SIMERP AT A GLANCE

The Self-Insured Medical Expense Reimbursement Program (SIMERP) recommended by ESG Advisors is designed to help qualifying employers enhance employee access to healthcare while creating payroll tax efficiencies and supporting workforce stability. The program operates within established regulatory frameworks and is designed to integrate with existing employer-sponsored healthcare coverage rather than replace it.

Employee Healthcare Access

• 24/7 access to medical care with NO deductible and NO copay required for covered services.

• Board-certified medical practitioners with substantial clinical experience.

• Primary care access with short appointment lead times.

• Immediate urgent care access when needed.

• Mental health support and counseling resources.

• Weight management and wellness support.

• Fitness monitoring and wellness tools.

• Access to more than 1,000 commonly prescribed medications—at NO cost.

• Eligible dependent family members receive the same access to services.

• Convenient virtual access often reduces delays associated with traditional provider scheduling.

• Works alongside existing health insurance coverage and can provide referrals to traditional providers when appropriate.

Employee Financial Advantages

• Reduced reliance on high deductibles, copays, HSAs, and FSAs for routine healthcare needs.

• Participants often experience meaningful reductions in annual out-of-pocket healthcare expenses. (Statistics accumulated by provider suggest $2,500 +/- annual reduction in medical expenses.)

• Program utilization has been associated with fewer emergency room visits among participating populations. (Statistics accumulated by provider suggest 36% reduction in ER visits.)

• The value of the healthcare benefits provided through the program can substantially exceed the employee's participation cost due to regulatory design.

• Program design results in increased take-home pay or a neutral financial impact for participating employees due to regulatory payroll design.

Participation & Eligibility

• Generally available to full-time W-2 employees working at least 30 hours per week.

• Independent contractors and 1099 workers do not qualify.

• To maximize the intended financial advantages, employee compensation generally should exceed approximately $25,000 annually, subject to individual circumstances.

• Employees are required to maintain qualifying employer-sponsored health coverage through their own employer or a spouse's employer.

• Employers implementing the program commonly experience strong employee participation and utilization rates. (Statistics accumulated by provider suggest 85-90% participation.)

Employer Advantages

• Minimal employer administration requirements.

• Professional implementation and enrollment support provided by the program administrator.

• Reduced employee absenteeism through easier access to healthcare.

• Improved workforce satisfaction and engagement.

• Reduction in medical insurance claims activity is typical.

• May help mitigate future healthcare and insurance cost increases.

• Can improve employee recruitment and retention.

• Direct payroll tax savings generated through program participation.

• Payroll tax savings offset small program cost, resulting in net bottom-line financial increase.

• Straightforward implementation process with ongoing support.