March 4, 2022

You’re In Control: Group Captives Offer Freedom of Choice

pointing to a gear


  • With fully insured healthcare plans, you do not have the freedom to make changes to your health insurance coverage.
  • Self-funded health insurance from Roundstone puts you in control by giving you the freedom to choose your plan options.
  • Roundstone’s health insurance plans leverage a group medical captive designed for small and midsize businesses to band together for the same scale, resources, and purchasing power as a larger enterprise.
  • Roundstone also provides you with access to claims data and analytics  that help you make informed decisions to improve employee benefits and reduce costs.

Self-Funded Health Insurance That Gives Employers Freedom of Choice

Unlike most traditional fully insured health plans that offer little flexibility, a self-funded plan can offer freedom of choice in every aspect of your health insurance coverage. You choose the solution providers, Third-Party Administrators (TPAs), Pharmacy Benefits Managers (PBM), and providers that work best for your needs. Freedom of choice gets your employees the right care for their health at the right price for your bottom line.

Freedom of choice gets your employees the right care for their health at the right price for your bottom line.

Self-Funded Health Insurance: It’s Your Plan, Your Way

Self-funded health  insurance plans are structured for freedom of choice, unlike traditional, fully insured plans. With a fully insured plan, small to midsize businesses are subject to full-cost premiums for services they may not use.

There is no opportunity to choose networks, solution providers, PBMs, or TPAs. Instead, the insurance company chooses these elements for you, no matter how well they meet your company’s healthcare needs or budget.

Self funding through Roundstone’s group medical captive is different. First of all, your benefits advisor works with you to design individual components of your plan. With fixed insurance costs at about 15% of your total health insurance expenses, the remaining 85% of your costs are variable, allowing you to implement optimization and cost-containment strategies that can reduce those costs and save you money.

group working together

Freedom to create a health plan that works for you on all levels gives you control of your employee health benefits. It allows you to take more of a strategic, long-term view, as you would with any other business investment.

Your benefits advisor can help advocate for your best interest. They know your company and its healthcare needs and work on your behalf to build the right coverage for your business. Roundstone has a trusted network of benefits advisors who understand the self-funded model and how it works. They can help determine if an organization is a good fit.

All benefits advisors make a commission for signing you up for coverage. With the No Surprises Act, you are now entitled to know how much your advisor is earning as a result of selling your company’s policy. This transparency helps to ensure that advisors are making decisions not based on what makes them the most money but instead on what is best for you, the client.

At Roundstone, transparency is one of our core values. We focus on developing a relationship with your insurance benefits advisor to get you the coverage options that work for your company’s specific needs.

Insurance benefits advisors who partner with Roundstone work on your behalf to craft health insurance solutions that meet your needs. They present you with cost-containment strategies that help you save money rather than choose plans that benefit them.

Freedom to Create Your Own Plan

With self-funded health insurance, you are free to choose the elements that make up your coverage plan. This includes PBMs, TPAs, solution providers, and networks.

Third-Party Administrators

Your TPA performs all the administrative tasks associated with implementing health insurance coverage. They develop your specialized plan document for insured employees, prepare and process claims, and provide you with data reports about your claims.

With a group captive plan, you are free to choose your own TPA. You can opt for a TPA who provides transparent claims data and specializes in working with companies comparable in size to yours. The right TPA will offer flexible network and vendor options to help you customize a plan that meets the needs of your business and your employees.

Pharmacy Benefits Managers (PBMs)

PBMs are responsible for obtaining access to prescription medications as part of your healthcare plan. They negotiate with pharmaceutical companies for rebates and discounts on pharmacy drugs and determine which drugs are available to benefit on insurance plans.

In the traditional model, PBMs operate under opaque conditions. They often work for the large fully insured insurance carriers, and when they find savings, they keep the savings as profit rather than passing it on to policyholders. With a fully insured plan, you don’t have a choice in your PBM and are therefore subject to the practices of the PBM your carrier opts to use.

With a group medical captive plan, you have the freedom to choose a transparent or pass-through PBM. Transparent PBMs use an up-front fee schedule that allows you to see exactly where your money is used. Pass-through PBMs pass any savings they receive on to you, making them a much better option.

A financial company saved over $250,000 for the first year of treatments for a newly diagnosed cancer patient by utilizing clinical management programs used by their PBM partner, for example.

Solution Providers and Networks

With traditional insurance, the company determines solution providers that supply healthcare-related items, such as diabetes supplies. Additionally, fully insured companies trap you into using a pre-existing network of providers, regardless of the level of care they provide. This lack of control causes unnecessary expenses and prevents your employees from seeking the most effective care.

With a group medical captive plan, you are free to choose solution providers and network providers that better fit the needs of your employees. You can opt for solution providers that offer specialized services like wellness management programs or discounts on supplies.

You can also choose networks that include specialized care providers or high-level providers that wouldn’t have been included in a fully insured plan. You can even opt for a Direct Primary Care program within your local healthcare community.

The fact is, there are many options that most people don’t know about because our current healthcare system is monopolized by big networks that want to keep you in the dark.

Freedom To Access Claims Data

presenting to a group

With a group captive plan from Roundstone, you have the freedom to access all of your claims data. This is in opposition to fully insured plans, which do not give you access to your own data. Without transparent data access, you can’t see where your money is going or implement cost-containment strategies in areas that would save you money.

At Roundstone, we provide you with data transparency so that you can determine appropriate cost-saving strategies for your plan as well as the best coverage options for your employees. We do this with user-friendly data analysis tools and a dedicated team of Cost Savings Investigators (CSIs), who can help you find “areas to impact” by exploring your own data trends.

Data Analysis Tools

As part of a group captive plan with Roundstone, you can access your data through our CSI Dashboard.  The CSI Dashboard provides you with insights into healthcare spending categories, such as pharmacy costs and ER visits, and compares them to national benchmarks. You can use that information to change elements of your plan for better cost-effectiveness.

The CSI Dashboard is easy to use and HIPAA compliant. Your data is anonymized and aggregated so you can check it anytime, anywhere without fear of displaying sensitive information.

Cost Containment

To help you implement cost-containment solutions, Roundstone employs professionals in plan description optimization, nursing, claims, underwriting, and data analytics. These experts make up your CSI Team.

Your CSI Team analyzes the claims data from your CSI Dashboard to recommend cost-containment solutions that you can use to get better coverage and savings. You are free to choose which ones to implement, giving you an additional level of control over your health insurance plan.

Take Control of Your Health Insurance

Traditional insurance companies don’t offer you the freedom to choose your healthcare plan because they don’t want you to control which solution providers, PBMs, or TPAs you use.

Take control of your health insurance plan with group captive insurance from Roundstone. We can help you save up to 20% on health costs by giving you the freedom to build your healthcare plan based on your needs. Request a proposal and benchmark review today.

Download our free eBook to find out why the mega insurance carriers don’t want you to have control over your employee healthcare plan.

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