Am I eligible for Solo?

Solo is built for self-employed business owners. To qualify, your business needs its own active federal Tax ID (EIN) — an LLC, S-corp, sole proprietorship, or another business structure all work — and you'll complete a short health questionnaire as part of enrollment. If you have an active EIN and pass the questionnaire, you should be eligible to enroll. Final eligibility is always subject to questionnaire review and approval.

Business owners with employees are welcome too — your Solo plan covers you and your family as the owner. For a fuller walkthrough of who qualifies and when you can enroll, see our guide to health coverage for solopreneurs.

What is the health questionnaire, and is it mandatory?

Yes, everyone who enrolls completes it — it's how Solo keeps the membership healthy and costs down for everyone. There's no traditional medical underwriting: no exams, no records pulled. Just a short set of health questions, answered honestly.

You can review the health questions here before you start, so there are no surprises.

Your answers are used for one purpose only — determining eligibility. Our support team never requests or views your medical history, and your questionnaire is never shared with or released to any other entity.

What happens if I don't pass the questionnaire?

If the questionnaire results don't meet the plan's participation requirements, your business won't be able to establish a plan in the captive at this time. Each covered individual is evaluated on their own answers, and honest, accurate responses matter — inaccuracies discovered later can lead to a denial of coverage.

How do I set up my plan?

The whole process happens online and takes just minutes. Calculate your cost, review the three plan designs, complete and pass the health questionnaire, select your deductible level, sign your plan documents, and enter your payment details. That's it — you're done.

When should I set up my plan?

We recommend setting up by the 20th of the month before your desired start date. That gives our partner services — claims, pharmacy, telemedicine — time to coordinate before your coverage begins. Miss the 20th? You're still fine: plans set up through month-end start on the 1st of the following month; they may just need a little extra processing time.

Your first payment isn't drawn until your effective date, so there's no downside to setting up early. You can choose an effective date up to six months out.

What exactly is Solo?

Solo is a self-funded major medical health plan built for the self-employed. Your business establishes its own plan and joins Vault Health Captive – Series C, a regulated captive domiciled in North Carolina and overseen by the North Carolina Department of Insurance. It's real, comprehensive coverage — not a healthshare, not a limited-benefit plan, and not a short-term plan.

How is Solo different from other health coverage?

Two big ways. First, the structure: every participating business contributes to a shared pool, and because everyone in the pool passed a health questionnaire, the group stays healthier — which is what makes Solo's pricing possible. Members benefit directly when the group spends wisely.

Second, the simplicity: your deductible is also your out-of-pocket maximum. Once you hit it, your eligible medical care is paid at 100% for the rest of the plan year — no added percentage to cover on top. The only exception is prescriptions, which move to low flat copays after the deductible.

Are there caps on coverage?

There are no dollar caps on what the plan pays. Solo has no annual or lifetime dollar limits on benefits — the same standard as large employer plans — and reinsurance sits above the captive, so members are never personally responsible for eligible costs beyond their deductible. No matter how large a covered claim gets, the plan's payout is not capped.

A few specific services do have visit limits rather than dollar limits — for example, outpatient mental health therapy, chiropractic care, and home health care are each covered up to 40 visits per year per covered individual. Your SPD lists every service-level limitation.

Is preventive care covered?

Yes — preventive services are covered at 100% with the deductible waived, from day one. Solo follows the federal ACA preventive care guidelines, which cover routine screenings, annual wellness visits, immunizations, and certain preventive medications.

Can I cover my team?

Yes. With Solo Health Plus, a business owner can extend Solo to a small team under the same EIN. Each person completes their own health questionnaire and can choose their own deductible level — they don't all have to match. If one person doesn't qualify, the rest of the group can still enroll. Talk to our team to learn more.

What plan designs are there?

There are three, and they differ only by deductible: $2,500, $5,000, or $10,000 per individual. Whatever you choose, your deductible is also your out-of-pocket maximum — once you reach it, eligible medical care is paid at 100% for the rest of the plan year, with prescription copays as the only exception. The family aggregate is twice the individual amount.

Which plan designs are HSA-eligible?

The $2,500 and $5,000 plan designs are HSA-eligible, letting you set aside pre-tax dollars for qualified medical expenses. You can open an HSA through your bank, credit union, or any online HSA provider — no special arrangement needed. The $10,000 design is not currently HSA-eligible.

Are my monthly payments tax-deductible?

Monthly payments are generally tax-deductible as a business expense. For how that applies to your specific situation — and how to structure HSA contributions — confirm with your tax professional.

How do I pay, and when does billing start?

You can pay by ACH bank draft, credit card, or debit card. Your first payment is drawn automatically on your plan's effective date — never at enrollment — and you're placed on autopay with payments on the 1st of each month while your plan is active.

Do monthly costs change during the year?

No — your monthly cost is guaranteed through the end of the calendar year. Any changes to costs or plan designs happen once a year on January 1. Each November, every plan has the opportunity to renew for the next calendar year.

Can I change my plan design?

You choose from the three designs when you enroll. Once your contracts are signed, changes wait until renewal — at that point you can select a different deductible level for the new year. As the owner of your plan you may request a mid-year change, but it requires approval and re-rating, which can change your monthly cost.

What do I pay before I meet my deductible?

Until you reach your deductible, you pay the plan's negotiated cost for non-preventive care — and every dollar counts toward your deductible and out-of-pocket maximum, so it's never wasted spending. Preventive services and Tier 1 preventive medications are always covered at 100%, deductible waived.

What provider network do I use?

Solo runs on the Multiplan PHCS (now Claritev) network — one of the largest PPO networks in the country, with providers in all 50 states. Search the network to confirm your doctor participates. No referrals are ever required.

Can I see a doctor who isn't in the network?

Yes. Solo is an open-network plan — you can see virtually any provider willing to work with your plan, with the exception of HMO-only providers. Give your ID card to the office and have them contact the claims team using the number on the back to coordinate payment.

One important habit: don't pay for care in full up front when you can avoid it. Let the claim process first so it's applied at the plan's allowed amount. If a provider is hesitant to call the number on your card to verify the plan, politely insist.

What is Reference-Based Pricing?

Reference-Based Pricing (RBP) is how out-of-network claims are priced fairly. Fairos reviews each claim, corrects errors, and prices it against objective benchmarks — Medicare rates, cost of care, and regional cost data — eliminating the fraud, waste, and inflated billing that's common in healthcare. Fairos begins its review as soon as Vault Admin Services receives the first bill from your provider.

How do I find the best hospital or facility for a procedure?

Contact the Fairos Care Navigation Team at 855-426-1100 (the number is also on your ID card). They'll work with you to locate a "friendly" facility based on cost, quality, location, and prior experience with the plan — before you commit to care.

Do any services require prior authorization?

Yes — certain inpatient admissions, procedures, surgeries, and some mental health treatments need approval in advance. Contact Vault Admin Services before scheduling anything major, and check your SPD for the full list of services that require it.

Where can I see prescription coverage?

The full covered drug list is in the Prescription Drug Formulary — read it carefully, especially for any medications you take regularly. Tier 1 preventive drugs are always $0; other tiers move to flat copays after your deductible. You can also check coverage and participating pharmacies anytime through the FairosRx portal or app.

Is there help for complex or serious medical situations?

Yes. The Vault Cares Network is your resource for complex and high-cost care — it coordinates case management and prior authorizations, and provides expert second opinions, care navigation, and member advocacy. If you're facing something serious, start with Solo Concierge — send a request and we'll connect you to the right resource.

How is durable medical equipment covered?

Coverage for medical equipment depends on the item and the circumstances, and some equipment requires prior authorization. Contact Vault Admin Services before purchasing or renting so they can confirm coverage — and remember the SPD governs the final determination.

What is a captive?

A captive is a privately held risk-sharing company owned by its participating members. In Solo's case, the members are self-employed business owners who each establish a self-funded plan for their own business, then pool together for scale. That group approach gives every member the strength of a large plan — the pool covers the medical risk, and members benefit from potential savings compared to buying coverage alone.

Two things keep the model working. First, every applicant passes a health questionnaire — roughly 5% of people drive 95% of healthcare costs, so a screened pool dramatically reduces the chance of outsized claims. Second, every member does their part: seeking in-network or plan-friendly providers, reviewing their bills and reimbursements, and using claims advocates when needed.

How does the Vault Health Captive work?

Vault Health Captive is owned by its participating member businesses — each with its own self-funded plan. Vault Health Holdings serves as the captive manager, and Vault Admin Services administers the plans. Above the captive sits a reinsurance contract that covers claims exceeding the target loss ratio, with no per-claim or aggregate cap.

Who reinsures the captive?

Odyssey Re, an A-rated reinsurer. If claims exceed expected levels, they're paid by the reinsurer and Vault — there is no maximum coverage limit and no reinsurance cap. The captive structure is filed with, and meets all requirements set by, the North Carolina Department of Insurance.

How do I participate in the ownership of the captive?

By signing the Joinder Agreement when you establish your plan — that's what makes your business a member of the captive. The Joinder describes how the captive operates and communicates with members, alongside the Administrative Services and Managed Care Agreement.

What documents do I sign when I establish my plan?

Four things: the Joinder Agreement, your company's self-funded Plan Document, the Medical Reimbursement Contract, and your attestations. All are signed electronically during enrollment.

What is the Advisory Board?

The Advisory Board is the voice of the member-owners. It reviews annual audits, has visibility into captive financials, and decides how to manage any annual surplus — whether to grow the reserve fund or apply it to reduce or stabilize monthly costs for members.

What is the reserve fund?

The reserve fund is where surplus accumulates when the group spends less on care than it contributes. Monthly payments are set to cover 100% of anticipated claims — so if actual claims come in at, say, 80% for the year, the remaining 20% builds the reserve or benefits members in other ways, as the Advisory Board decides. It's the mechanism that turns a healthy year into future savings.

Can I switch to Solo mid-year, before my current plan renews?

In most cases, yes. Eligible members can establish a Solo plan at any time during the year, with coverage starting on the 1st of any month you choose. You generally don't need to wait for your current plan's renewal window — most coverage can be changed at any time. Check your current plan's terms to confirm.

Should I switch now, or wait until my current plan year ends?

That decision is yours, and two factors usually drive it: the monthly cost of Solo versus what you're paying now, and how much progress you've already made toward your current plan's deductible. If you've spent significantly toward this year's deductible, it may make sense to finish the year; if you're early in the year or your deductible is untouched, switching sooner usually captures more savings. Talk to our team and we'll walk through the math with you.

When should I cancel my current coverage?

Wait until after the 1st of the month in which your Solo coverage takes effect — that way there's no gap. You're responsible for proactively canceling your current plan; it won't cancel automatically when you join Solo.

When will I receive my ID cards?

On your effective date you'll receive an email from [email protected] with instructions to access your Member Portal and download your digital ID card. Your physical card arrives by mail within 2–3 weeks after your effective date. Keep in mind that some partner services may take 5–7 business days after your effective date to fully activate.

What's printed on my ID card?

Your card shows Multiplan PHCS PPO information — the network you'll use to find in-network doctors — plus Vault Admin Services details, so providers know exactly where to send claims for processing. Everything a provider's office needs to verify your plan is on the card.

What should I do when I get a bill or an Explanation of Benefits?

Compare your Explanation of Benefits (EOB) against the provider's bill before you pay anything. If the two don't match, contact Vault Admin Services at 888-211-5706 before paying — mismatches are usually a coding or billing issue that can be corrected, and paying an incorrect bill up front makes it harder to fix.

How do I submit a claim myself?

If a provider won't bill Vault Admin Services directly, you can self-submit through your Member Portal — the claims submission guidance walks you through it step by step. Have your itemized bill ready (it needs patient info, the provider's name, address, and tax ID, date of service, diagnosis and procedure codes, and the total charge). Submit within the timely filing window in your SPD — late submissions are denied.

Can I talk to someone about my options?

Absolutely. Our support team is available at 646-328-6968, Monday–Friday, 9:00 AM–5:00 PM ET — or reach us through the contact page anytime.

Can you help me choose a plan design?

We can walk you through how each plan design works and how the deductible levels differ, so you can weigh the trade-offs with confidence. As a general guide: members who expect to use care frequently often weigh the lower deductibles, while those who expect minimal use often prefer the lower monthly cost of a higher deductible. The final decision is yours — made on your own or with your tax professional — but you won't be making it without support.

Can you give me tax advice?

We can share the facts — monthly payments are generally tax-deductible as a business expense, and the $2,500 and $5,000 designs are HSA-eligible — but for how any of it applies to your situation, your own tax professional is the right resource.

Once I join, who do I call for benefits or payment questions?

Solo Concierge is your first stop for almost everything — benefits questions, payment issues, or adjustments to your plan. Call or text 646-328-6968 or send a request online. The team is available Monday–Friday, 9:00 AM–5:00 PM ET.

Who do I call about claims?

Vault Admin Services handles claims. Reach them at 888-211-5706, Monday–Friday, 8:00 AM–5:00 PM CT — for claim status, EOB questions, prior authorizations, and anything related to a specific bill.