Reference Based Pricing
Affordable Healthcare Is Finally Here!
Insurers have done little to control the escalating cost of health insurance. To offset losses in fully insured profits, these companies grossly inflate the fixed cost and then share in any potential claim savings. The result is an ongoing escalation of health plan expenses for the employer and employees, which forces employers to reduce premiums through increased deductibles and erosion of benefits. The higher deductibles put access to healthcare out of the reach of many.
Are you tired of escalating costs and erosion of benefits? NP Benefits offer the right solution. We believe that it is time to stop the cycle of excess profits and escalating costs generated by large insurance companies.
Through our Reference Based Pricing (RBP) Plan, we offer cost-effective level-funded health plans designed to make access to care accessible. Unlike fully insured plans, our Reference Based Pricing Plan operates as Federally qualified ERISA plans that eliminate premium bloating created by State Premium Taxes, State Mandated Benefits, ACA Minimum Loss Ratios, and cost-shifting associated with many Exchange Plans.
How can this plan save you money?
Our program utilizes risk assessment and management tools to ensure the program is a good fit for the employer. These tools include:
interactive clinical oversight and management for both medical and pharmacy benefits
reimbursement based on providers' cost of care or an aggressive, national PPO network.
The results are reductions as much as 20% when compared to traditional PPO plans.
Frequently Asked Questions
What is the minimum and maximum group size for the program?
The program is targeted at employers with 75-200 full-time employees. Employers with more than 200 will be considered on a case by case basis.
What are the participation requirements?
The program requires a minimum of 51 enrolled FTE or 50% of eligible FTEs whichever is greater. The program will not accept employers with less than 51 enrolled.
Can fully insured employers join the SHI program?
Yes. We welcome all employers with 75-200 employees to request a quote.
How long does it take to get a quote?
The typical quote takes 7 business days to complete provided all required information is submitted. Delays providing information and data will result in slower proposal times.
What does this plan offer?
• Four health plan options
• 4-tier composite rates
• Turnkey level-funded health plan structure
• Pooling risk of like-minded employers
• Accountable Care for both provider and
• Pricing designed to remain level for 2-3 years
• Creation and management of
individual employer Benefit Trusts under IRC
• Risk Management and contracting/ oversight
of all service providers
• Reinsurance management
• Regulatory compliance and financial filings
ERISA level-funded plan
Guaranteed maximum cost (2 years)
Standardized Plan Designs
Pooling to leverage cost and services
Pooled reinsurance coverage
Referenced Based Reimbursement of claims (no PPO network)
Pharmacy Management targeting provider and patient engagement
24 Hour access to physicians (telephone/web)
Employee/Patient financial incentives