Association Health Plan
PHCS PPO + Reference-Based Pricing (RBP) Association Health Plan
Nationwide PPO access. Lower hospital costs. Predictable monthly premiums — powered by the PHCS MultiPlan network and an innovative Reference-Based Pricing approach for hospital services.
PHCS PPO + Reference-Based Pricing Association Health Plan
Nationwide Physician Access with Lower Hospital Costs
The PHCS PPO + Reference-Based Pricing (RBP) Association Health Plan provides employers, sole proprietors, and professionals with affordable nationwide health coverage by combining the PHCS MultiPlan physician and ancillary provider network with an innovative Reference-Based Pricing approach for hospital services.
By leveraging the purchasing power of more than 60,000 association members together with a cost-effective hospital reimbursement strategy, the plan delivers competitive premiums, comprehensive benefits, and a familiar PPO experience for employees.
Participating employers enjoy the simplicity of a traditional carrier health plan while benefiting from one of today's most efficient healthcare purchasing models.
Available nationwide for groups with 1 to 99 employees (subject to state eligibility guidelines).
Why choose the PHCS PPO + RBP Association Health Plan?
The plan combines thousands of employers into one professionally managed Association Health Plan representing more than 60,000 covered members. This larger membership base creates economies of scale that help produce competitive premiums, stable renewals, and comprehensive nationwide coverage.
Instead of relying on traditional hospital PPO contracts that often contain significant price variation, eligible hospital claims are generally reimbursed using a transparent benchmark based on a percentage of Medicare reimbursement — typically ranging from 120% to 140% of Medicare, depending on the service, provider, and plan design.
Since its inception, the Association has maintained average annual renewal increases in the single digits, helping employers better manage long-term healthcare costs.
A health plan that works like traditional insurance
From the employer's perspective, the PHCS PPO + RBP Association Health Plan functions much like a traditional fully insured health plan.
- Pay one fixed monthly premium
- Enroll eligible employees
- Receive member ID cards
- Employees access the nationwide PHCS physician network
- Claims are professionally administered
There is:
- No employer claims administration
- No employer responsibility for claim payments beyond the monthly premium
- No catastrophic claim exposure
- No surprise assessments
- No additional employer funding requirements
Everything is professionally administered by the Association and its third-party administrator.
Fixed premiums for 12 months
Every employer receives a 12-month premium guarantee beginning on the group's effective date. Whether coverage begins in January, April, or October, premiums remain fixed throughout the employer's plan year. At renewal, rates are reviewed through the Association's annual underwriting process.
PHCS physician network + RBP for hospitals
Employees receive nationwide access to physicians and ancillary providers through PHCS MultiPlan. Eligible hospital claims are reimbursed using Reference-Based Pricing benchmarked to Medicare — professionally administered with patient advocacy and provider support.
- Primary care physicians
- Specialists
- Urgent care centers
- Laboratories
- Imaging centers
- Outpatient providers
- Ancillary healthcare providers
- Nationwide pharmacy network
- Telemedicine
Who is eligible?
- Group Size
- 1–99 Employees
- Ideal Market
- 1–35 enrolled employees
Simple underwriting
Fewer than 10 enrolled employees
Health Questionnaire underwriting.
10 or more enrolled employees
May qualify for AI-powered census underwriting through Gradient, significantly reducing paperwork and accelerating approvals.
Why businesses choose PHCS + RBP
Plan options
Multiple deductible options, so employers can choose the balance of premium and out-of-pocket costs that best fits their workforce.
1500 Classic
Lower deductibles with predictable office visit copays for rich physician access.
2500 Classic
Balanced premium and out-of-pocket costs with copay-based physician benefits.
3500 Classic
Lower monthly premiums while retaining comprehensive PPO benefits.
5000 Classic
Traditional PPO experience with reduced monthly premiums.
7350 Value
The most affordable option — preventive care at 100% and coinsurance-based benefits.
5000 HSA
HSA-qualified high-deductible plan with pre-tax HSA contributions.
PHCS PPO + RBP plan comparison
Side-by-side comparison of medical benefits across all six plan designs.
| Benefit | 1500 Classic | 2500 Classic | 3500 Classic | 5000 Classic | 7350 Value | 5000 HSA |
|---|---|---|---|---|---|---|
| Individual Deductible | $1,500 | $2,500 | $3,500 | $5,000 | $7,350 | $5,000 |
| Family Deductible | $3,000 | $5,000 | $7,000 | $10,000 | $14,700 | $10,000 |
| Individual Out-of-Pocket Maximum | $7,350 | $7,350 | $7,350 | $7,350 | $7,350 | $6,550 |
| Family Out-of-Pocket Maximum | $14,700 | $14,700 | $14,700 | $14,700 | $14,700 | $13,100 |
| Preventive Care | 100% (Deductible Waived) | 100% (Deductible Waived) | 100% (Deductible Waived) | 100% (Deductible Waived) | 100% (Deductible Waived) | 100% (Deductible Waived) |
| Primary Care Visit | $30 Copay | $30 Copay | $45 Copay | $45 Copay | Plan Pays 80% After Deductible | Plan Pays 80% After Deductible |
| Specialist Visit | $60 Copay | $60 Copay | $90 Copay | $90 Copay | Plan Pays 80% After Deductible | Plan Pays 80% After Deductible |
| Chiropractic Care | $20 Copay | $20 Copay | $20 Copay | $20 Copay | $20 Copay | $20 Copay |
| Telemedicine | Fabric® – $0 Copay | Fabric® – $0 Copay | Fabric® – $0 Copay | Fabric® – $0 Copay | Fabric® – $0 Copay | Fabric® – $0 Copay |
| Urgent Care | $60 Copay | $60 Copay | $90 Copay | $90 Copay | $100 Copay | Plan Pays 80% After Deductible |
| Laboratory Services | 80% After Deductible | 80% After Deductible | 80% After Deductible | 80% After Deductible | 100% After Deductible | 80% After Deductible |
| Diagnostic Testing | 80% After Deductible | 80% After Deductible | 80% After Deductible | 80% After Deductible | 100% After Deductible | 80% After Deductible |
All plans include
- National PHCS MultiPlan Physician Network
- Reference-Based Pricing for Hospital Services
- Preventive Care Covered at 100%
- Telemedicine
- Prescription Drug Coverage
- Nationwide Urgent Care
- Emergency Services
- Hospital Coverage through RBP
- Digital Member ID Cards
- Online Member Portal
- Care Management Programs
- No Lifetime Maximum
- Available Nationwide
Available to groups with 1–99 employees nationwide (subject to eligibility).
Frequently asked questions
Apply Now
Start your application for the PHCS PPO + Reference-Based Pricing Association Health Plan below. Complete the secure form and a licensed advisor will follow up to finalize your enrollment.
Lower hospital costs. Nationwide physician access. Predictable premiums.
The PHCS PPO + Reference-Based Pricing Association Health Plan offers employers a smarter way to provide quality health benefits by combining the nationwide PHCS physician network with innovative hospital cost management.
- National PHCS MultiPlan Physician Network
- Reference-Based Pricing for Hospitals
- Fixed Premiums for 12 Months
- Groups from 1–99 Employees
- Available Nationwide*
- Fast Underwriting
- Multiple PPO Plan Options
Plan Disclosure: This is an association-sponsored health plan utilizing the PHCS PPO network and Reference-Based Pricing (RBP) for certain services. PHCS is a provider network and does not underwrite or insure the plan. RBP reimbursement may differ from a provider's billed charges, and members may be subject to provider balance billing depending on the plan, provider, service, and applicable law. Eligibility, benefits, rates, networks, and plan terms are subject to the official plan documents. In the event of any discrepancy, the official plan documents shall govern.