Reference-Based Pricing (RBP) Health Plans

Employers across the country are searching for sustainable ways to control rising healthcare costs while continuing to offer competitive employee benefits. Traditional PPO plans often come with unpredictable renewals, limited transparency, and escalating premiums year after year.

At Beckham Ellis Insurance Group, we help employers take a smarter approach to healthcare spending through Reference-Based Pricing (RBP) health plans. By using Medicare-based pricing strategies instead of traditional carrier network pricing, RBP plans can significantly reduce healthcare costs while still providing employees with quality care and strong support protections.

For many businesses, Reference-Based Pricing creates an opportunity to regain control over healthcare spending without compromising employee access to care.

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What Is Reference-Based Pricing (RBP)?

What Is Reference-Based Pricing (RBP)?

Reference-Based Pricing is a healthcare funding strategy that bases medical claim payments on a benchmark price—most commonly a percentage above Medicare reimbursement rates—rather than relying on inflated hospital and provider network contracts.

Instead of paying the highly variable prices negotiated through traditional PPO networks, RBP plans establish fair and transparent reimbursement levels for medical services.

This approach often allows employers to:

Reduce overall healthcare plan costs
Improve claims transparency
Gain greater visibility into healthcare spending
Create more predictable long-term renewals
Maintain flexibility in plan design

At Beckham Ellis Insurance Group, our Reference-Based Pricing solutions are available in both fully insured and level-funded structures and include balance billing protections to help support employees throughout the claims process.

How Reference-Based Pricing Works

Traditional PPO plans depend on provider networks that negotiate pricing behind the scenes. Those negotiated rates can vary dramatically between providers and healthcare systems, often leading to higher premiums for employers.

Reference-Based Pricing changes the model.

Under an RBP plan:

Medical services are priced according to a benchmark, typically Medicare plus a fixed percentage.
Claims are reviewed for fair and reasonable pricing.
Employers and employees gain greater transparency into actual healthcare costs.
Advocacy and balance billing support help employees navigate provider questions or disputes.

Because reimbursement rates are tied to a transparent benchmark, employers often experience meaningful cost reductions compared to conventional PPO plans.

Key Benefits of Reference-Based Pricing for Employers

Significant Cost Savings

One of the biggest reasons employers explore RBP health plans is the potential for substantial premium savings. Businesses commonly see healthcare cost reductions of 15–20% compared to similar traditional PPO plans.

For organizations facing repeated double-digit renewals, these savings can create long-term financial stability and budget predictability.

Greater Claims Transparency

Traditional group health insurance plans often provide limited insight into how healthcare dollars are spent. Reference-Based Pricing offers clearer visibility into claims data and healthcare utilization patterns.

This transparency allows employers to make more informed benefit decisions and better understand cost drivers within their plan.

Flexible Plan Structures

Reference-Based Pricing can be implemented through:

Fully insured health plans
Level-funded health plans
Customized employer-sponsored benefit strategies

This flexibility allows employers to choose a structure aligned with their financial goals, workforce size, and risk tolerance.

Long-Term Healthcare Cost Control

Instead of being tied to continually increasing hospital network contracts, RBP plans use more consistent pricing methodologies. This often helps employers stabilize long-term healthcare spending and avoid extreme annual renewal increases.

Employee Protection Matters: Balance Billing Support

A common concern employers have about Reference-Based Pricing involves balance billing. Balance billing occurs when a healthcare provider attempts to bill a patient for charges beyond what the plan reimburses.

At Beckham Ellis Insurance Group, employee advocacy is a critical component of every RBP strategy.

Our plans include balance billing protections and support services designed to help employees:

Navigate provider questions
Resolve billing disputes
Understand their benefits
Access claims advocacy resources

This support helps create a smoother employee experience while protecting both employers and employees from unnecessary stress.

Is Reference-Based Pricing Right for Your Business?

Reference-Based Pricing can be an excellent fit for employers that:

Are frustrated by large annual premium increases
Want more transparency in healthcare spending
Have at least 10 enrolled employees
Are seeking alternatives to traditional PPO plans
Want greater long-term control over benefit costs

While RBP may not be the ideal solution for every organization, many employers find it to be a powerful strategy for improving plan performance while maintaining competitive employee benefits.

The best approach depends on your workforce demographics, financial goals, and overall benefits strategy.

Explore a Smarter Approach to Healthcare Costs

Healthcare expenses continue to rise, but employers have more options than ever before.

Reference-Based Pricing offers an innovative alternative for businesses seeking transparency, cost control, and long-term plan sustainability. With the right strategy and support partner, employers can reduce unnecessary healthcare spending while continuing to provide valuable employee benefits.

Contact Beckham Ellis Insurance Group to learn whether a Reference-Based Pricing plan could help your business lower healthcare costs and improve benefit performance.

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