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
- Walmart Health Virtual Care® – Virtual Urgent Care and Talk Therapy visits are available through Walmart Health Virtual Care6.
- Urgent Care: U.S. board-certified doctors and medical providers are available 24/7/365 to diagnose, treat, and prescribe medication (when medically necessary) for many minor illnesses and injuries via phone or online video visits.
- Talk Therapy: For members 18 years+. Licensed therapists can help with a wide range of mental and emotional health needs. Receive ongoing support, on your schedule, from the comfort of your home via phone and/or video visits in as little as 48 hours.
- Vori Health: A nationwide specialty medical practice delivering virtual-first muscle and joint pain solutions. With Vori Health, members get treatment from a specialty physician, physical therapist, and health coach who work together to manage all aspects of your muscle and joint pain care. This holistic model reduces unnecessary surgeries, lowers spend, and improves outcomes.
How it works
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 Price™ service and a provider accepting the payment made by the Core Value plan. Healthcare Bluebook is not included with Core Value Access.
6Walmart Health Virtual Care® offers medical consultations, behavioral health counseling, and talk therapy services via telehealth to patients nationwide. Services are provided in accordance with state law by physicians, nurse practitioners, and other licensed professionals. When medically necessary, Walmart Health Virtual Care providers may prescribe medication that patients can pick up at a local pharmacy. Virtual Urgent Care visits are not a replacement for a primary care physician or annual physical exam.
7For members 18 years+. Licensed therapists can help with a wide range of mental and emotional health needs. Receive ongoing support, on your schedule, from the comfort of your home via phone and/or video visits in as little as 48 hours.
8Pharmacy benefits and transplants rely on the use of network providers. Core Value Access offers network usage.
