Preventative Care Benefits Program
The transparent, compliance-backed wellness plan that benefits your bottom line and your workforce simultaneously.
Preventative care benefits program
SIMRP is an employer-sponsored preventive health and wellness program designed to complement, not replace, existing major medical coverage. The program gives employees and their households access to a broad suite of §213(d)-compliant medical and preventive services with no out-of-pocket cost, while helping employers proactively manage healthcare utilization and payroll tax exposure.
For employee populations without traditional major medical coverage, the program may also be implemented as a standalone preventive benefit, subject to eligibility and plan design.
Financial Impact
From a financial perspective, the program is structured to create savings without reducing employee take-home pay. Employers typically see an average net FICA savings of ~$1,186 per eligible employee annually. Employees receive meaningful preventive care benefits without a reduction in net pay, while gaining easier access to care that can help reduce downstream claims and absenteeism.
While many providers structure their services with hidden or recurring administrative fees, we pride ourselves on a transparent, no-fee administrative model. This approach ensures you are not losing margin to overhead, resulting in a significantly higher net return compared to industry standards.
Program Mechanics & Compliance Framework
The program is built on a well-established statutory framework and administered in accordance with its governing plan documents:
Actuarial Valuation
The pre-tax election amount is based on the actuarial fair market value of the medical benefits made available for the plan year, supported by an independent Deloitte actuarial analysis, rather than a per-visit or claims-paid model.
Payroll Mechanics
Employee participation is elected through a Section 125 cafeteria plan
Medical Reimbursement
Qualifying medical benefits are provided through a self-insured medical reimbursement plan operating under IRC §105(b) for §213(d) medical care.
Tax Integrity
The program is administered so that reimbursements remain tied to meaningful medical care provided during the plan year. If an employee does not use qualifying medical benefits during the applicable period, the corresponding reimbursement is treated as taxable income, consistent with IRS guidance and plan terms (Clarification on the Program)
Included Benefits (Employees & Households)
- Unlimited Virtual Urgent Care and Primary Care
- Mental Health and Teletherapy Services
- Weight, Health, and Metabolic Support
- Prescription Access and Preventive Diagnostics
- Preventive Biometrics and Wellness Assessments
- Additional Support Services, Including Financial and Legal Guidance Resources
Benefits Subject to Eligibility Criteria
MEC (Minimum Essential Coverage)
- 3 in-person primary care visits per year at no net out-of-pocket cost
- 3,500+ generic medications covered at no net out-of-pocket cost
Group Whole Life Insurance Policy
- Up to $150,000 Policy
- Cash accrual after year 2, earning 4-7% interest