ClearHealth: Executive Overview

A portable, HSA-compatible alternative to employer-tied health insurance — built from first principles.

This document is for entrepreneurs, partners, and investors who want to understand the ClearHealth business concept, financial model, and path to scale.

The Problem

American health insurance is broken in four specific, fixable ways:

1. Coverage is tied to employment. People lose leverage when changing jobs, starting a business, freelancing, retiring early, or facing COBRA. The plan relationship belongs to the employer, not the member.
2. The tax advantage is trapped inside the wrong structure. HSAs are powerful, but most people experience them as a side account attached to an opaque employer plan instead of the center of a portable healthcare strategy.
3. Prices are hidden. Patients don't know what care costs until after the bill arrives. Providers don't know what they'll be paid. No one has leverage.
4. The middlemen capture the margin. PBMs, networks, and administrative layers add overhead without making routine care easier to understand.

The Solution

ClearHealth is a portable, HSA-compatible high-deductible health plan concept with five defining characteristics:

This is not just a cheaper plan design. It is a different ownership model: portable coverage, tax-advantaged healthcare savings, transparent routine care, a clear member out-of-pocket cap, and program-level reinsurance.

How It Works (Plain English)

1. Members enroll directly in portable coverage. The plan can be supported by an employer contribution, but it is not dependent on staying employed by that sponsor.
2. Members maintain an HSA tied to the HDHP structure. Contributions can come from the member and, where allowed, from an employer.
3. They use any doctor or pharmacy. The plan card tells providers: "Bill your cash price or 120% of Medicare — whichever is lower."
4. Members pay routine care from HSA dollars until the deductible is met. The plan covers eligible expenses after that point.
5. Prescriptions start with Cost Plus Drugs by default, with ClearHealthRx discount card pricing as the fallback for unavailable medications or local retail needs.
6. The member's covered exposure is limited by the plan's out-of-pocket maximum. Large claims trigger the program's stop-loss layer, which protects the fund from ruinous exposure and helps keep the program financially stable.
7. Any year-end surplus is retained as reserves or rebated to members.

Why Portability Is the Hook

Employer-sponsored insurance is structurally fragile for modern work:

• A job change can mean a new network, new deductible, new doctors, and a new claims history.
• COBRA keeps coverage alive but often at a price that feels punitive.
• Freelancers, founders, consultants, and LLC owners are forced into individual-market plans without employer-style support.
• Small employers want to help with healthcare but do not always want to manage a full group plan.
• Early retirees and people approaching Medicare need continuity before they age into public coverage.

ClearHealth gives employers a different role: contribute to the person's healthcare capital instead of owning the entire insurance relationship. The member keeps the plan and HSA strategy as life changes.

HSA Strategy

The HSA is not an accessory in this model. It is the everyday spending engine.

For 2026, IRS HDHP rules require minimum deductibles of $1,700 self-only / $3,400 family and maximum out-of-pocket exposure of $8,500 self-only / $17,000 family. ClearHealth's proposed plan design fits inside that HSA-compatible frame.

Prescription Strategy: Cost Plus + ClearHealthRx

ClearHealth is purpose-built around a two-channel prescription strategy:

• Cost Plus first: Members use transparent mail-order pricing when the medication is available.
• ClearHealthRx discount card fallback: Members use the discount card for drugs not available through Cost Plus, urgent local fills, and retail pharmacy needs.
• Unified price lookup: The member portal should show both options so the member can choose the better price and fulfillment path.
• HSA-compatible workflow: Pre-deductible prescription purchases can be paid from the member's tax-advantaged account when eligible.

The point is not a single pharmacy partner. The point is a transparent prescription stack: Cost Plus where it works best, discount card coverage where Cost Plus does not reach.

Financial Model

Year 1 Projections (1,000 members)

The central planning assumption is $450 per member per month for individual coverage. That is intentionally closer to unsubsidized lowest-cost Bronze marketplace pricing for a 40-year-old, while giving ClearHealth enough room for claims, program-level reinsurance, administration, and reserves.

Capital required to launch: $1.1 – 1.4M (2-month claims and operating reserve + stop-loss deposit + legal/tech)

Monthly contribution pricing:

These are competitive with ACA Bronze HDHPs — but with real price transparency and an integrated Cost Plus + ClearHealthRx prescription strategy.

Business Model Options

ClearHealth can scale through three structural approaches:

Option A — MGA Partner Model (fastest) Partner with a licensed carrier. ClearHealth is the transparent pricing, HSA, and UX layer. Revenue: approximately $25 per member per month admin fee. Fastest to market; less control over fund logic.

Option B — Member-Funded Pool (current model) Members contribute to a trust, ClearHealth Admin Services LLC acts as licensed TPA. Full control. Portable, individual coverage. Stop-loss protects the fund. Employers may support members through HSA contributions or defined contribution arrangements without owning the full plan relationship.

Option C — Captive Insurer (after scale) After 2,000–3,000 members, evaluate established captive domiciles and form where the regulatory fit, capital requirements, healthcare-risk experience, and reinsurance access are strongest. The captive assumes stop-loss risk, manages reserves, and becomes a member-aligned structure with investment float.

Growth Path

Target markets: independent professionals, LLC owners, freelancers, small employers tired of opaque group plans, workers facing COBRA, families priced out of employer-dependent coverage, and pre-Medicare members who need continuity.

Regulatory Structure

Phase 1 (Now): Operate as a TPA. Register ClearHealth Admin Services LLC. No insurance license required — the fund is member-owned and fully disclosed. Contract with stop-loss carriers and HSA custodians.

Phase 2: Member-funded pool. Stop-loss protects the fund against catastrophic claims. Outside ERISA. Individual, portable coverage.

Phase 3: Captive formation. Domicile selected after legal, actuarial, and reinsurance review. Long-term control of reinsurance pricing and risk capital.

Key Partnerships Needed

Why This, Why Now

• Employer-sponsored insurance is losing fit with how people actually work: fractional careers, small businesses, consulting, remote work, and job changes.
• COBRA exposes the real cost of employer coverage at the worst possible moment. ClearHealth gives people a portable option before the crisis.
• The ACA created a generation of HDHP members who are already paying cash before their deductible — but without price transparency or fair rates. ClearHealth formalizes what they're already doing.
• Reference-based pricing (120% Medicare) has been proven at scale by self-funded employers. ClearHealth brings it to individuals.
• Cost Plus Drugs and discount-card pricing made cash-pay Rx comparison familiar. The same transparency model applies to medical care.
• The TPA/member-pool structure creates a path to portable individual coverage with employer-compatible funding support.

What ClearHealth Is Asking For

This is a working proposal and design document. We are looking for:

• Strategic partners in reinsurance, pharmacy, and fintech
• Early members willing to join a transparent pilot cohort
• Investors interested in a capital-efficient path to a $54M+ revenue insurance alternative

Contact: See the Launch Blueprint for next steps and entity structure details.

Also see: Concept Overview · Pricing Model · Launch Blueprint · Prescription Strategy