Authority 01Code
IRC §105(b)
Excludes employer-provided preventive care benefits from employee gross income.
[ Program ]Preventive Care Benefits Plan
A federally compliant SIMRP, in full.
The Preventive Care Benefits Program (PCBP) is a Self Insured Medical Reimbursement Program (SIMRP) that delivers comprehensive preventive care to full-time W2 employees with no out-of-pocket expenses for employers or employees. Structured under IRC §105(b), IRC §125, and ACA participatory wellness — average savings of $1119–$1186 per employee per year.
01 · Annual Savings
$1,119+
Per W2 employee · employer FICA
02 · Employer Cost
$0
No out-of-pocket expenses
03 · Prescriptions
1,000+
Preventive care Rx covered
04 · Life Insurance
$150K
Group term · per enrolled
05 · Implementation
2–3 wk
Enrollment to active
[ 02 ]The mechanism
How the program works.
The PCBP utilizes a Section 125 cafeteria plan to establish a pre-tax payroll deduction of $1,220 per month. This deduction funds the preventive care benefits while simultaneously reducing FICA-taxable payroll. At the combined employer FICA rate of 7.65% (6.2% Social Security + 1.45% Medicare), each participating employee generates $93.33/month in employer tax savings.
Employees' net take-home pay remains virtually unchanged because the pre-tax deduction is offset by reduced income tax and FICA withholding. The result: employers save over $1,100 per employee per year while employees receive thousands of dollars in preventive care benefits with no out-of-pocket expenses.
According to the Kaiser Family Foundation, the average annual premium for employer-sponsored family health coverage reached $23,968 in 2024. The PCBP provides comparable preventive care coverage with no out-of-pocket expenses — while generating employer FICA tax savings instead of costs.
[ 03 ]Legal foundation
Built on established code.
Authority 02Code
IRC §125
Authorizes the pre-tax cafeteria plan structure that funds the program.
Authority 03Code
42 U.S.C. §300gg-4(j)(3)(C)
Classifies the program as a compliant participatory wellness program.
Authority 04Code
IRS CCA 202323006
IRS Chief Counsel Advisory confirming compliant SIMRP structures.
[ 01 ]Coverage
Comprehensive care, delivered at the payroll level.
Every enrolled employee receives this full suite of preventive care benefits with no out-of-pocket expenses for employer or employee.
No. 01Included
Rx
Preventive Care Prescriptions
Access to over 1,000 preventive care prescription medications with $0 out-of-pocket expenses, covering cholesterol, blood pressure, diabetes prevention, mental health, and more.
No. 02Included
Tm
Telemedicine
Unlimited 24/7 telemedicine consultations with licensed physicians via phone or video with no out-of-pocket expense.
No. 03Included
Mh
Mental Health Counseling
Access to professional mental health counseling and behavioral health support services.
No. 04Included
Dv
Dental & Vision Discounts
Discounted dental and vision care services through a nationwide network of providers.
No. 05Included
Li
$150,000 Life Insurance
Group term life insurance coverage of $150,000 with no out-of-pocket expense to the employee, with beneficiary designation.
No. 06Included
Ad
$150,000 AD&D Coverage
Accidental death and dismemberment coverage of $150,000, providing additional financial protection.
No. 07Included
Hb
Hospital Bill Reduction
Professional medical bill negotiation services that can reduce hospital bills by up to 35%.
No. 08Included
Ha
Health Advocacy
Personal health advocacy services to help navigate the healthcare system, find providers, and coordinate care.
No. 09Included
Mb
Medical Bill Negotiation
Expert negotiators review medical bills for errors and negotiate with providers to reduce out-of-pocket costs.
No. 10Included
Id
Identity Theft Protection
Comprehensive identity theft monitoring and protection services for enrolled employees.
[ End ]
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