I know this!
Regular health insurance is built as a major risk pool. The goal (even for Medicare) is that premiums come in and a minimal of payouts happen.
Vision and dental have a risk component built in, but operate more as a super high fee savings account. You’re buying in for a discount and a very small (relative to premiums) payout.
There are health plans like this too (not ACA accredited) that do this too. Limited benefit plans.
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