Published by Trustmark Small Business Benefits on July 15th, 2025

Why More Brokers Are Offering RBP — And When It Makes Strategic Sense

For small and mid-sized businesses, Preferred Provider Organizations (PPOs) have long been the go-to solution for employer-sponsored health insurance. They're familiar, easy to explain, and widely accepted by provider systems. But with healthcare costs rising faster than wages, many employers are reaching a breaking point— and brokers are being asked to find smarter, more cost-effective alternatives.

Enter Reference-Based Pricing (RBP). This cost-containment strategy is quickly gaining traction as a flexible and transparent health plan model that helps employers save money without sacrificing quality of care.

What Is Reference-Based Pricing?

Reference-Based Pricing is a provider-reimbursement strategy where plans pay providers based on a benchmark or reference point, rather than using network contracts. The benchmark or reference point is usually a percentage or multiple above the Medicare allowable rate or tied to the provider's cost.

This strategy enables plans to cover services from any willing and qualified provider, with no unnecessary network restrictions or penalties. RBP can deliver meaningful cost savings, while preserving employee benefits and provider choice.

Most providers accept Reference-Based Pricing; however, some may seek additional payments by sending bills directly to members—a practice known as balance billing. It’s very important that employers understand how their plan will handle balance bills and any other issues related to plan-acceptance. Without clear, effective resolution practices, employees could be left holding the bill. Fortunately, if you’re with Trustmark, we manage your balance billing concerns hassle free. The key to success with RBP plans is in choosing experienced and trusted administrative partners.

For the right groups, RBP offers an affordable health plan option that puts them back in control of their healthcare spend.

RBP vs. PPO: A Side-by-Side Comparison

  PPO Networks RBP
Provider Reimbursement Network contracted amounts Calculated from reference point or benchmarks
Provider Access Limited to in-network providers, with restrictions to coverage or increased cost-sharing for non-preferred providers Any willing provider, but some providers may not accept or will balance bill the member
Cost Savings Typically, on average around 50% off-billed charges, varies significantly by network, provider, claim type, and market area Typically, on average 60%-75% off-billed charges, varies by claim type and market area

When Does Reference-Based Pricing Make Sense?

RBP isn't for every client, but in many cases, it’s a better fit than a PPO plan. Here’s when it works best for small businesses:

  • Health Plan Costs Are Rising Unsustainably
    If a client is facing year-over-year premium increases, Reference-Based Pricing health plans can significantly reduce their total healthcare spend. The model often results in lower fixed costs and predictable budgeting.
  • Employers in RBP-Friendly Provider Markets
    Like any other type of plan, RBP is most effective in certain areas. Similar to selecting a network, it’s important to understand how highly utilized providers will respond to plan benefits.
  • The Group Is Open to Change and Support
    For groups used to a network-based plan, transitioning to RBP requires a mindset shift. Employers who partner with strong member education and advocacy services, like Trustmark®, can unlock powerful cost savings and long-term value.

How Trustmark Supports Reference-Based Pricing Success

  • Experience and Insights – With nearly a decade of RBP expertise, we help brokers determine the best-fit health plan for each client—whether that's a traditional PPO plan or a Healthy Choices RBP solution. Leverage our insights to identify which of your groups are ideal candidates for RBP savings.
  • Flexible RBP + PPO Pairing – Offer side-by-side plan options that let members stay with traditional network-based plans or explore RBP alternatives that lower premiums and out-of-pocket expenses.

For employers who are a strong fit for RBP, Trustmark’s Healthy Choices℠ RBP plans deliver:

  • Member and Provider Support – Comprehensive member education and resources with real-time claims and provider support
  • Balance Bill Protection – Ensures members are not responsible for balance bills. Our process is hassle-free and delivers fast, with 90% of balance bills resolved in two business days or less.
  • Trusted Member Care – Our experienced, responsive advocacy specialists provide personalized support to help members navigate their benefits with confidence. Our goal: help brokers offer Reference-Based Pricing plans that are easy to manage, easy to explain, and designed to succeed.

Not a Broker? Here's What to Do.

If you're a small to mid sized business owner looking to lower healthcare costs or explore alternatives to PPOs, talk to your benefits broker. They’ll help you understand if a Reference-Based Pricing health plan aligns with your goals for cost control, employee experience, and long-term value.

Final Takeaway

Reference-Based Pricing isn’t a replacement for PPOs; it’s a powerful complement.
In the right situation, RBP gives employers the pricing transparency, cost control, and long-term sustainability they’ve been looking for. For brokers, offering RBP through Trustmark means going beyond plan options—you're delivering a smarter, strategic benefits strategy.

Trustmark® and Trustmark Healthy Choices℠ are trademarks of Trustmark Insurance Company, an affiliate of Star Marketing and Administration, Inc., and Trustmark Life Insurance Company. Plans are administered by Star Marketing and Administration, Inc., and stop-loss insurance and ancillary coverage are provided by Trustmark Life Insurance Company.