Solutions — CGS Health

Self-funded plans

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

A strategy discussion between benefits advisors

Level-funded plans

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

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Pharmacy — CAPSL Rx

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.

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Stop-loss — Litchfield Underwriters

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.

Visit Litchfield →

Group captives — Aerie Captive Benefits

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.

Visit Aerie Captive Benefits →

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Networks

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.

Explore our networks →

Cost containment

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.

Built in-house

CGS Solutions Lab

Our in-house team that designs, tests, and deploys custom cost-containment strategies — modeling new approaches against your real claims data before they ever hit your plan.

Partner ecosystem

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.

CGS to confirm: full list of cost-containment programs and named partners to feature publicly.

Integrated platform

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.

Ready when you are

See which plan fits your workforce.

Send us your renewal and census. We'll model the structure that makes the most sense.

Request analysis → For employers

A plan structure for every workforce.