What's Included
Benefits people actually use.
No change to take-home pay.
Employees often assume "no cost to you" means "not worth much." It's the opposite here. This is what's actually in the program — and what it pays when someone needs it.
In plain English
What this program actually is
A Section 125 cafeteria plan, paired with a self-insured medical expense reimbursement plan and a preventive care management program. Employees get a package of health and financial benefits. Their take-home pay doesn't change. The employer's taxable payroll drops — and so does their FICA bill.
Show me the IRS code it operates under
The program is built on IRC §125 (cafeteria plans), §105(b) and Treas. Reg. 1.105-11 (self-insured medical reimbursement plans), §106(a) (employer-provided coverage excluded from gross income), §213(d) (definition of medical care), and §104(a)(3) (exclusion of certain benefit payments).
The wellness component is a participatory program under the framework described in the Federal Register, Vol. 78 (June 3, 2013), p. 33,161, and 42 U.S.C. §300gg-4(j)(3)(c). The plan is designed to meet ERISA, HIPAA, and ADA requirements, and it must be paired with an ACA-compliant medical plan to form an integrated 105 plan.
The benefits
What every participating employee receives
The care platform is included with every membership. The insurance benefits alongside it depend on the plan design selected for your group and on the issuing carrier — amounts below are typical values, not a quote.
Virtual Care Platform
Urgent care, primary care, mental health, pharmacy and weight health — delivered through a member portal and app. Primary care by phone or video carries a $0 copay with unlimited visits. Prescriptions, laboratory work and treatment are priced separately. Employees can add up to six dependents.
$0 copay · $0 deductible · nationwide
Short-Term Disability
State disability typically replaces about 55% of income. This closes the gap toward roughly 72% — the maximum generally allowed — for off-the-job injury or illness.
About $600/mo in additional benefit
Critical Illness with Cancer
A lump sum paid immediately on diagnosis of internal cancer, heart attack, stroke, kidney failure, or other major critical illness. Guaranteed issue — no health questions.
$10,000 paid on diagnosis
Hospital Indemnity
Cash paid directly to the employee for a covered hospital stay — not to the hospital. Use it for the deductible, the mortgage, or anything else.
$2,000 admission + $200/day confined
Accident Coverage
Covers accidents on or off the job, 24/7, and pays a schedule of benefits for treatment received — surgery, ER, ambulance, and more.
$2,000 first 24 hrs + $500/day — doubles in ICU
Guaranteed Issue Life
Whole life to age 95 with no underwriting questions. Builds cash value the employee can borrow against, and pays the full face value if they live to 95.
Face value based on age — often $100k+
Benefits are issued by licensed insurance carriers. Amounts, availability, and exact terms vary by state, by group, and by the plan design selected. Supplemental policies are not comprehensive health insurance and do not satisfy minimum essential coverage requirements.
The care platform, in detail
What employees actually get
This is the part employees use most, so it is worth being specific rather than waving at “telemedicine.” Care is delivered by licensed providers, and membership extends to the whole household.
Urgent care — day or night
- By phone or video, 24 hours a day, 365 days a year
- Nights, weekends and holidays included
- Licensed providers on every visit, from the first request
Infections, fevers, rashes, minor injuries
Primary care — $0 copay
- By phone or video, with unlimited visits
- No copay for the virtual visit itself
- Requested from home or work, usually in minutes
Ongoing care without a waiting room
Mental health support
- Stress, anxiety, low mood and life changes
- Reached from home, on the employee’s own schedule
- No waiting weeks, and no explaining an absence at work
Included in membership
Prescriptions
- A 3,000-medication program, searchable by name, dose and quantity
- Retail pharmacy pickup, or home delivery with free standard shipping
- International pharmacy program for name-brand medications
- Income-based prescription assistance
Insulins and diabetic supplies have their own section
Care Concierge
- Real people on the phone, in every program
- Finds providers and handles appointment scheduling
- Explains benefits, care options and next steps
- Stays available for as long as they are members
The reason people actually use their benefits
Weight management
- Provider-led program covering GLP-1 class medications such as semaglutide and tirzepatide
- Prescribed only when clinically appropriate
- Consultation and health assessment, lab review when appropriate, then an individualized recommendation
- Ongoing follow-up with progress tracking
Employees are asking for this; most employer plans don’t cover it
Care for the whole family
Membership extends to the employee’s household — up to 8 family members at no additional cost. One membership covers a sick child at 2 a.m. and a spouse’s prescription question the same way it covers the employee.
Family members access the same services: urgent care day or night, primary care, and mental health support. Their prescriptions, labs and treatment carry their own costs, the same as for the employee.
What costs extra — stated plainly
Virtual care is the part that carries no copay. Several things sit outside it, and it is better to know now than to find out at a front desk:
- In-person primary care visits carry a $20 copay; in-person specialist visits, $50
- Generic prescriptions carry 10% coinsurance; brand-name, 20%
- In-person urgent care, lab work, X-ray, CT and MRI are not in the benefit schedule
- Weight-management medication, labs and treatment are separate and depend on clinical evaluation and eligibility
- Emergencies still mean 911
Essential Plus MEC is not comprehensive major medical coverage. Benefits depend on plan terms, networks and formularies, and the schedule may change. This is a membership benefit, not insurance, for the virtual care component.
How employees pay for it
A monthly benefit reserve, funded by the tax savings
Employees don't write a check for any of this. The arrangement creates a monthly reserve, and they choose which benefits to spend it on. Here's a representative example.
Monthly benefit reserve
The reserve is not deducted from take-home pay. Net pay is designed to stay exactly the same.
What the remaining $190.88 can buy
Representative monthly costs. Employees choose the mix — these are options, not a required bundle.
Figures are illustrative examples from a sample plan design and vary by age, state, carrier, and elected benefit amounts.
ACA compliance
Preventive coverage that counts toward your offer requirement
Every membership includes Minimum Essential Coverage — not a separate election, not an optional add-on. For Applicable Large Employers, that matters beyond the benefit itself.
Preventive services included
- Annual preventive and wellness visits
- Preventive health screenings, blood pressure and cholesterol
- Diabetes screenings for qualifying individuals
- Preventive cancer screenings
- Routine immunizations and vaccinations
- Well-woman and women’s preventive services
- Well-child visits and pediatric preventive care
- Preventive counseling and screenings under ACA guidelines
- ACA preventive medications at no copay
Why this matters if you have 50+ employees
For Applicable Large Employers, MEC Part A is designed to help satisfy the IRC §4980H(a) offer requirement — when coverage is properly offered to at least 95% of eligible full-time employees and their dependent children.
That is a design intent, not a legal opinion. Whether your specific offer satisfies §4980H(a) depends on your workforce, your measurement periods and how the offer is made. Review it with your own benefits counsel — we will hand them everything they need.
Source: 26 U.S.C. §4980H; HealthCare.gov preventive services. Essential Plus MEC is not comprehensive major medical coverage.
The two things employees ask
Both answers, up front
"Your net paycheck does not change. Not by a dollar."
"This doesn't replace your current coverage. It pays in addition to it."
Those two sentences resolve nearly every objection that comes up during enrollment. We say them first, out loud, in every employee meeting — and then we show the math.
Proof
The same paycheck, before and after
A sample monthly paycheck for an employee earning about $3,705 per month. Look at the last row — that's the number employees care about, and it doesn't move.
| Monthly paycheck | Current | With the program |
|---|---|---|
| Gross monthly pay | $3,705.00 | $3,705.00 |
| Existing health deductions | $465.00 | $465.00 |
| Pre-tax program deduction | — | $1,220.00 |
| Taxable income | $3,240.00 | $2,020.00 |
| Federal withholding | $388.80 | $242.40 |
| State withholding | $186.30 | $116.15 |
| Social Security | $200.88 | $125.24 |
| Medicare | $46.98 | $29.29 |
| Benefits purchased (post-tax) | — | $309.88 |
| Non-taxable plan reimbursement | — | $1,220.00 |
| Net take-home pay | $2,882.04 | $2,882.04 |
What changed for this employee
Their take-home pay is identical to the dollar. What's different is that they now have disability, critical illness, hospital, accident, and life coverage plus a virtual care platform — roughly $310 a month of benefits they weren't carrying before.
What changed for the employer
This one employee's monthly FICA liability dropped by $93.33. Net of the $40 fee, the company keeps $53.33 — every month, for this one person. Multiply by headcount.
Illustration based on a sample employee in a single state. Figures vary with wages, withholding elections, state of residence, and plan design.