Give your team prescribed labs, repeated as often as they are medically necessary.
When a provider orders labs from the included list, there is no annual cap, for the whole family, under the ESPA.
Some health conditions need more than one check a year.
With the Employer Sponsored Preventive Access (ESPA) plan, labs a provider orders from the included list can be repeated as often as a person’s care requires. There is no annual limit, and it applies to the whole family. That turns lab work from a once-a-year snapshot into real ongoing monitoring for your employees.
What Unlimited Prescribed Labs Means
There is no annual limit on the labs a provider orders from the included list. If an employee’s care needs the same test four times in a year, they can have it four times. If a dependent needs ongoing monitoring, that monitoring is available as often as it is medically necessary. The only conditions are simple: the test is on the included list, and a provider has ordered it.
Who it is for
This applies to the whole family. The enrolled employee, their spouse, and their dependents can all have medically necessary labs repeated without an annual cap.
A real example
An employee managing type 2 diabetes can have their Hemoglobin A1c (A1C) checked every three months instead of once a year, which is what good diabetes care actually calls for. Someone adjusting thyroid medication can recheck thyroid markers until levels are stable. A parent tracking iron or vitamin D can follow the numbers until they are back in range. None of that runs into an annual cap.
How it works
A provider orders the labs through the employee technology portal.
The labs come from a defined list of included tests, spanning general health markers, hormones, and infectious disease screening.
The employee or family member visits a contracted lab for the draw.
When the same test is needed again, a provider can order it again, as often as it is medically necessary.
Why it matters for employers
Routine and chronic-condition monitoring usually runs through the major medical plan. Moving that monitoring into the ESPA means fewer of those draws and visits land on the major medical plan over time, which helps hold down claims pressure at renewal. For employees managing an ongoing condition, removing the annual cap is the kind of benefit that earns real loyalty. The ESPA works alongside your existing major medical plan and does not replace it.
What it means for your employees
The included lab list (optional expandable section)
General health markers
Frequently asked questions
It means there is no annual cap on labs a provider orders from the included list. If a test is medically necessary more than once a year, it can be repeated as often as the employee’s care requires.
There is no annual cap on the number of times an included lab can be repeated. The conditions are that the test is on the included list and that a provider has ordered it as medically necessary.
Yes. Medically necessary repeat labs from the included list are available to the enrolled employee, their spouse, and their dependents. [Scope pending confirmation against the brief.]
The included list spans general health markers, hormones, and infectious disease screening, with common tests such as a comprehensive metabolic panel, lipid panel, Hemoglobin A1c (A1C), thyroid function, iron studies, and vitamin D. The list can change from time to time.
The included list spans general health markers, hormones, and infectious disease screening, with common tests such as a comprehensive metabolic panel, lipid panel, Hemoglobin A1c (A1C), thyroid function, iron studies, and vitamin D. The list can change from time to time.
Labs that are not on the included list are billed to the major medical plan or the member at the best available price.
Labs from the included list are reimbursable under the ESPA, with no insurance billing, and employee take-home pay does not change.
No. The ESPA works alongside your existing major medical plan. It is not insurance and does not replace your major medical coverage.
Care that keeps up with your team's health, not a yearly cap.
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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