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 and/or providers costs 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 $20,438, according to the Kaiser Family Foundation Employer Health Benefits 2020 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:
  • control plan costs,
  • offer freedom of provider choice1, and
  • include premier reference-based pricing services from our vendor partner, AMPS.
For most covered healthcare services1, providers are reimbursed a Reasonable Fee, calculated as a multiple of the Medicare reimbursement rate and/or provider costs.

Ideal Cost-Savings Combination:

Our New Hybrid Option

Employers can choose an ideal cost-savings combination of a PPO network for practitioner services and reference-based pricing. Our Hybrid Option:
  • Allows covered members to select providers nationwide from the MultiPlan Network for practitioners only
  • Provides savings via a PPO discount for in-network services, including physician/specialist office visits, therapies and alternative medicine
  • Provides freedom of provider choice with reference-based pricing for out-of-network covered services1
  • Includes premier reference-based pricing services from our vendor partner, AMPS
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Trustmark Healthy ChoicesSM Plan Design Hybrid Option

Watch our video to learn more about the Hybrid Option. Employers who want an affordable, customizable self-funded benefit solution can select the Hybrid Option, which combines a practitioner-only PPO network and reference-based pricing.


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.

Product Availability

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

Ancillary Coverage

Employers can offer a complete benefits package by adding ancillary coverage to a health benefit plan designs.

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 or limited medical plan designs.

Wellness and Cost-Saving Services

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