Whether you refer to it as Reference-Based Pricing (RBP), Medicare Reference, Cost Plus or something else, the important thing is to understand what it is and why it’s being used to lower health plan costs.

​Level-funded health plans with reference-based pricing provide high quality coverage at a lower cost by using Medicare fee schedules as a base. Then they negotiate with hospitals and physicians to determine an acceptable percentage margin over and above Medicare. Margins often fall within a range of 25% to 65%. 

Open enrollment is just around the corner. There are many ways you can help your company operate more strategically and efficiently by opting for level-funded health plans. Not only does a level-funded health plan benefit employees, but you might find that there are plenty of ways these plans help you out as well.

Telehealth, also called telemedicine, allows you to receive health care without an in-person visit to a provider by using computer, tablet or smartphone.
 
Telehealth technically started in the 1940s in Pennsylvania when providers realized they could send radiology images over the phone lines between two townships. In the 1950s, a Canadian doctor expanded on the concept and constructed a teleradiology system that was used in and around Montreal. And in 1967, the University of Miami School of Medicine partnered with a local fire department to transmit electrocardiographic rhythms over radio to Jackson Memorial Hospital in rescue situations.

It’s no wonder small businesses are confused when they are told they need to file Form 5500 with the Internal Revenue Service (IRS) and pay PCORI fees. For instance, if you look up 5500 filing requirements on the Internet, most sites say something like, “Form 5500 is required on behalf of any welfare benefit plan that has 100 or more participants as of the beginning of the plan year or is funded through a trust, regardless of participant count.”

Clear as mud to the average employer, right? WRONG! Let’s break it down.

​For many, the end of the year is a time to slow down, relax and reflect on the year behind us while setting resolutions for the year ahead. At Allied National, our employees are busy paying claims, providing agent support, closing new business and booking renewals. But we still have time to look back at what we accomplished in 2021 and share with our readers what’s ahead for Allied National in 2022. And be sure to take our quick survey at the end for a chance to win an Amazon gift card! 

Reference-based pricing (RBP) is touted as the economical alternative to Preferred Provider Organization (PPO) pricing and statistics bolster that claim.

RBP is a reimbursement methodology primarily used by self-funded employers. Instead of carriers negotiating a fee directly with a provider (usually through a PPO network), employers reimburse providers and facilities according to a reference point – such as a percentage above of Medicare rates. For instance, Allied National’s self-insured Funding Advantage Freedom Plans reimburse physicians at 125% of Medicare and facilities at 150%.

The question many people have is whether RBP really can save employers and employees a significant amount of money on group health plan premiums and member out-of-pocket costs.

The answer?

Article reposted with permission from BenefitsPro. Written by Kelly Smith, Senior Vice President at MVP Health Care.

​Brokers are experiencing an increase in demand for level-funded plans, which are an exciting offering providing predictability, funding diversity and innovation to their portfolio.

Although Preferred Provider Organizations (PPOs) have been a popular group health benefit plan feature since their introduction in the 1980s, their shine is starting to fade.
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PPOs are supposed to be a great way to lower health care costs. Providers agree to a discounted rate in exchange for insurers steering members to their services. The problem is that retail prices charged by hospitals and physicians continue to rise steeply. 

Ned Schaut, President at Agency Leverage, and host of Benefits Influencer - a podcast highlighting thought leaders in the Employee Benefits industry – recently interviewed Allied National Executive Vice President Gary Ashley. 

Mental health is an incredibly broad subject. When you hear someone talking about mental health, what do you think? It is not just about people who have multiple personalities or severe alcohol or drug additions.