The Pre-Tax PlaybookThe employer's briefing on Section 125 benefits
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An owner looks down at his warehouse floor

For owners

The benefit you've wanted to offer.

Something real for the people who can't afford your medical plan, and a payroll-tax line that can help pay for it. Here's how, and what to check first.

Illustrative photo · not a real employee

Required federal noticeFixed indemnity insurance

IMPORTANT: This is a fixed indemnity policy, NOT health insurance

This fixed indemnity policy may pay you a limited dollar amount if you're sick or hospitalized. You're still responsible for paying the cost of your care.

  • The payment you get isn't based on the size of your medical bill.
  • There might be a limit on how much this policy will pay each year.
  • This policy isn't a substitute for comprehensive health insurance.
  • Since this policy isn't health insurance, it doesn't have to include most Federal consumer protections that apply to health insurance.

Looking for comprehensive health insurance?

  • Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
  • To find out if you can get health insurance through your job, or a family member's job, contact the employer.

Questions about this policy?

  • For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under "Insurance Departments."
  • If you have this policy through your job, or a family member's job, contact the employer.

The moment

You know who doesn't take your medical plan.

It's the line lead with three kids, the new hire on the second shift, the aide who works doubles. Nationally, only 41% of the lowest-paid private-sector workers have access to employer health benefits, and 18% enroll.[94] Many who are covered still carry a deductible near $1,900.[93] This program is built for exactly those people: it sits on top of whatever you already offer.[28]

Without it

  • Skipping the doctor over a copay — 26% of adults did last year[89]
  • Coming in sick because a day off costs a day's pay[96]
  • One surprise bill away from trouble: 37% can't cover $400 in cash[88]

With it

  • 24/7 $0-copay virtual urgent care for the family[21]
  • $0-copay virtual primary care, behavioral health and generic Rx[22, 23, 24]
  • Fixed cash benefits for a covered hospital stay[20]
  • Take-home that can rise — about $140/month on average in Elysian's data[37]

The thin-margin truth

The payroll tax you keep is real money.

Every pre-tax premium dollar is a dollar your company doesn't pay 7.65% FICA on, for most hourly workers.[40] Program fees are designed to come out of that.[35] What's left is yours to decide: reinvest it, absorb rising costs, or — for owners who've been paying everyone but themselves — give yourself a modest raise.

Requires that claim payments aren't treated as wages, the point the IRS disputes for activity-based plans.[33, 58]

OWNER'S EXAMPLEIllustration only

≈ $82,620/ year, before fees

150 enrolled × $600/mo premium × 12 × 7.65%.[104]

Your census and Financial Impact Statement replace every number here. Not guaranteed.[41, 67]

Run your own estimate

Before you sign

Get these in writing.

  1. What triggers each claim payment — medical services, not activities.[31, 58]
  2. The policy form naming the carrier.[14]
  3. The full fee schedule.[34]
  4. Audit-defense terms and audit history (per Elysian, under NDA).[68, 69]
  5. Your own CPA's read of the Holland & Knight memo.[64]
Book a census reviewHow it works

Held back from this site

The numbers by headcount, the IRS-line checklist, and 20 questions to ask any vendor.

Work email and company name. We email you a link to confirm it's really you, and the link unlocks the PDF.[41, 58, 69]

The risks are not gated: the federal notice, the IRS positions and every source stay free to read.

Email me the kit