Yes. The Plus is a qualified Section 125 plan set up as a self-funded employer-sponsored plan that is 100% funded by employees through a pre-tax payroll deduction. The amount deducted represents the maximum claims for the policy year. The third-party administrator (TPA) holds the monies in a custodial account and pays claims as they incur in accordance to the plan document and the schedule of benefits. The definition of a claim is defined as claims made to providers, facilities, pharmacies, or employees.

Claims to employees result when an applicable CPT code is triggered with a corresponding explanation of benefits (EOB). Examples of these claims include preventive examinations, bio-metric screens, health risk assessments, and chronic medication fulfillment. Claims made to employees are neither taxable nor considered ordinary income. The amount of premium charged to employees is actuarially set to cover the claim risk on the plan while meeting a desired medical loss ratio (MLR). At the end of the plan year and the runout period, any potential surplus left in the claim account is considered a plan asset to the employer.

Yes, and every month you wait, you’re losing out on potential FICA savings per employee!

The PLUS is funded by the tax savings created, generating a net savings! There are NO OUT of POCKET COSTS for employer or employee.

If an employee’s primary health plan is ACA compliant, it will also cover preventive services. One of our many goals with the PLUS is to drive healthcare utilization away from an employee’s primary health plan. We want employees to get better and faster care, for less money! By helping employees utilize their healthcare benefits more effectively and efficiently, we will accomplish lower costs for healthcare together. Employees that are not on the company health plan can still participate.

Think about this for a moment: the more employees use their primary health plan, the higher the claims will be on that plan. That has a direct correlation to how high premiums are. If we spread the cost of healthcare to other coverage and benefits, we can drive the cost of an employee’s healthcare down, and the employees are taking better advantage of their benefits! With the PLUS, it sheds the utilization away from your primary plan.

The PLUS meets the definition of an MEC for the individual mandate, but may not be sufficient from an employer’s perspective. We suggest you call us to discuss employer MEC options.

The PLUS covers a long list of generic and name-brand prescriptions at 100% (see the formulary list.) The plan will also cover prescriptions not on the list at a significant discount. In addition, the Stayhealthy Rx Card will assist in finding you the lowest prices on a range of prescription and over-the-counter medications.

An employee will note additional line items on their paycheck because of the employee’s participation in the PLUS These line items reflect a pre-tax premium contribution to the PLUS a post-tax premium for a PLUS type benefit. What you want to compare is what your paycheck is without participating in the PLUS versus adding the PLUS to your benefits package. Our plan design puts more money into your pocket and, in every employee’s case, increases their net take-home pay every month.

Your privacy is one of our primary focuses. We are passionate about keeping your personal information safe and secure. We are fully HIPAA compliant.

Every month, employees will receive notifications (messages and reminders) and emails providing them with important information about their plan benefits and information intended to be used to help improve their health.

The PLUS is a voluntary plan, and as such, an employee is not required to participate. If an employee chooses not to participate, they will not be able to join the plan until the next year’s enrollment.

For employees who choose to participate but forget, we allow assessments to be completed anytime throughout the plan year quarter plus an additional (30) days grace period. However, suppose an employee misses a month of questions. In that case, their HR department may be notified, and communication will go out to remind that employee to participate.

The PLUS Preventive Care benefits cover the services required to be covered under ACA guidelines for the employee.

Because the PLUS is set up through a section 125 Cafeteria Plan, the rules and regulations of IRS Sections 125 apply to our plan. Unless an employee experiences a Qualifying Life Event, an employee who enrolls in the PLUS not be eligible to make changes until the end of the plan year.