RBP Benefit 7: Avoid Government Penalties

RBP Benefit 7: FairPrice help you Avoid Government Penalties


Reference-based pricing offers many benefits over traditional health insurance options. Perhaps most importantly, though, reference-based pricing health coverage plans can be designed to meet current Affordable Care Act requirements. Additionally, they’ll likely continue to be compatible with any future changes in the nation’s healthcare laws. Both of these are important considerations for any company considering a reference-based pricing plan, and any human resources directors leading their companies towards this type of health coverage.

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(This seventh and final installment completes a reference-based pricing series that’s designed for human resources professionals.)


FairPrice Provides Sufficient Access to Coverage


The Affordable Care Act requires health coverage plans to provide employees with sufficient access to coverage. In other words, employers aren’t able to claim they offer employees health coverage but only provide access to just a few potential providers. Health coverage plans must actually give employees the ability to obtain medical care.


Some employers have delayed switching from a traditional health insurance policy to a reference-based pricing plan because they’re afraid they won’t be able to provide sufficient access to care. This is an unfounded fear, though.


Reference-based pricing plans can be set up to give employees plenty of access to coverage — in some cases, they provide even more access than traditional health insurance policies do. Moreover, third-party agents can take care of finding providers who will participate in a plan, so employers don’t have to worry about building a network themselves.


FairPrice Limits Employees’ Out-of-Pocket Expenses


The Affordable Care Act also requires health coverage plans to limit employees’ out-of-pocket expenses.  

This also is possible to do with a reference-based pricing plan. For example, contracts can be used to prevent employees from being balance-billed. Additionally, caps can be placed on how much employees can expect to spend on medical providers who have contracted using a reference based transparent price.  (The Affordable Care Act excludes out-of-network expenses from out-of-pocket limits.)  In this way, should an employee choose a provider not contracted the employee can expect to pay more.


FairPrice + RBP Will Continue to Meet Legal Standards


In the current political climate, it’s impossible to know what future health coverage requirements employers will be required to meet. If any changes are made to the healthcare laws, though, reference-based pricing plans will adjust and provide additional clarity while meeting all legal standards. These plans are becoming more and more popular, and many industry experts believe they could have a positive effect on the industry. Therefore, lawmakers will probably continue to take RBP plans into account when formulating any new laws.


Meeting any legal requirements is, naturally, a major concern for all companies. It’s also, therefore, a concern for human resource professionals who help their employers find health coverage plans.

To find out how FairPrice’s reference-based pricing models meet current legal requirements and may be adapted in the future, contact us to speak with a representative.