-funded, and captive programs.
Share the risk. Keep the reward.
For employers who want the upside of self-funding with a built-in cushion, our group captive solutions through Aerie Captive Benefits let you pool risk alongside like-minded companies. Premiums that aren't spent on claims come back to members rather than a carrier — turning your health plan from a pure cost into a shared asset.
The right network for the population — not a one-size-fits-all.
Network strategy is one of the biggest levers in a self-funded plan. We design around your members' geography, utilization, and budget rather than forcing them into a single national contract.
National PPO
Broad, nationwide access for distributed or multi-state workforces.
Regional
Strong local contracts and provider relationships where your members actually live and work.
Narrow
High-performing, curated provider sets that drive quality and lower total cost of care.
Reference-Based Pricing
Medicare-referenced reimbursement with member advocacy and balance-bill support built in.
Tiered & custom
Steerage designs that reward members for choosing higher-value providers — built to your plan.
A full stack of cost containment — built in, partnered, and purpose-built.
We bring together best-in-class partners and our own CGS Solutions Lab to attack cost wherever it lives — high-cost claims, specialty drugs, out-of-network bills, and everything in between.
Best-in-class partnerships
We're vendor-agnostic. When a specialized partner is the right answer, we integrate them — so you get the best solution for each problem, not whatever a single carrier happens to own.
Out-of-network negotiation
Claims negotiation and repricing on out-of-network charges.
Medical bill review & editing
Line-item review and claim editing to catch errors and overcharges.
Large case management
Clinical oversight and care coordination on catastrophic claims.
Specialty & high-cost drugs
Specialty Rx, gene and cell therapy management through CAPSL Rx.
Utilization management
Prior authorization and medical necessity review.
Centers of Excellence
Bundled, high-quality care for major procedures.
Subrogation & recovery
Overpayment recovery and third-party liability subrogation.
Why integrated wins.
Most TPAs stitch together vendors. We don't. Medical, pharmacy, stop-loss, and administration all sit inside the CGS Group platform. One contract, one phone call, one team accountable for the whole plan.
Plan design, TPA administration, member services.
Integrated PBM with transparent pricing.
Stop-loss underwriting and risk management.
Group captive solutions for shared-risk employers.
See which plan fits your workforce.
Send us your renewal and census. We'll model the structure that makes the most sense.