Self-Funding 101: What Makes a Great Benefits Advisor?

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  • The best way to pick the right self-funded employer-sponsored health insurance plan is with the help and guidance of a knowledgeable benefits advisor.
  • A benefits advisor (also called a broker) helps coordinate healthcare communications and advises employers on their healthcare options.
  • Expertise in the complexities of modern healthcare helps benefits advisors create the right strategies for your company.
  • A great benefits advisor will have excellent communication skills and remain in contact with employers throughout the year.
  • Because of constantly shifting circumstances, a great benefits advisor will have the ability to rapidly adjust to new conditions.
  • Benefits advisors can help businesses find the best health insurance plan to meet the needs of their budgets and their employees.



Choosing affordable health insurance is a complicated challenge for employers all across the country. A great benefits advisor helps employers make the best decisions with regard to their coverage and also advises owners on the best options to make available. Their expertise enables them to identify and implement cost containment strategies that keep healthcare costs low while providing high-quality care that’s customized to the way employees use it. They will have a deep understanding of self-funding and know if you are a good candidate for self-insurance.



Healthcare Knowledge and Expertise


As consultative experts, benefits advisors use their knowledge to help employers make smart choices, including whether or not they are a good fit for self-funded health insurance. They are educated in the complexities and nuances of modern healthcare and are up to date on the details of healthcare options.


The shifting landscape of U.S. healthcare is too complex for many people to follow, meaning that business owners and their employees benefit from the guidance of an expert.





Benefits advisors need to have the ability to communicate the complexities of healthcare coverage to business owners and their employees. An ability to relay the technicalities in layman’s terms helps people make decisions they understand.


A great advisor will also be available when you need them. With fully insured insurance carriers, you hear from your benefits advisor once a year — at renewal time. A great benefits advisor will stay in touch with your company all year round to make sure that your healthcare strategy continues to meet your needs and help you react to changing circumstances. With a self-funded health plan, you consistently hear from your advisor. They are an active partner at your side, working one-on-one with you to optimize savings and improve the quality of care offered by self-insurance.



Flexibility and Control


Optimally, a benefits advisor will recommend a path that is suited to a company’s current needs but also has the flexibility to change direction over time to adjust to new needs. That’s the beauty of self-funded health insurance. You can tweak and adjust it throughout the year to better accommodate your employees’ needs and optimize savings. Conditions change rapidly — unexpected health crises or sudden financial difficulties can make inflexible plans a hazard.


A great advisor will have a thorough understanding of self-funding options so they can give the best possible advice on the funding strategies available to help their clients determine the plan elements they can control.



The Resources to Find the Right Partners in a Self-Funded Health Insurance Plan


With a self-funded health insurance plan, you have the option to choose the insurance professionals you work with. However, those decisions can be complicated, and a great advisor will gladly help you make them. With a great benefits advisor, you are guided through the self-insurance journey so the process is seamless and simple.


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Third-Party Administrators

A great benefits advisor will help find a Third-Party Administrator (TPA) who fits the needs of their client and can deliver the best self-insurance experience. The TPA is responsible for performing the administrative tasks involved in implementing self-funded health insurance coverage. They prepare and process claims, develop specialized plan documents for insured employees, and provide data reports about claims.


A self-insured group captive plan lets businesses choose their own TPA, and the advisors we work with are trained to help you make the right choice.



Pharmacy Benefits Managers

A great benefits advisor will also help you choose the right Pharmacy Benefit Manager (PBM). PBMs administer your plan’s prescription drug benefits and negotiate prices with pharmaceutical companies.


Unlike in a self-funded health insurance plan, the mega carriers do not let you choose your PBM, so you have no control over what you pay for medications. A self-insured plan, on the other hand, allows businesses the freedom to select the PBM that’s right for them. This can save hundreds of thousands of dollars in the long term.



Ability To Share Your Data in a Self-Funded Health Insurance Plan

Fully insured insurance carriers raise rates without telling you why, regardless of how little or how much you submit in claims each year. By contrast, our network of benefits advisors works to make your data as transparent as possible. Then, they go one step further to help you interpret it. That’s the beauty of a self-funded health insurance plan. You can use data to improve both the savings and care quality that’s possible through self-insurance.


With a Roundstone self-funded health insurance plan, our CSI Dashboard makes this possible. The CSI Dashboard comes with personalized recommendations from our Cost Savings Investigator (CSI) team, who work with our members year-round to find cost containment solutions.


The dashboard provides easy-to-use visual analytics of a client’s medical claims info and a real-time review of their spending compared to national benchmarks. Our members can then adjust their coverage plan, creating tangible savings — without having to wait for annual renewal time.


All the data you view in the CSI Dashboard has had Protected Health Information (PHI) removed, so you can keep tabs on your self-funded health plan’s spend anytime, anywhere, without fear of exposing sensitive information.


Using the CSI Dashboard, advisors can help employees initiate strategies to do all of the following:


  • Learn which ER visits are preventable
  • Compare diagnostic test costs for local hospitals
  • Identify where Rx spending is higher than the national average
  • Switch to a transparent PBM for significant savings in drug costs
  • Reduce high ER costs due to chronic conditions


A great advisor will help you interpret your data and work with your CSI team to help you implement opportunities for cost savings in a self-funded health plan.



The Roundstone Difference: The Freedom of Self-Funded Insurance


With fully insured insurance carriers, an insurance broker presents a handful of options for your healthcare plan that are not customizable. Worse, every year, they hand businesses a significant rate increase without explanation.


Roundstone’s vision is different. When you join our group captive, we work with your existing advisor or refer you to a benefits advisor from our network of trusted advisors who will always work in your best interests.


Your advisor will communicate with you regularly to help you make good coverage choices. They will help you choose your TPA and PBM and help you custom-build the best possible coverage plan for your individual company and employees. And they will support you every step of the way.


But what our recommended advisors do best is come up with innovative solutions to meeting the challenging and changing needs of small and midsize businesses. Along with your CSI team, your advisor will be available to you anytime during the year to help you identify and implement changes to keep your healthcare costs down.


Are you a benefits advisor interested in presenting the Roundstone captive health insurance plan to one of your employer groups? We’d love to hear from you.



Provide Better Benefits With a Roundstone Self Funded Group Captive Health Insurance Plan


A self-insured group captive plan from Roundstone gives businesses the flexibility and control they need to provide the highest-quality care to their employees for the lowest cost. Our network of benefits advisors help our clients provide the best possible care at the lowest possible cost.


For more information about the difference self-funded group captive insurance can make to your business and your employees, download our free e-Book.






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