Highlights:

• With Roundstone, plan renewal is part of a long-term strategy, not a once-a-year premium increase.
• Roundstone plan members have full access to their claims data and year-round opportunities to identify cost-containment opportunities.
• Roundstone’s Strategic Relationship Managers begin collecting data from advisors months before the renewal date.
• It is important for advisors to talk to Roundstone about their current TPA, network provider, and PBM to get a custom-fit plan for their clients.
• Advisors should expect to discuss cost-containment strategies, size changes, staffing changes, and helpful insights about their client’s healthcare needs.

As renewal time approaches for employee healthcare benefits, many small and midsize business owners are bracing themselves. Traditionally, plan renewal time has been an unpleasant experience that leaves employers with an unexplained premium hike and no control over the situation.

Roundstone is different. Our business model has always been to watch what the mega carriers are doing, and do the opposite. Plan renewal is no exception. Here’s why.

“Plan Renewal” With Roundstone Is An Ongoing Process

At Roundstone, plan renewal is not a “one-and-done” annual event with a take-it-or-leave-it premium increase. We view these annual check-ins as part of a long-term strategy that allows you and your clients to tweak their plans and implement cost-containment measures throughout the year.

Unlike renewal time with a fully insured carrier, when you meet with your clients, they will have full access to their claims data with flexibility and control over changes made to their existing plans.

As part of that process, our Strategic Relationship Managers (SRMs) will meet with you each year to evaluate your clients’ captive plans. These conversations better equip the underwriters and cost-savings investigators (CSI Team) to customize your clients’ insurance plans to save them money while ensuring the best possible coverage for their employees.

There are three main themes your SRM will discuss with you: claims analysis and cost-containment strategy, plan setup, and business structure and demographics.

Claims Analysis and Cost-Containment Strategy

One of the first actions that Roundstone’s SRMs will take leading up to the renewal date is to work with you to analyze your client’s claims data to discover potential cost-containment strategies and gaps in coverage.

After analyzing your client’s data, our cost-savings investigator (CSI) team will compare them with national benchmarks and offer cost-containment strategies designed to help lower the costs of expensive services such as primary care, ER visits, and pharmacy.

Many suggestions are for bolt-on strategies like condition management education, mental health services, or the implementation of an incentivized employee well-being program. They can also come in the form of highly discounted rates on high-cost prescription drugs.

Plan Setup

In the world of group captive insurance, the plan setup refers to the three overarching partners that make up your client’s insurance plan. These are your third-party administrator (TPA), network providers, and pharmacy benefits manager (PBM).

To help your client create custom-fit coverage, Roundstone is looking for answers to two big questions, “How is the current setup working for you?” and “How has the service been?”

TPAs

Third-party administrators provide you with claims processing and employee benefits management services. Essentially, your TPA takes care of the administrative work related to your client’s health insurance.

A TPA simplifies the process and reduces the possibility of errors. The TPA plays a large part in how smoothly your client’s group captive plan operates. Your SRM will want to discuss what is working well and what may need to change so that Roundstone can help you make adjustments at renewal time.

Network Providers

Network providers are healthcare professionals, such as doctors and hospitals, where your client can receive care under their plan. If you have found that the network is too limited or that several healthcare providers offer substandard care, bring this up with your SRM so it can be adjusted.

PBMs

Pharmacy benefits managers play a significant role in finding your client deals on costly prescription drugs.

Traditional PBMs usually work for fully insured insurance carriers, who don’t pass savings on to the policy holder. However, with a group captive plan from Roundstone, you have access to transparent PBMs who pass discounts and rebates on to your client so that they save money.

Let your SRM know if a client’s current PBM is not meeting their needs. They can recommend PBMs who work in the best interests of their clients.

Review of Business Structure and Demographics

Big changes in your business structure or employee demographics will affect your client’s healthcare insurance plan. Underwriters have to consider these types of changes when renewing the policy.

The two most common changes you’ll want to discuss are whether the decision-makers in the company have changed and whether the size or type of staff at the company has shifted.

Decision-Makers

Changes in decision-maker roles can lead to big changes in your client’s health insurance. If a new owner or HR manager is not educated on group captive plans, they may wish to switch back to a fully insured plan, which can cause the company to lose money and quality coverage. Let your SRM know about the change so you can work together to educate new decision-makers about the benefits of using group captive healthcare.

Company Growth or Downsizing

If your company shifts in size, the change will affect the cost of premiums. Whether the company adds new staff or downsizes, it is important to let your SRM know so the underwriter can alter your client’s plan appropriately.

Additionally, if the company’s employee demographic shifts, for example, from an older male to a younger female demographic, your coverage may need to be changed to accommodate their specific health concerns.

Advisors Are In-the-Know

As an advisor, you likely have intimate knowledge of your client’s current healthcare needs. When it comes time to renew, Roundstone needs to know what you know.

For example, if you are aware of any big changes within the company, such as an increase in pregnancies or mental health needs or a cancer diagnosis, it is helpful to share the information with your SRM so your client’s coverage can be adjusted accordingly.

It is vital to maintain patient confidentiality when sharing this type of information; however, informing your SRM of general healthcare trends within the company can help our CSI Team find cost-containment strategies that speak directly to these situations.

 

 

“90% of what we do is relationship building.” – Dan Santora, Roundstone Strategic Relationship Manager

 

 

The Roundstone Difference

At Roundstone, relationships with trusted advisors are of the utmost importance. We understand that for some employers, switching to a group captive can be a daunting experience. This is why we work closely with advisors like you to explain the benefits — such as better healthcare and cost-savings — to your clients.

Our CSI team will work with them year-round to monitor your clients’ claims data and identify cost-containment opportunities, many of which can be implemented without waiting for renewal time.

Your clients will no longer be in the dark or feel helpless. With Roundstone, they will never have to brace themselves again when it’s time for their annual renewal.

Ready to Talk About Group Captive Insurance with Roundstone?

Whether you are an advisor looking to join our widening advisor network or an employer curious about group captive insurance, contact us to discuss how Roundstone can make a group captive plan work for you.

To learn more about the ways insurance companies keep you in the dark, download our e-Book today.