Not all Group Health Plans are Created Equal

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 to controlling future costs. To assist employers achieve maximum success utilizing a self-funded plan, Roundstone has created the Roundstone Summary Plan Document (Roundstone SPD).

The Roundstone SPD utilizes plain language and thoroughly defined terms to ensure a clear and concise understanding of the coverage. Not only does this improve an eligible employee’s understanding of what is or is not covered under the plan, the defined terms prevent providers from manipulating a definition to inflate costs.

The Roundstone SPD also utilizes a number of incentives and penalties to encourage members to utilize available programs or to deter member abuse. The incentives and penalty combination improves efficiency, compliance, and helps manage costs while ensuring members receive the best care they require. These are added to integrated cost containment programs, such as dialysis and prescription management, designed to manage risk and lower high cost claims while still providing maximum care. Optional additions to the Roundtone SPD, such as the utilization of Centers of Excellence, not only increased employee benefits, but may do so at an additional cost savings over Network arrangements.

The Roundstone SPD was designed by a team of claims adjusters, nurses, and attorneys who, combined, possesses over half a century’s worth of experience and has been externally reviewed by an independent ERISA attorney. The Roundstone Plan is designed to manage and minimize self-insured health care costs, rather than ease the burden of the third party administrator.