Updated September 2024
Capstone Health Management offers the ability to control your cost of medical coverage and extend the allowance to you through your employer’s Self-Insured Medical Reimbursement Plan (SIMRP). You can receive reimbursement for your contribution by participating in the SIMRP program and receive qualified incentives based on utilization.
Pre-tax contributions are made under an IRS Section 125 Cafeteria Plan. Standard tax savings are based on current state and federal income tax rates.
If you meet certain criteria established by your employer and Capstone Health Management under your employer’s SIMRP program, your employer may reimburse all or a portion of the premium you have contributed.
Additional Income
I understand that IRS Code Section 213(d) lists acceptable medical expenses if I use my voluntary benefit reserve for an expense other than a Section 213(d) expense, that portion of the voluntary benefit reserve will be reported to the IRS as taxable income.
I understand the savings and estimates are not exact and I should consult an accountant or tax expert for more exact estimates. I further understand and acknowledge the Plan Administrator has entered into a contractual arrangement with my employer and me.
I understand that if the total premium of the selected supplemental plans exceeds my Voluntary Benefit Reserve, the difference will be deducted from my current net pay. By accepting these terms and conditions, I understand that participation in the SIMRP program requires me to fulfill my wellness utilization obligations as directed. This may include completing, among other things, health risk assessments, talking with a designated nurse/disease/dietitian coach, in addition to utilizing other services. All medical information received is for my use only and will not be disclosed to my employer.
I further understand and agree to pay Capstone Health Management an administrative fee for the Capstone Health Management Program that will be deducted from any gross tax savings that I may receive from participating in this program.
I understand that failure to satisfy my utilization requirements may lead to removal from the SIMRP Program and reimbursement of any premiums paid under the SIMRP may become taxable. I understand that all Section 125 rules apply, and I cannot stop this plan unless there is a qualifying event or open enrollment each year. Furthermore, participation in the SIMRP program requires compliance with all HRA, HSA, and FSA regulations.
I also affirm by agreeing to these terms and conditions, that I have coverage for medical insurance through an employer-sponsored plan and affirm that my coverage is not through the Exchange Marketplace (healthcare.gov). I further understand the information above will be kept on file for Capstone Health Management, Inc's records and mine