Pharmacy Benefit Managers Your Self Funded Plans Secret Weapon
Your pharmacy benefit manager makes or breaks drug spend. Here’s how self-funded employers choose a PBM aligned with their interests, not the PBM’s.
Your pharmacy benefit manager makes or breaks drug spend. Here’s how self-funded employers choose a PBM aligned with their interests, not the PBM’s.
Finding the right TPA shapes claims accuracy, employee experience, and total spend. Here are 8 secrets self-funded employers use to pick the right one.
Highlights Self-funded health insurance plans use a third-party administrator (TPA) to manage the program and process claims on behalf of its members. The right TPA provides high-quality customer service and keeps the plan compliant with state and federal guidelines. Choosing an efficient TPA for your self-funded health insurance plan helps
Twenty percent of employees drive eighty percent of healthcare costs. Self-funded plans give you the data to manage chronic conditions and cut spend.
Group medical captive insurance lets small to mid-size companies share self-funded risk, return surplus, and gain control of skyrocketing healthcare expenses.
Group medical captive insurance pools risk across like-sized employers, returns unused premium, and gives members the claims transparency to control costs.
A medical group captive is a self-funded health insurance model where employers share risk to gain stability, transparency, and buying power.
Employers using fully-insured pay a fixed premium for the carrier to take 100% of the risk and keep any profits. Captives allow employers to band together to control costs and receive refunds for better-than-expected claims.
Employers using level-funded pay a fixed monthly fee to cover administrative, claims, and stop-loss insurance expenses. Any surplus may be partially refunded at the carrier’s direction. With captives, you gain control—full data ownership, plan flexibility, and the ability to keep any savings.
Roundstone works with employers ranging in size from 25 to 1,000+ eligible employees.
Yes, with the right partners, transitioning to self-funding is easy. Roundstone assigns a dedicated Customer Outcomes Manager to guide clients through the process. Your third party administrator (TPA) then handles day-to-day administration and claims.
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