How the structure works, what the law actually says, and the answers to the questions a CPA asks first.
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Two plans arrive with SIMERP on the proposal. One makes a cash payment to an employee for completing an activity, whether or not there was a medical expense, and every IRS memo is about that one. The SIMERP methodology reimburses real medical care, delivered by licensed physicians and valued by an independent actuary. One sentence in Treasury Regulation 1.105-2 separates them.
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SIMERP is a tax structure first and a care program second, and its history runs in two lanes. The tax lane starts in 1954 and hasn't changed in the ways that matter, though not for lack of trying. The delivery lane is only a few years old.
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Ten questions that take one meeting and need no background in tax law. The first three tell you whether the payment is cash for doing an activity or a reimbursement of real, documented medical care. If the proposal reimburses real care and you are happy with whoever sent it, good. This page exists so nobody signs the indemnity plan by accident.
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Every SIMERP proposal uses the same thirty or so words, and most come from the tax code. Each one in plain English, with the statute or regulation behind it. Read the irrespective test first; it decides which kind of plan you're looking at.
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Insurers asked for a median 14% small-group premium increase for 2027, with most filings between 10% and 20% and six insurers above 30%. Here’s what the filed median, the employer surveys and the cost of care itself each measure, and how to place your own renewal against them.
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Your broker answered the renewal increase with a list: ICHRA, level-funded, PEO, raise the deductible, shift more premium. This page asks the same two questions of each one, what happens to your group plan and what happens to your employees, and names the option most checklists leave out.
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What lowers the cost of the plan you already have, in the order a small company can do it, and what each move is worth: a clean list of who is on the plan, premiums taken out of pay before tax, the premium split, and payroll tax savings.
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A point-by-point answer to the blanket "illegal" opinions, covering the statutes SIMERP runs on, the guidance critics misapply, and the difference between real medical care delivery and the schemes the IRS actually targets.
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The three sections of the Internal Revenue Code SIMERP runs on, the IRS memorandum that causes most of the confusion, and the specific differences between a compliant program and the arrangements that got companies in trouble.
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What the payroll math looks like for a multi-property gaming operation, how implementation runs across locations, and what dealers and housekeeping actually experience on day one.
Read itThe Savings Assessment takes about a minute and shows how much payroll tax your company could save. Every month you wait, your company throws away payroll tax it could have put toward more medical care for your team.