• Self-Insured Medical Reimbursement Plan (SIMRP): Offered through Capstone Health Management, allowing employees to control medical coverage costs and receive premium reimbursements and incentives based on participation.
• Pre-tax Contributions: Contributions are made under an IRS Section 125 Cafeteria Plan with estimated tax savings based on current state and federal tax rates.
• Eligibility Criteria: Employees may qualify for full or partial premium reimbursement if specific criteria set by the employer and Capstone Health Management are met.
• Premium Deductions: If selected plan premiums exceed the employee’s Voluntary Benefit Reserve, the difference will be deducted from their net pay.
• IRS Section 213(d) Compliance: Voluntary Benefit Reserve funds must be used for IRS-approved medical expenses (Section 213(d)). Non-compliant usage will result in taxable income.
• Tax Estimate Advisory: Savings are estimates; employees are advised to consult a tax professional for accuracy.
• Wellness Compliance: Participation in the SIMRP may require completion of wellness activities, such as health risk assessments, and consultations with health coaches (nurse, dietitian, disease coach).
• Privacy Assurance: Medical information gathered is confidential and will not be shared with the employer.
• Fee Deduction: An administrative fee is deducted from any gross tax savings obtained through participation in the program.
• Section 125 Compliance: All Section 125 Cafeteria Plan rules apply. Plan changes are only allowed during open enrollment or in the event of a qualifying life event.
• Additional Compliance: Participation mandates adherence to HRA, HSA, and FSA regulations.
• Insurance Coverage Confirmation: Employees must confirm they have employer-sponsored medical insurance (not through the Exchange Marketplace).
• Record Retention: The information provided will be retained on file by Capstone Health Management for future reference.