The ESPA pairs with your major medical. It does not replace it.
Putting an Employer Sponsored Preventive Access (ESPA) in place does not require switching insurance carriers, switching brokers, or rebidding any line of coverage. The ESPA sits alongside your existing major medical plan and adds capability your team does not have today.
What stays exactly the same
When you put an ESPA in place, four things do not change
Your major medical plan.
Carrier, network, deductibles, copay structure, and renewal cycle stay exactly as they are. The ESPA is a separate plan.
Your employees' major medical coverage.
Employees keep their existing major medical plan. The ESPA adds preventive health benefits and supplemental insurance benefits on top of what they already have.
Your broker relationship
Your broker keeps the major medical relationship. The ESPA does not require rebidding your medical, dental, or vision lines.
Employee take-home pay.
The Section 125 plus SIMRP structure is built so that take-home pay does not change.
What is added
Putting an ESPA in place adds three layers on top of the major medical plan:
Preventive health benefits access
Every enrolled employee and their family gets 24/7 access to virtual urgent care, virtual primary care, mental health support, specialist navigation, and prescription benefits through one employee technology portal. Qualified medical expenses are fully reimbursable under the ESPA, with no insurance billing.
Annual comprehensive lab panel
Each enrolled employee receives an annual comprehensive lab panel. The panel is delivered through the employee technology portal and is structured as a preventive health benefit under the ESPA.
Supplemental insurance benefits
An average of $150 a month per employee in supplemental insurance benefits. These are separate, licensed insurance products (Critical Illness, Life, Accident) that pair with the rest of the plan.
How the ESPA reduces pressure on the major medical plan over time.
When employees use the ESPA for routine and preventive needs, they rely less on the ER, urgent care, and specialist visits. Each of those visits costs the major medical plan something. Over time, fewer of those visits softens claims pressure at major medical renewal.
The ESPA does not promise to lower your major medical premium. What it does is shift routine care to a separate, lower-cost path so that the major medical plan is used for the things it was designed for: hospitalization, major procedures, and ongoing chronic care management.
For brokers
The ESPA is broker-friendly by design. We do not require switching the major medical carrier, the broker of record, or any line of supplemental coverage. Brokers add the ESPA to a client’s book without disrupting the rest of the relationship. For brokers who want to lead with the ESPA directly, our broker schedule pays $30 Per Employee Per Month (PEPM), recurring, for the life of every enrollment.
Frequently asked questions
No. The ESPA pairs with your existing major medical plan. Carrier, network, and renewal cycle stay exactly as they are.
No. Your broker keeps the major medical relationship. The ESPA does not require rebidding any line of coverage.
Not directly. What the ESPA does is shift routine and preventive care to a separate path, which softens claims pressure on the major medical plan over time. The result is typically reflected at renewal, not on next month’s invoice.
No. The ESPA is not major medical insurance. It provides preventive health benefits access (virtual urgent care, primary care, mental health support, specialist navigation, prescription access) plus an annual comprehensive lab panel and an average of $150 a month in supplemental insurance benefits. Hospitalization, major procedures, and chronic disease management remain under your major medical plan.
Note: Tax benefits stem from the structure of the Self-Insured Medical Reimbursement Plan, which uses pre-tax funding. Employers benefit from reduced FICA taxes, while employees only realize tax advantages if they actively participate in the plan and earn the reimbursement after-tax. Without participation, any reimbursement becomes taxable, negating the financial benefit.
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