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Plan Document Tips

By the Numbers: Eligibility Audits

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Written by Book Chrobak, Health Analytics Manager Many of us read about the importance of the plan document language in last month’s By the Numbers.  Eligibility is an important part of a strong plan document and is the topic of our CSI bulletin this month.  Employers are the main source […]

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Not all Group Health Plans are Created Equal

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By Jamie L.C. Pience, Associate General Counsel At Roundstone, we believe in a proactive approach to cost containment and plan language. Precise language which strictly states available coverage and full compliance to the terms required for coverage, combined with an administrator committed to the protection of the plan, are essential […]

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By the Numbers: Plan Documents

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By Book Chrobak, Health Analytics Manager Switching to self-funding health benefits allows employers to take control of their costs, design their benefit coverages, and understand their healthcare spend. The plan document is the “formal, written, legal statement listing the provisions of the insurance plan.” It is the instrument that sets […]

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Education & Transparency: The Keys to RBP

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By Ellen Winson, Policy Administration Specialist Employers are continually looking for ways to control medical costs. This is especially true for self-insured employers. One strategy that has emerged is the implementation of Referenced-Based Pricing (RBP). With RBP, the employer sets a maximum reimbursement tied to a particular benchmark. The amount […]

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7 Secrets to Finding a TPA that Fits Your Needs

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Matt Monda, Chief Operating Officer At its most basic, self-funding is a mechanism an employer uses to pay for its employees’ health care costs. But it’s also an investment in controlling a major cost of doing business. The employer relies on three consultants to deliver a return on that investment: […]

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Choosing a TPA

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At its most basic, self-funding is a mechanism an employer uses to pay for its employees’ health care. It’s also an investment in controlling a major cost of doing business. The employer relies on three consultants to deliver a return on that investment: their insurance advisor, the stop loss carrier, […]

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