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.
Access to quality care nationwide
Through Reference-Based Pricing
Designed for employers, sole proprietors and professionals
PHCS PPO + Reference-Based Pricing Association Health Plan
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).
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.
From the employer's perspective, the PHCS PPO + RBP Association Health Plan functions much like a traditional fully insured health plan.
Everything is professionally administered by the Association and its third-party administrator.
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.
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.
Health Questionnaire underwriting.
May qualify for AI-powered census underwriting through Gradient, significantly reducing paperwork and accelerating approvals.
Multiple deductible options, so employers can choose the balance of premium and out-of-pocket costs that best fits their workforce.
Lower deductibles with predictable office visit copays for rich physician access.
Balanced premium and out-of-pocket costs with copay-based physician benefits.
Lower monthly premiums while retaining comprehensive PPO benefits.
Traditional PPO experience with reduced monthly premiums.
The most affordable option — preventive care at 100% and coinsurance-based benefits.
HSA-qualified high-deductible plan with pre-tax HSA contributions.
Side-by-side comparison of medical benefits across all six plan designs.
$1,500
Individual Deductible
$3,000
Family Deductible
Benefit
$2,500
Individual Deductible
$5,000
Family Deductible
Benefit
$3,500
Individual Deductible
$7,000
Family Deductible
Benefit
$5,000
Individual Deductible
$10,000
Family Deductible
Benefit
$7,350
Individual Deductible
$14,700
Family Deductible
Benefit
$5,000
Individual Deductible
$10,000
Family Deductible
Benefit
Available to groups with 1–99 employees nationwide (subject to eligibility).
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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.
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.
