Broad networks contract with a large percentage of local providers; narrow networks trade choice for better-negotiated rates. Self-funded employers can build tiered structures that offer employees both options at different cost-sharing levels.

Unlike fully insured plans, self-funded health plans give employers complete freedom to contract with any network that fits their workforce. You can also layer specialty arrangements like Centers of Excellence on top of a broader network.

National provider counts mean little if coverage is thin near your workforce. Ask vendors to map in-network providers against your employees’ home zip codes before committing.

Network adequacy measures whether employees can actually access in-network care in a timely way. When they can’t, out-of-network claims drive up plan costs and undermine your cost containment strategy.

Benchmark reimbursement rates against Medicare, not billed charges, because billed charges are arbitrary and easily manipulated. Ask networks for rate data on your most common procedure codes specifically.

It sets plan reimbursement based on an objective benchmark, typically a Medicare multiplier, rather than arbitrary network discounts. It can significantly reduce facility costs and is one of the most effective cost containment strategies available to self-funded employers.

One of the core advantages of self-funded health insurance is the ability to change network vendors without restructuring your underlying plan. You can also add specialty arrangements mid-year without disrupting overall plan design.

Your claims data tells you which specialties employees use most, which facilities they visit, and where costs are concentrated, all of which should drive the network decision. Roundstone Reporting gives group captive members direct access to that information.

Most self-funded plans cover out-of-network care at a higher cost-sharing level, and the No Surprises Act provides protections against balance billing for emergency services. Your TPA and plan documents govern how those claims are processed.

Roundstone’s Preferred Bundle pairs the Cigna national network with Bywater TPA and select transparent PBMs, delivering an average of $1,700 less per employee annually versus other configurations. Group captive members who prefer a different network can bring their own, because flexibility is built into the model.

PBM selection is the primary lever. Traditional PBMs profit from spread pricing, the gap between what they charge your plan and what they pay the pharmacy, which is invisible in a fully insured arrangement. Roundstone’s Preferred Bundle includes transparent, pass-through PBMs that show ingredient costs at the transaction level, so self-funded employers manage pharmacy spend rather than absorb it.