Health Benefits

What Is Reference-based Pricing?

Reference-based pricing is an innovative way for employers to help control healthcare spend and give their members the freedom to see the provider of their choice under their self-funded health benefit plan.

With reference-based pricing, reimbursement is based upon a fair percentage (typically 150% or 200%) of a cost-based metric or what Medicare pays for a particular service instead of a discount off of the medical facility’s Chargemaster price, which is what happens with a PPO plan.

Because there’s no PPO network with reference-based pricing solutions, members can go to any provider of their choice for the care that is subject to reference-based pricing under their plan.

Chart of Reference-based Pricing options

Saving Success Stories

Making the switch to reference-based pricing can bring big savings. Here’s a look at three of our clients who saw significant savings when they switched to a hybrid RBP option.
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Industry: Food prep
Location: Pennsylvania   
Members: 500

Reduced claim costs by over 30%, or $300 per employee per month
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Industry: Transportation
Location: Kansas
Members: 300

Reduced claim costs by 20%, or $150 per employee per month
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Industry: Insurance
Location: Illinois 
Members: 500

Reduced claim costs by 30%, or $200 per employee per month

Reference-based Pricing Models

As with all Trustmark Health Benefits’ solutions, there’s not a one-size-fits-all solution when it comes to reference-based pricing. We offer flexible options so our clients can choose the model that’s right for them.

Best-in-Class Vendors

In addition to these different models, Trustmark Health Benefits has built relationships with some of the biggest names in the reference-based pricing industry to give our clients the specific solution that meets their needs. Our vendors can give our clients and their members support and protection.
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