Proof & compliance
Every claim on this site is numbered. Each one below shows the plain-English statement, its status, and the source with an exact quote and date. Where a source is a private Elysian document, it is labeled as such and available on request (subject to Elysian's permission).
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.
Looking for comprehensive health insurance?
Questions about this policy?
What we don't claim. We don't claim the program is "IRS-approved," that savings are guaranteed, or that Bain Capital owns Elysian. Public records show Bain Capital's interest is in the parent of Federal Life Group, one of the carriers Elysian is appointed with.[10, 2, 15]
Elysian Healthcare LLC is an active Florida limited liability company, document #L25000554581, filed December 10, 2025.
Entity L25000554581, filed 12/10/2025, managers Kevin Poynter and Corey Elzner.
Elysian Healthcare is a licensed insurance producer firm (Nevada #4135885) with health appointments from Federal Life Insurance Company and United States Fire Insurance Company. An appointment means Elysian may sell that carrier's products; your policy documents name your carrier.
FEDERAL LIFE INSURANCE COMPANY Health Active 12/10/2025 … UNITED STATES FIRE INSURANCE COMPANY Health Active 08/12/2025
Founded by Kevin Poynter, a 25+ year employee-benefits veteran (formerly Humana and Boston Mutual).
“…a 25+ year career in the Financial Services and Insurance Industry.”
Hired as Regional VP of Sales, Workplace Solutions; previously Humana and ING Employee Benefits.
Bain Capital holds an indirect economic interest in the parent company of Federal Life Group. Control of Federal Life Group and its parent rests with a general partner independent of Bain. Bain's percentage is not disclosed.
“…included Federal Life Group, Inc. in Item 7.A solely due to Bain Capital’s ownership of an economic (limited partnership) interest in Federal Life Group, Inc.’s parent company. Actual control of Federal Life Group, Inc. and its parent company rests with a general partner that does not control, is not controlled by, nor is under common control with Bain Capital Insurance Solutions, LP.”
Federal Life describes itself as “backed by leading investment firm, Bain Capital,” with an A- (Excellent) AM Best rating (as of June 2025).
“With an A- (Excellent) rating from AM Best, and backed by leading investment firm, Bain Capital, Federal Life is in a strong financial position…”
(same text)
Federal Life Insurance Company is a wholly owned subsidiary of Federal Life Group, Inc. Bain's disclosed interest sits above the group, at the parent-company level.
“Federal Life Insurance Company is a wholly owned subsidiary of Federal Life Group, Inc. that operates as an insurance company.”
In December 2025 Federal Life Group's parent owned more than 90% of its common stock. That measures the parent's stake, not Bain's.
“Federal Life’s parent currently owns more than 90% of the common stock of Federal Life…”
Coverage is fully insured and issued by a licensed insurance carrier; your policy documents name the carrier. We have requested the policy form and state filing from Elysian.
Requested Nov 2026.
If your policy is issued by Federal Life: Federal Life is backed by Bain Capital through an indirect economic interest in its parent company. Bain Capital is an investor in the carrier — it is not the owner of Elysian Healthcare.
The hospital indemnity coverage is fully insured by a licensed carrier, not self-funded by your company.
“There is no self-insured option or component to the Elysian program. It is a fully insured product that is regulated by the insurance commission of each state where it is offered.”
Fixed cash benefits for covered hospital events — such as a hospital admission, each night in the hospital, and ambulance transport. Amounts depend on the plan chosen; your Schedule of Benefits governs.
“$200 for ambulance transport, $500 initial hospital admission benefit, and $200 per night for inpatient hospital stays.” Employee only.
$0-copay virtual urgent care by phone or video, 24/7/365, for employees and their families.
“Virtual Urgent Care available 24/7/365 via phone or video… (No out of pocket cost | $0.00 copay | Available to Spouses and up to 8 Dependents Birth-26 Years)”
$0-copay virtual primary care, including ongoing care for chronic conditions.
“Virtual Primary Care dedicated to developing a tailored care plan for members with specialized, ongoing care for chronic conditions.”
$0-copay virtual therapy, counseling, and psychiatry.
“Virtual Behavioral Health that includes therapy, counseling, psychiatry, and medication management.”
$0 copay on formulary generic medications at tens of thousands of pharmacies or by home delivery.
“Enjoy full coverage on generic medications included within our formulary… over 60,000 pharmacy locations nationwide.”
Lab and biometric screenings, health risk assessments, and one-on-one health coaching.
“Biometric Screening (Basic LIPID Panel, Inflammation, Liver Function Test, Kidney Function Test, Glucose Profile)… Health Coaching”
Members can call a tax advice line run by the law firm Brennan Manna & Diamond. (This is a member service — not a legal opinion on the program.)
“All plan participants have free access to tax advisory services provided by Brennan Manna & Diamond, LLC, and its online platform of BMD Gateway.”
A supplemental benefit. It does not replace your major medical plan.
“This supplemental plan will not replace other benefits.”
Per Elysian, the average benefit payout is $3,146, based on more than 150,000 individual policyholders.
“…the average benefit payout in the Elysian product is $3,146 … based on claims in a population of more than 150,000 individual policy holders.”
Employees pay for the coverage with pre-tax payroll deductions through a Section 125 cafeteria plan. One client's published enrollment form listed monthly premiums of $600, $900, $1,200 and $1,600 depending on plan.
“Pursuant to § 125, the amount of an employee’s salary reduction through a cafeteria plan applied to purchase health coverage is not included in gross income…”
“…a pre-tax deduction of monthly premiums equal to $600 for Plan 3, $900 for Plan 1e, $1,200 for Plan 2e, or $1,600 for Plan 4e…”
The plan pays a fixed cash benefit when a covered, provider-coded medical service occurs, as defined in the policy. We have requested Elysian's written claim-trigger definition; some Elysian materials describe monthly assessments and “participation,” so ask for the document before you decide.
“For a claim to be paid under the Elysian policy, the Current Procedural Terminology (‘CPT’) codes included by the clinical services provider must indicate that medical expenses under Section 213 of the Code were provided.”
Requested Nov 2026.
The insurance carrier funds each claim payment; your payroll system passes it to the employee as the carrier's paying agent and reports it on the W-2 (Box 14).
“The employer’s only obligations are to remit the payments as directed by the carrier and to report the payment amount on Form W-2.”
Elysian's tax counsel concluded claim payments are not wages. The IRS has taken a different view of programs that pay for activities rather than medical expenses — see P-58 and P-60.
“…the Elysian benefits do not fit within the definition of ‘wages.’” Benefits are taxable to the insured only “to the extent that benefits exceed the actual medical expenses.”
Program fees are disclosed in your Financial Impact Statement. We have requested Elysian's complete fee schedule.
“One defined pre-tax election plus an employer-paid claims processing fee, which is net in your savings.”
Elysian's model is designed so that program fees are covered by the payroll-tax savings the plan creates. Your Financial Impact Statement shows the projected net result; actual results may vary.
“…the program is net-neutral or net-positive for the company because of the payroll-tax savings from Section 125 pre-tax premiums. We will model the exact numbers for your headcount before you commit.”
Employees buy real insurance with pre-tax dollars and the carrier pays real benefits. The net gain comes from taxes not paid on premium dollars — which is why the plan must meet strict tax rules, and why its value depends on those rules being met.
In Elysian's case data, enrolled employees took home about $140 more per month on average. Individual results vary with pay, withholding, and claims.
“…a net increase in employee take-home pay averaging $140 per month ($1,700 per year).”
Change in monthly take-home = claim payments received − premium deducted + taxes saved on the premium. Example (assumed 19.65% combined tax rate): a $600 premium saves about $117.90 in tax, so claims of about $622 that month would produce the +$140 average.
Assumption: 12% federal + 7.65% FICA + 0% state.
Payments above an employee's actual medical costs may be taxable to the employee; lower Social Security wages can mean slightly lower future Social Security benefits; Section 125 elections are generally locked for the plan year.
“…this premium deduction authorization will be irrevocable (absent a ‘Change in Family Status’)… through the end of the current plan year.”
Employers pay 6.2% Social Security on wages up to $184,500 (2026) plus 1.45% Medicare on all wages.
2026 maximum taxable earnings: $184,500.
Employer rate 6.2% Social Security + 1.45% Medicare.
Annual employer FICA reduction ≈ monthly pre-tax premium × 12 × 7.65% per enrolled employee (below the wage base), before program fees, and only if claim payments are not wages. Elysian's own 3,785-employee proposal projected $2,060,534.30 per year net of fees across 3,019 qualified employees (about $682.52 each).
“Employer – Annual Savings* $2,060,534.30 … *Employer – Annual Savings is NET of Program Administrative Fees … a projection based on the data provided, and actual results may vary.”
In California, workers' comp payroll excludes qualifying Section 125 benefit deductions (with proper records), so the plan may lower your workers' comp premium too. We'll model it with your actual rates; we don't promise a percentage.
Excludes the salary reduction used to fund the welfare benefit portion of a Section 125 cafeteria plan, if separately recorded.
Employees must earn enough each week for the pre-tax deduction to work in their favor (Elysian screens out those under about $240/week). In Elysian's case data, roughly 60–80% of a workforce qualified.
“Part-time employees earning less than approximately $240 per week are excluded… approximately 60% to 63% of employees meet qualification parameters.”
Total employees 3,785; total qualified employees 3,019.
“Employees will be auto-enrolled only if their net-take home pay is higher with the plan.”
Only W-2 employees can participate pre-tax; some owners (e.g., more-than-2% S-corporation shareholders), partners, and 1099 contractors are excluded by IRS rules.
“…certain owners, such as more-than-2% S corporation shareholders, are treated differently under IRS rules.”
Employees get advance notice and an easy opt-out by phone or online. Exact windows are set in your plan documents.
“Employees can opt out at any time by contacting our Call Center at (800) 214-6484.”
Premiums are paid through a written Section 125 cafeteria plan, operated consistently and tested for nondiscrimination.
“IRS guidance requires a written cafeteria plan and proper benefit design, elections, and operation.”
Premiums for accident or health insurance paid by salary reduction under Section 125 are excluded from the employee's gross income; hospital and fixed indemnity insurance generally count as accident or health insurance.
“Premiums paid by an employer (including by salary reduction pursuant to section 125 of the Code) for accident or health insurance are excluded from an employee's gross income under section 106(a) of the Code.”
When premiums are paid pre-tax, benefit payments are excluded from income only to the extent they reimburse medical expenses (Section 213(d)) the employee actually incurred and that weren't paid by other coverage.
“…the exclusion ‘applies only to amounts which are paid specifically to reimburse the taxpayer for expenses incurred by him for the prescribed medical care.’”
The exclusion “does not apply to amounts which the taxpayer would be entitled to receive irrespective of whether expenses for medical care are incurred.”
Fixed indemnity benefits are generally not taxable when premiums are paid after tax — which is how Treasury says most such premiums are paid. Paying pre-tax creates the savings and is the reason the stricter 105(b) rules apply.
“Employers are reminded that amounts received through accident or health insurance are not taxable if premiums for the coverage are paid on an after-tax basis… The Treasury Department and IRS understand that is how most premiums for hospital indemnity or other fixed indemnity insurance are paid.”
Medical care means diagnosis, cure, mitigation, treatment, or prevention of disease — not things merely beneficial to general health.
“Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease… They don't include expenses that are merely beneficial to general health.”
The IRS says taxable indemnity payments not made on account of medical expenses are wages for FICA, FUTA and withholding. Elysian's counsel disagrees for payments made by an insurance carrier. Employers carry the withholding risk.
“…taxable wellness indemnity benefits are wages for purposes of FICA, FUTA, and FITW…”
“…we do not find ready support for the conclusion that the non-Elysian benefits paid through an insurance contract are subject to federal income tax withholding and FICA.”
In the group market, fixed indemnity insurance must be independent and non-coordinated and pay a fixed amount per day (or other period) to be an excepted benefit. Since plan years beginning on or after January 1, 2025, a federal notice must appear prominently on the first page of marketing, application and enrollment materials, including websites, in at least 14-point type. (That is the notice at the top of every page of this site.)
“In the group market… the insurance must pay a fixed dollar amount per day (or per other period) of hospitalization or illness (for example, $100/day), regardless of the amount of expenses incurred.” “…displays prominently on the first page (in either paper or electronic form, including on a website) of any marketing, application, and enrollment materials… in at least 14-point font…”
Requested Nov 2026.
This plan sits on top of your ACA-compliant medical plan — it doesn't replace it. Employers with 50+ full-time-equivalent employees must offer minimum essential coverage; fixed indemnity insurance doesn't count.
Applicable large employers must offer affordable minimum essential coverage to full-time employees or may owe a payment.
ERISA welfare-plan documents (SPD) and possibly Form 5500 filings may apply; Elysian states it provides plan documents.
“…ERISA welfare-benefit notice, SPD, and possible Form 5500 requirements may still apply.”
IRS Chief Counsel memos aren't binding law, but they show how the IRS reads it.
“This advice may not be used or cited as precedent.”
The IRS said employers may not exclude fixed indemnity payments from income when the coverage was bought pre-tax (2017), and that self-funded “fixed indemnity” and wellness cash rewards are income and wages.
“An employer may not exclude from an employee’s gross income payments under an employer-provided fixed indemnity health plan if the value of the coverage was excluded from the employee’s gross income and wages.”
Self-funded plan paying cash for health-related activities: amounts are included in income and wages.
Earlier memo on similar arrangements.
In July 2023 Treasury proposed that the 105(b) exclusion not apply to amounts paid without regard to actual medical expenses. It was not finalized in 2024; Treasury said more guidance would come.
“…the Treasury Department and the IRS are not finalizing the proposed amendments to 26 CFR 1.105-2 at this time.”
Payments from a pre-tax fixed indemnity policy are taxable — and are wages for FICA, FUTA and withholding — when the employee has no unreimbursed medical expense, including when the triggering activity costs the employee nothing or is covered by other insurance.
“The exclusion from income in § 105(b) does not apply to payments when the employee has no unreimbursed medical expense either because the activity that triggers the payment does not cost the employee anything or because the cost of the activity is reimbursed by other coverage.”
The IRS warned that personal expenses for general health and wellness are not medical expenses under the tax law.
“…personal expenses for general health and wellness are not considered medical expenses under the tax law.”
Treasury said its concerns had escalated about arrangements paying cash even when no medical expense was incurred or when participants simply complete health-related activities, and that such payments generally don't qualify for exclusion from income, FICA, FUTA or withholding. Compliance efforts continue.
“In some cases, no medical expenses are incurred and participants simply complete certain health-related activities. Benefit payments from such accident and health plans that are not made on account of medical expenses incurred generally would not qualify for exclusion from gross income, FICA, FUTA, or Federal income tax withholding.”
A national law firm reported in September 2026 that the IRS has begun auditing fixed indemnity health/wellness plans marketed on payroll-tax savings.
“The Internal Revenue Service (IRS) has begun to audit fixed indemnity health/wellness benefit plans that have been marketed by promising significant payroll tax savings…”
Our point-by-point map of each IRS line, Elysian's stated approach, and how strong the evidence is — shown on the How It Works page.
Employers whose plans are audited may be liable for under-withheld tax, penalties and interest; this liability generally can't be handed off to a vendor.
“Employers whose fixed indemnity health/wellness benefit plans are audited may be found liable for under-withheld tax as well as penalties and interest.”
Liability for HR and benefits tax issues “often cannot be delegated to outside vendors.”
Elysian has a written tax memorandum from the national law firm Holland & Knight (Dec. 1, 2025) concluding the product is “on solid footing under the published rulings and regulations.” It was written for Elysian; your own advisor should review it.
“The Elysian product is on solid footing under the published rulings and regulations, including Revenue Ruling 69-154.”
The memo relies on facts that should be confirmed for your company: claims triggered only by CPT-coded medical care; no payments for activities; and (in its words) enrollees who “typically do not participate in a traditional employer-provided group medical plan.”
“Elysian insurance does not offer benefits linked to participation in wellness activities.”
Projections are estimates based on Elysian's model and your census; actual results may vary. Not tax or legal advice — consult your own tax advisor.
“Elysian Healthcare and the insurance carriers do not guarantee, and expressly disclaims guaranteeing, any and all employee health or wellness benefits or tax savings…”
Elysian states it provides legal defense at no cost if the program is examined by the IRS or NCCI. Per Elysian, documentation available under NDA, pending. Ask whether it covers taxes, penalties and interest (it is not described as an indemnity).
“…the provider contractually guarantees free legal defense for any IRS or NCCI inquiries regarding the program.”
Per Elysian, the program has been through IRS and NCCI examinations with no taxes or penalties assessed. Per Elysian, documentation available under NDA, pending.
“…concluding all audits with zero dollars assessed in penalties, back taxes, or fines.”
Requested Nov 2026.
A basic urgent care visit averaged $118 to $169 in negotiated (allowed) amounts by region in 2023, and $229 to $445 in billed charges.
“…the average charge amount for S9083 varied from $229 in the Midwest to $445 in the West… The average allowed amount for that code varied from $118 in the Midwest to $169 in the Northeast.”
Workers with a copay paid an average of $27 for an in-network primary care visit in 2025.
“…the average copayment for primary care physician office visits is $27…”
Private-practice therapists' cash-pay rates averaged about $143 a session in a national study of 175,083 providers.
“…reported cash pay rates, which averaged $143.26 a session.”
Workers in plans with three or more drug tiers paid an average $12 copay for first-tier (typically generic) drugs in 2025.
“…the average copayment is $12 for first-tier drugs…”
Example month: $3,500 gross pay, a $600 pre-tax premium and an assumed 19.65% combined tax rate. Before: taxes $687.75, take-home $2,812.25. After: taxable pay $2,900, taxes $569.85, plus claim payments of $622.10 that month, take-home $2,952.25, about $140 more. Assumes claim payments aren't taxed (Elysian's counsel's position; the IRS has taken a different view of some plans, see P-33 and P-58). Actual results vary.
37% of U.S. adults would not cover a hypothetical $400 emergency expense using cash or its equivalent; 63% would.
“Sixty-three percent of adults said they would cover a hypothetical $400 emergency expense exclusively using cash, savings, or a credit card paid off at the next statement…”
26% of adults went without some form of medical care in 2025 because they couldn't afford it — 38% of those with family income under $25,000, and 24% even among the insured. 10% skipped mental health care and 9% skipped prescription medicine.
“Twenty-six percent of adults went without some form of medical care in 2025 because they could not afford it… Among those with income less than $25,000, 38 percent… compared with 24 percent among the insured.”
21% of adults had an unexpected major medical expense in the prior 12 months.
“Unexpected major medical expenses — 21”
28% of adults skipped or postponed needed health care in the past 12 months because of cost; 27% didn't fill a prescription and 19% cut pills in half or skipped doses because of cost.
“…about a quarter (27%) say they have not filled a prescription and about one in five (19%) say they have cut pills in half or skipped doses of medicine due to cost.”
About 41% of adults reported debt due to medical or dental bills (2022).
“In 2022, about four in ten adults (41%) reported having debt due to medical or dental bills…”
In 2025 the average family premium for employer coverage was $26,993, workers paid $6,850 of it, and the average single deductible was $1,886.
“Annual premiums for employer-sponsored family health coverage reached $26,993… workers contributed $6,850… The average deductible… was $1,886 for single coverage.”
Only 41% of private-industry workers in the lowest-paid quarter had access to employer medical benefits in March 2025, and just 18% were enrolled. Part-time workers: 25% access. Service occupations: 48%.
Private industry, lowest 25 percent average wage: access 41, participation 18. Part-time: 25 percent access. Service occupations: 48.
Paid sick leave access among private-industry workers ranged from 55% in leisure and hospitality to 97% in information and finance.
“Access to paid sick leave for private industry workers ranged from 55 percent for the leisure and hospitality industry to 97 percent…”
In a 2025 survey of New York workers, 68% of those who got sick reported working while sick; 52% of low-income workers did so because they couldn't afford to lose the pay (31% overall). One state's data, not national.
“…low-income workers (52 percent) reported working while sick because they could not afford to lose the pay… and 31 percent overall.”
In 2023, 53.9% of adults with any mental illness received mental health treatment — about 27 million of 58.7 million did not.
53.9% of adults with AMI (31.6 million of 58.7 million) received mental health treatment in the past year.
8.0% of people in the U.S. were uninsured for all of 2024.
8.0 percent of people were uninsured for the entire calendar year 2024.
23% of working-age adults (19–64) were underinsured in 2024 — covered all year but with out-of-pocket costs high relative to income.
23 percent of working-age adults were underinsured.
Gallup estimates replacing an employee costs one-half to two times annual salary; about 40% of salary for frontline employees.
“The cost of replacing an individual employee can range from one-half to two times the employee's annual salary…”
“…frontline employees 40% of their salary.”
88% of employers rated health-related benefits “very” or “extremely” important for their workforce in 2025, the top benefit category.
“Health-related benefits remained a top priority in 2025, with 88% of employers listing them as ‘extremely important’ or ‘very important’…”
U.S. hospitals' average expense per adjusted inpatient day was about $3,132 in 2023. That's the hospital's cost, not what a patient is billed.
United States, 2023: $3,131.91
At the end of 2025, 502 PEOs served about 5.4 million worksite employees at 233,000 client businesses.
502 PEOs · 5.4 million worksite employees · 233,000 clients (year-end 2025)
Example only: 150 enrolled employees × $600/month pre-tax premium × 12 × 7.65% employer FICA ≈ $82,620 a year in employer FICA the business no longer pays, before program fees. Whether any of it goes to the owner is the owner's decision. Requires that claim payments are not wages (see P-33, P-58). Not guaranteed.
Example only: if a PEO retained $300 a year per enrolled worksite employee (assumption) across 2,000 enrolled employees, that's $600,000 of added annual EBITDA. At a 6× multiple (the figure used in an Elysian PEO analysis; real multiples vary with size, growth, retention and quality of earnings), that implies about $3.6 million of enterprise value — if buyers treat it as recurring. Depends on your contracts, licensing and how the IRS treats the plan.
Held back from this site
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.
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