ESPA is easiest to understand when you separate the two medical benefits.
First, the employer provides an Employer-Sponsored Medical Benefit. It contains defined qualifying medical services. Eligible employees may prospectively use the employer’s Section 125 cafeteria plan to satisfy their required share of that benefit. Employer-provided accident or health coverage is addressed under Section 106.
Second, the employer separately funds the SIMRP. The SIMRP is a Self-Insured Medical Reimbursement Plan that may reimburse eligible qualifying medical expenses under Section 105(b).
The employee’s Section 125 election pays for the first benefit. It does not fund the SIMRP reimbursement.
Share your payroll structure. We model the ESPA for your census and return a per-employee picture. Takes about 15 minutes of your time. Within a few business days, you receive a written estimate.
Employees enroll through a simplified onboarding flow. Each creates one login to the employee technology portal, registers their family, and is set up for whole-family access. Typically under 10 minutes.
Every enrolled employee, plus the employee’s spouse and dependents, has access through the employee technology portal.
The ESPA is structured for employers with W-2 employees. It works for:
The ESPA is structured for employers with W-2 employees. It works for:
Three things specifically do not change when you put an ESPA in place:
ESPA does not require an employer to replace its existing broker or rebid existing coverage.
About 30 days from contract signature to the first payroll cycle reflecting the plan.
Your CPA can review every plan document during setup. We work directly with outside auditors and produce the documentation needed for an annual review.
No. The ESPA is participation-based. Participation is measured through points earned annually as a passive matter, not through specific monthly activities. This is one of the structural differences that keeps the plan compliant.
