Reference-Based Pricing (RBP)

Plan Designs

Benefit Solutions

Partner with the experts at 90 Degree Benefits

90 Degree Benefits guides employers down their path for success by creating and
administering self-funded benefit plans that meet an employer’s specific needs.
Our offerings range from traditional self-funded solutions to reference-based, level-funded plan
options and much more. Each plan is built to address the specific savings and coverage
needs of an employer, helping organizations go further with their health plan than ever
before.

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A full suite of services, protecting you from the ever
changing healthcare landscape.

Self-Funded Plans

Reference-Based Pricing

Level Funding

Minimum Essential Coverage

Telemedicine

Integrated Wellness

Member, Employer and Provider protals

Flexible Spending Account

Pharmacy Management Solutions

Transparency and Analytics

Utilization and Disease Management

Consumer Driven Health Plans

COBRA/HIPAA

Consolidated Billing

Vountary Products

Association Health Plans

With 90 Degree Benefits, your health benefits plan will:

What is Reference Based Pricing?

Reference-Based Pricing (RBP) is a highly effective, widely used cost containment strategy, for establishing an optimal reimbursement for
medical services. The current medical services reimbursement system uses a discount off some negotiated dollar amount agreed to by
the provider of medical services and a PPO or other organized network of providers, typically administered by a fully-insured provider.

A way for consumers to combat this highly flawed pricing model and to reduce the increasing cost of healthcare is Reference Based
Pricing. Reference Based Pricing establishes a maximum amount that an employer plan sponsor will pay providers for certain, specified
medical or prescription services. It is not uncommon for medical services to have drastic cost variations between providers with no
discernible differentiation in quality.

How it works?

Reference Based Pricing reimbursement rates are established as a multiple of what Medicare pays based on the Medicare Fee
Schedule. A traditional PPO network marks up healthcare services just so they can be marked down! Reference Based Pricing is a more
transparent and fair pricing system. An employer can see significant savings over a PPO plan while the provider is still receives more than
they would normally receive from Medicare.

What are the benefits?

COST SAVINGS – Both employers and employees can save significantly with Reference Based Pricing
strategies. By basing reimbursements off actual costs of facility services, payments with an RBP plan
verses a traditional PPO plan, are consistently lower, often times as much as half the cost.

Transparency – Both employers and employees can save significantly with Reference Based Pricing
strategies. By basing reimbursements off actual costs of facility services, payments with an RBP plan
verses a traditional PPO plan, are consistently lower, often times as much as half the cost.

Patient Support – One concern with Reference-based pricing plans is the potential for balance
billing, putting members’ credit and finances at risk. Balance billing can occur when members are billed
the difference between what the provider typically charges and the allowed amount under the plan.
Providers can also deny care, especially if the number of patients using RBP pricing is high. With 90
Degree Benefits, we work with providers to establish

Seven Reference-Based Facts To Know

Seven Reference-Based Facts To Know

1 You can establish the multiples of the Medicare fee schedule your health plan will pay.

2 A good Reference Based Pricing (RBP) administrator will contact doctors and other medical service providers utilized by your plan participants at plan inception. Coverage, coding values, eligibility and verification that your plan participant’s new plan is noted in the medical provider’s computer.

3 RBP balance billing problems occur with about 2% of all claims using a good RBP administrator. This is about the same percentage as a PPO plan with hospital-based physicians: anesthesiologists, radiologists, pathologists and emergency department doctors who are not in the PPO network.

4 RBP repricing vendors provide legal advice and assume health plan fiduciar responsibilities on problematic claims.

5 Health plan has flexibility to incent utilization of high-quality, low-cost providers. When needed, health plan can negotiate unique payment arrangement with a specific medical provider.

6 RBP requires more time and labor by HR department and administrator. Because employees must be educated on plan usage for the best results, some benefits advisors will advocate for the status quo to avoid the extra work. However, the value to the company and employees far outweighs the extra work.

7 Some medical providers may demand payment at the point of service. Alternate providers and one-time payments can be applied to mitigate disruption.

The Decision Tree

The Decision Tree can help employers define the pros and cons of whether or not to implement a
reference-based payment methodology. Assign a number to the branches that are most important
to your company and add up the total.

Do your Rewards outweigh the Risks?

90 Degree Benefits is an expert in RBP administration — contact us today to design a plan that works
for you and your employees.

Self-Funded Plans for Every Employer

Self-funded health plans give employers the freedom to create a benefit plan that is designed to save money while meeting the needs of their business and employee population. From traditional self-funded plans to level funded and beyond, self-funding with 90 Degree Benefits Benefits allows employers to take their business in the right direction through crafting the right health plan for their needs.

Self-Funded

With a traditional self-funded plan, employers of all sizes gain the flexibility to customize and adjust benefit plans as organizational needs change. This in turn improves cash flow and overall ease of administration by centralizing services through a TPA and only paying for actual claims, not projected costs.

Level Funded

Level Funding allows employers to enjoy the financial consistency of a fully-insured plan while still reaping some of the savings benefits of a self-funded plan. Employers pay a set monthly fee for claims and administration but instead of losing any savings at the end of the plan year, unused claims dollars are saved for the following year or given back to the employer.

Minimum Essential Coverage (MEC)

While health care reform continues to change, 90 Degree Benefits offers plans that comply with the minimum benefit requirements of the ACA, giving employers peace-of-mind that their benefit offering remains compliant in all states.

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Consumer Driven Health Plans

Consumer-driven health plans (CDHP) are plans that allow members to use medical payment accounts to pay routine healthcare expenses directly. Employers protect their employees from catastrophic medical expenses by pairing these accounts with high-deductible health plan designs, costing the employer less and allowing the employee to pay for medical claims using their prefunded spending account. 90 Degree Benefits offers a number of CDHP types for employers to choose from.

Health Savings Account (HSA)

An HSA allows plan members to pay for employer-provided health coverage and other insurance premiums with tax-free dollars. Both the employer and the employee can make contributions, depending on plan design. HSAs also remain with the employee even if they change jobs or leave the current health plan and can be used for any qualified medical expenses.

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Flexible Spending Account (FSA)

Both employers and employees can contribute to an FSA, tax-free, through regular payroll deductions and employees can be reimbursed directly from their account for qualified healthcare services.

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Healthcare Reimbursement Account (HRA)

Like an FSA, this account reimburses members for medical, dental and vision expenses that are not immediately covered by insurance. Employees do not have to pay taxes on money received from an HRA, however, the employer is the sole contributor and controls both what medical expenses are covered and when the account funds can be used.

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Dependent Care Reimbursement Account

This account reimburses members for daycare expenses for eligible children and adults. Through regular payroll deductions, members set aside a portion of each paycheck to pay for adult and child daycare centers, preschool and before or after school care on a tax-free basis.

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Telemedicine

An increasing number of employers are incorporating virtual care solutions into their health plan design in order to reduce healthcare claims, increase efficiencies and provide timely, quality care.

Convenience and Care When You Need It

Telemedicine, empowering employers to provide solutions that connect employees to the care they need, exactly when and where they need it.

Most comprehensive solution

The 90 Degree Benefits telemedicine offering addresses a broad spectrum of virtual care services from non-urgent needs like the flu and bronchitis to behavioral health and more complex medical conditions.

Unmatched clinical quality

Our telemedicine solution is NCQA-certified, has a 92% first-call resolution rate, and provides access to 50,000+ world-renown doctors.

Valuable cost savings

Studies show that 27% of Emergency Room visits could be replaced with telemedicine.1 Telemedicine allows employers to control healthcare costs while improving outcomes by providing timely access to quality care.

1NATIONAL CENTER FOR BIOTECHNOLOGY INFORMATION

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Telemedicine allows employees to access care in the moments they need it most, whether at home, at work or on the go.