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Core Value reference-based pricing plan

Simple, secure savings on employee benefits without compromising quality.

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About Core Value reference-based pricing plan

Looking for group medical coverage for your small- or mid-sized business? Core Value combines savings with quality care.

Core Value is a reference-based pricing (RBP) plan, meaning it determines benefits based on a multiple of the Medicare reimbursement rate1 (such as 130%), regardless of the billed amount. The rate at which Medicare reimburses health care providers for most procedures and services is set at 75% to 85% of the cost of providing those services.2 These rates are typically less than the amount that a health insurance company may pay.

RBP is an economical approach that allows small- and mid-sized businesses to offer more competitive health benefits by better controlling costs. Reference-based pricing can cut health care costs by 20%3, which saves money for both you and your employees. The following Core Value reference-based pricing options are also available:

  • Core Value Flex – Allows you the added flexibility of switching to a PPO network mid-year, without a change in your monthly payment.4
  • Core Value Access – Combines the savings of an RBP plan with access to a physician network.

And the convenience and savings don't stop there! These value-added features are included with Core Value:

  • Healthcare Bluebook™ – Prices for the same procedure can vary up to 500%, depending on the providers your members choose for care. Healthcare Bluebook is a cost and quality navigation tool that makes it easy for members to shop around for low-cost, high-quality providers, which means both you and your employees save!5
  • Teladoc® – With this cost-saving and convenient telemedicine service, your group members can receive treatment for many common medical conditions anytime and anywhere through the web, telephone or mobile app.

How it works

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Features & benefits

  • Savings – Core Value's rates are often lower than self-funded plans with a network, and employers with a level-funded plan may receive money back from their claims account in years when claims are lower than anticipated.6
  • Simplicity – There is no network, so your members can see any health care provider they choose.7
  • Hands-off administration – Customer service, claims, and other administrative services are handled by our trusted third-party administrator, Allied Benefit Systems, LLC. That means you can focus your attention on growing your business!
  • Stop-loss insurance – When your group has higher-than-expected claims, stop-loss insurance kicks in to protect your finances.
  • Dedicated support – The Member Advocacy Program responds to member questions and concerns. They can help members find a provider, understand their Explanation of Benefits, or resolve billing discrepancies.

More resources

Disclaimers and notes

1Or another derived equivalent.

2How Does Medicare Determine Reimbursement Rates? | Medicare & Medicare Advantage Info, Help and Enrollment

3Employers Cut Health Plan Costs with Reference-Based Pricing (shrm.org)

4As long as there are no changes to the group's benefits or enrollment.

5There is no correlation between the Healthcare Bluebook Fair PriceTM service and a provider accepting the payment made by the Core Value plan. Healthcare Bluebook is not included with Core Value Access.

6Refund applies to level-funded plans only. Refund is subject to any applicable Terminal Liability Coverage fee.

7Pharmacy benefits and transplants rely on the use of network providers. Core Value Access offers network usage.

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