FREQUENTLY ASKED QUESTIONS

What is the SIMERP Program? (Also Known As: Self Insured Medical Expense Reimbursement Plan)

The SIMERP Program is a voluntary benefit program that helps employees take charge of their health and well-being. It does this by reimbursing them for qualified healthcare expenses. This program is powered by the Affordable Care Act (ACA) and offers a unique opportunity to save your company money

Yes. After enrolling in the program, you must access your Personal Desktop, view the compliance video and either schedule or complete a Health Risk Assessment (HRA). Thereafter, you must meet monthly and/or quarterly objectives.

If you fail to meet the required participation criteria, you could be dropped off the program with the potential of losing all benefits received as a result of your participation. Prodigy Benefit Management will make several attempts to reach you but if we are unsuccessful, you will be dropped off the program and either lose your benefits or pay for them directly out of your check post-tax.

No. A gym membership is a taxable benefit under the rules of this program.

The effect would probably be minimal if you are approaching retirement age as Social Security is calculated on a 35-year average. One of the benefits we make available to employees is a Guaranteed Issue cash value life policy that usually accrues cash value at a higher rate than Social Security. (If you have specific questions on this effect, please consult your CPA).

Prodigy Benefit Management calculates your Wellness Reserve at 95% of your annual income. Therefore, if you should miss a couple of days during the year, there should be enough in reserve to pay the premium amounts without affecting your take home pay.

Yes. All benefits can be modified to cover your spouse and/or dependents.

Prodigy Benefit Management and your employer decide what the “Wellness Reserve” must be spent on.

No. Because you are pre-taxing the wellness program under a Section “125” Cafeteria program, the IRS has certain rules that must be followed such as; you cannot make any changes to the program until “Open Enrollment” each year unless there is a qualifying event. An IRS approved qualifying event allows you to make changes during the plan year that are consistent with the event. Your Prodigy Wellness advisor will explain this upon enrollment.

You will see additional line-item deductions on your paycheck. To truly see the effect on your take-home pay, compare two identical paychecks (i.e., hours worked, same pay rate, etc.) and you will see either a very slight increase in pay or no difference in take home pay.

You should always come out ahead as your taxable income is lowered by the wellness contribution. Therefore, you are paying the correct taxes based upon your gross taxable income after the wellness contribution. (For specific questions, please contact your tax advisor or CPA).

Yes. This is a tax qualified wellness plan that uses tax advantage provisions under the Internal Revenue Service codes “Section 125 and 105” and ACA wellness rules.

Eligibility to participate in a SIMRP must be satisfied by both of the following tests:

• Percentage test: The plan must benefit 70% or more of all employees or, 80% or more of all employees who are eligible to benefit under the plan (provided 70% or more of all employees are eligible to benefit under the plan).

• Classification test. The plan must benefit all employees who qualify under a given classification and cannot discriminate in favor of highly compensated Although certain employees may be excluded from consideration, it must be uniform for all participants, but may establish a maximum reimbursement limit. The following classification of employees may be excluded from consideration. Workers who—

• have not completed 3 years of service prior to the beginning of the plan year,

• have not attained age 25 prior to the beginning of the plan year are part-time employees (less than 35 hours per week),

• are part of a collective bargaining agreement, or

• are nonresident aliens who receive no earned