Common questions about participation, eligibility, and compliance
1. Q: What type of plan is this?
A: It is a Section 125 cafeteria plan that delivers preventive health and wellness benefits on a pre-tax basis.
2. Q: Does this replace existing health insurance?
A: No, it supplements existing group major medical coverage and requires employees to have such coverage to participate.
3. Q: Who is eligible to participate?
A: Any employee covered under an ACA-compliant group major medical plan, either through the employer or another employer.
4. Q: Are dependents covered?
A: Yes, as long as they are covered under the employee's group major medical plan.
5. Q: How are employees enrolled?
A: Employees are auto-enrolled and may opt out if they choose.
6. Q: What is the opt-out process for employees?
A: Employees simply contact the call center within the opt-out period.
7. Q: What does the program cost the employer?
A: There is no net cost to the employer; the program is funded through pre-tax salary reductions.
8. Q: What does the program cost the employee?
A: There is no net out-of-pocket cost; participation is funded through pre-tax payroll deductions.
9. Q: What benefits are included?
A: Telehealth, generic prescription coverage, health coaching, identity theft protection, biometric and DNA screening kits, and more.
10. Q: What is the Preventive Care Reward?
A: A monthly payment employees receive for completing qualified wellness activities.
11. Q: Are Preventive Care Rewards taxable?
A: They are intended to be non-taxable if the employee's Qualified Medical Expenses (QMEs) meet or exceed reward amounts.
12. Q: What counts as a Qualified Medical Expense (QME)?
A: Expenses defined under IRS Section 213(d), including co-pays, prescriptions, preventive care, dental, vision, and certain wellness services.
13. Q: How are payroll deductions handled?
A: Employers run a simple pre-tax deduction labeled "Wellness Program" or similar; payroll setup usually takes minutes.
14. Q: What is the employer's workload?
A: Minimal—about 90 seconds per pay period to upload payroll reports and review invoices.
15. Q: When does coverage start?
A: Benefits begin after payroll setup and the program "Go Live" date.
16. Q: How long is the participation term?
A: The initial term shall continue for a period of the number of months through the end of the calendar year plus twenty-four (24) consecutive months. Thereafter, the term shall be each twelve (12) consecutive months period until the termination of this Client Services Agreement pursuant to this Section X (Term and Termination) of the Client Services Agreement.
17. Q: Is the program ACA compliant on its own?
A: No, it must be offered alongside an ACA-compliant group major medical plan.
18. Q: How is compliance maintained?
A: Through monthly employee communications, activity reminders, and tracking via the Personal Health Dashboard.
19. Q: What reporting is available to employers?
A: Monthly compliance reports, utilization reports, and annual aggregate wellness reports.
20. Q: Who do employees contact for help?
A: The program's benefit specialists are available by phone or email during business hours.
Refer to your Preventive Care Program Member Packet for details on your program.
Contact our benefit specialists for any additional questions about the Preventive Care Program.
They can assist you with understanding your benefits, how the plan impacts your paycheck, and any issues with logging into your Personal Health Dashboard™.
908-625-0297 or info@thriv365.com
Note: The Preventive Care Program does not provide tax or legal advice. The information provided above is intended to be general in nature; you should discuss your personal tax situation with your tax professional.