Small Business Benefits

Reference-Based Pricing

Why Reference-Based Pricing?

Reference-based pricing is a great solution for employers seeking to save on healthcare costs without reducing benefits or limiting provider choice. Many pain points experienced by employers can be solved by combining level funding with reference-based pricing.

Advantages of Reference-Based Pricing

Typically Healthcare Costs Are Lower

Typically less expensive than traditional PPO health benefit plans, reference-based pricing plans calculate claim payments based on a reference point. A multiple of the Medicare reimbursement rate is a commonly used reference point. Reducing healthcare costs is a key goal for smaller employers, as the annual average cost for family coverage at small firms is $21,804, according to the Kaiser Family Foundation Employer Health Benefits 2021 Annual Survey.

Freedom of Provider Choice

Covered employees can select providers that best meet their needs, which enables them to maintain current provider relationships and/or choose a new physician. Typically, there are little or no restrictions placed on the selection of doctors or hospitals.

Bringing innovation to smaller groups

Leveraged by large employers for years, reference-based pricing is now being used to calculate provider reimbursement for affordable self-funded plans in the smaller group market.

Trustmark Healthy ChoicesSM Plan Designs

Our affordable self-funded, reference-based pricing plan designs:
  • offer freedom of provider choice1 for most services
  • include a streamlined process for resolving balance bills
  • feature Trusted Member Care specialists who deliver a high level of personalized support to help members make the most of their benefits
  • control plan costs
For most covered healthcare services1, providers are reimbursed a Reasonable Fee, calculated as a multiple of the Medicare reimbursement rate.
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Trustmark Healthy ChoicesSM CDHP Designs

Employers can customize health benefits through truly flexible mix-and-match plan designs to meet their needs and budget. These plan designs meet IRS requirements to be paired with an HSA.
Media for Trustmark Healthy Choices<sup>SM</sup>&nbsp;CDHP Designs
Media for Trustmark Healthy Choices<sup>SM</sup>&nbsp;CDHP Designs

Tell me more ...

To learn more about our reference-based pricing plan designs, please submit the online form (all contact fields required). Someone from the Trustmark Small Business Benefits® team will reach out to you.
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Product Availability

View the available products available by state to find out what employer-sponsored health benefit plan designs are available. 
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HRA Plan Designs

For lower costs and more cash-flow control, employers can pair a Health Reimbursement Arrangements (HRA) plan design with one of our major medical plan designs.
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Wellness and Cost-Saving Services

Health and wellness programs and our educational materials empower employers and their employees to become smarter healthcare consumers.