SIMERP®

The desk reference

Straight answers.

The questions employers actually ask, answered the way we would answer them across a table.

The queries, in the order they get asked

The question

What is SIMERP?

A Self-Insured Medical Expense Reimbursement Plan: an employer-sponsored plan that reimburses employees for real medical care tax-free. Because those reimbursements are excluded from wages, both the company and its employees stop paying FICA payroll taxes on those dollars, and the savings fund the care.

The question

If this is real, why have I never heard of it?

Because until recently it could not be delivered. A plan like this needs a third-party administrator and a medical provider built to work together, and it needs service-based medical care employees can actually access from anywhere, with no copay and no deductible: primary care, urgent care, mental health, and prescriptions. Once care could be delivered that way, tax law that has been on the books for decades could finally be put to work. The law is old. Being able to deliver on it is new. That is also a different question from why your CPA or broker has not raised it, which is that the plan sits across tax law, benefits law, and healthcare regulations, and neither advisor was hired to work all three.

The question

Can SIMERP offset a health insurance renewal increase?

SIMERP can offset part of a renewal increase, or all of it. Your business gets back up to $640 per enrolled employee a year without changing your plan, broker or carrier. Type your headcount and the percentage on your renewal notice at simerp.com/renewal. You see how much of the renewal increase you can get back, with no email required.

The question

Is SIMERP insurance?

No. There is no carrier, no policy, and no premium. SIMERP is additive: it sits alongside your existing group health plan and changes nothing about it.

The question

What does it cost?

Nothing on net. The FICA savings the program generates fully cover the cost of implementation, and your business keeps up to $53.33 per enrolled employee per month after all program costs. That is up to $640 per enrolled employee per year.

The question

Where do the savings actually come from?

From payroll taxes you are currently paying but are not required to pay. IRS Publication 15 states that medical care reimbursements under an employer's self-insured medical reimbursement plan are not wages and are not subject to social security, Medicare, and FUTA taxes.

The question

Does employee take-home pay go down?

No, it goes up. The pre-tax election lowers each employee's taxable income, which lowers their taxes. In a modeled example for an employee earning $44,460 a year, net take-home pay rose by $160.88 per month. Results vary by state, salary, and plan structure.

The question

Do we have to change our health plan, broker, or payroll provider?

No. Your existing health insurance, your broker relationship, and your payroll provider all stay exactly as they are. Employees' gross pay does not change either.

The question

How long does implementation take?

30 to 60 days from signed paperwork to launch, and your HR team typically spends under 5 hours on it. We prepare the core plan documents, give your team exact payroll instructions for your provider, and run employee onboarding.

The question

Is this the thing the IRS warned about?

No. IRS warnings target programs that pay employees cash whether or not medical care happened. SIMERP reimburses only actual medical care as defined in IRC Section 213(d), documented with CPT and ICD codes, which is exactly the line Treasury Regulation §1.105-2 draws.

The question

Who qualifies?

Businesses with 25 to 3,000+ W-2 employees, in every industry, in all 50 states. Construction, healthcare, manufacturing, transportation, retail, professional services, and more. If you run payroll for W-2 employees, your Recovery Ledger will tell you exactly what the program is worth to your company.

The question

What do employees get?

24/7 virtual urgent care with a doctor typically in under 20 minutes, primary care appointments scheduled in days, around-the-clock mental health support from licensed clinicians, more than 1,000 medications at no cost (maintenance delivered to your home, acute picked up at a local pharmacy), and physician-supervised weight health with scheduled visits. Zero copay, zero deductible, no fee for services, covering the employee plus up to 6 legal dependents.

The question

Why hasn't my CPA or broker mentioned this?

SIMERP sits at the intersection of tax law, employee benefits law, and healthcare policy. Your CPA focuses on tax compliance and your broker focuses on premiums, so this structure lives in neither of their lanes. That is why SIMERP specialists exist.

The question

What happens on the Savings Assessment?

On the Savings Assessment, you tell us how many W-2 employees you have, which takes about a minute. Right away, you'll see that your team gets real medical care and how much payroll tax your company could save. Payroll tax is only one of the ways SIMERP saves your company money. There's no cost and no obligation.

The question

Different plans arrive with SIMERP on the proposal. Which one is this?

The SIMERP methodology, which reimburses real medical care as defined in IRC Section 213(d), delivered by licensed physicians and clinicians, valued by an independent actuary, and tracked with CPT and ICD codes. The IRS memos on this category describe the indemnity plan, which makes a cash payment for an event or an activity whether or not there was a medical expense. The difference, in the regulation's own words, is at simerp.com/two-kinds-of-simerp.

The question

Another company sent us a proposal that says SIMERP. Can you look at it?

Yes, bring it to a Discovery Call and we'll go through the ten questions at simerp.com/check-a-simerp-proposal against it, starting with whether the plan makes a cash payment for an event or an activity. We won't grade another company's plan for you, but you will leave knowing what to ask.

Question we didn’t cover? Call (888) 887-2343, write to info@simerp.com, or start with the plain-English definition.

OpenSavings Assessment · no cost, no obligation

See how much payroll tax you're overpaying.

The 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.