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Expanding Benefits, Reducing Taxes - Preventative Care Program
SIMERP - Self Insured Medical Expense Reimbursement Program
(SIMERP) is an employer-sponsored workplace program that allows employees to upgrade their benefits while reducing both the employer's & employee's healthcare costs & expenditures. SIMERP reduces business payroll by up to $1120 per W2 employee.
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Preventative care management program is a participatory program.
The 11 participatory model was developed under the Affordable Care Act (ACA)
Federal Register, Vol. 78, June 3, 2013, pg. 33,161
This model is an integrated 105 plan requiring at least one activity per year.
42 U.S. Code 300gg-4 (j)(3)(c)
Compliance Tax Codes
Medical Services Are a Key Component
The program is always paired with an ACA-approved medical plan to make an integrated 10 5 plan.
Post-Tax Program Reimbursements
Any reimbursements or payments for medical care (as defined under 213(d) provided by the program is excluded from the employee's gross income under 105(b). Also, Code 1.105-II(i) & 104(a)(3). Reimbursement guidelines are spelled out in the SIMERP plan documents provided by EHP.
Plans Designed For Compliance
The Plan is a Self-Insured Medical Reimbursement Plan (SIMERP) and was purposely created, thoroughly researched, and found compliant with IRC 213(d), 106(a), 105(b), 1,105-II(i), and 104(a) (3) codes, and all applicable IRS memos, ERISA regulations, HIPAA, and the ADA.
Deduction Of The Plan Is Pre-Tax Eligible
The deduction of the plan cost from an employee's gross wages is addressed by IRC Codes 106(a). The Office of Chief Counsel Internal Revenue Service Memorandum (Number: 01703013, Dated: 1/20/2017) states: "The value of coverage by an employer-provided wellness program that provides medical care (as defined under 213(d) is generally excluded from an employee's gross income under 106(a). The pre-taxing of this deduction, made possible under a Self-Insured Medical Reimbursement Plan and a Cafeteria Plan (125), creates the reduction of taxable income, generating savings for the employee and the employer.
Reimbursement Allowances
Allowable pre-taxing and reimbursement amount based on the Health and Human Services report (July 2016) and national average cost total for the monthly value of benefits. Amounts allowed are also based upon fair market value of benefits provided through the Program for preventative services that are 213(d) compliant. All regulations and guidelines of the EHP Self-Insured Medical Reimbursement Plan (SIMERP) regulations and guidelines are used for benefits and paired with a Section 125 Cafeteria Plan. SIMERP must be paired with medical insurance for an integrated 105 plan.
Wellness
- IRCs106(a) - ERISA
- IRCs213(d) - ADA
- IRCs105(b) - HIPAA
- IRC 5125
- IRCS105.11
Pre-tax
- IRCS 213(d)
- IRCS106(a)
- IRC s125
Medical
- IRCS213(d) ACA
Post-tax
- IRCS 213(d)
- IRCS 105(b)
- 1.105.11(i)
- 104.(A)(3)
- 1.105.11(k)(1)
- 1.105.11(k)(2)
Program Eligibility
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EHP Roadmap
1 - Discovery Call
2 - Census Collection
3 - Proposal Call
4 - Onboarding
5 - Enrollment
6 - Active Case
Three Essential Elements
1 - Wellness Plan Documents
2 - Section 125 Cafeteria Plan
3 - SIMERP 105-11 Documents
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