SIMRP vs Traditional Health Insurance
How does the SIMRP-based Preventive Care Benefits Program compare to traditional group health insurance? Here is a detailed side-by-side comparison across cost, coverage, compliance, and implementation.
| Feature | PCBP (SIMRP) | Traditional Group Health Insurance |
|---|---|---|
| Employer Cost | $0 out-of-pocket expenses | $7,000-$22,000+ per employee/year |
| Employee Cost | $0 effective cost (pre-tax funded) | $1,000-$6,000+ per year in premiums |
| FICA Tax Savings | $1,119-$1,186 per employee/year | $0 (premiums are not FICA-deductible for most small businesses) |
| Preventive Rx | 1,000+ preventive medications at $0 | Varies by plan; copays typically apply |
| Life Insurance | $150,000 included | Usually separate purchase ($50-$200/mo per employee) |
| Telemedicine | Unlimited, $0 out-of-pocket expenses | May include; copay often applies |
| Implementation Time | 2-3 weeks | 4-8 weeks typical |
| Minimum Employees | No strict minimum | Often 2-50 for small group |
| Replaces Health Insurance? | No — supplemental program | Yes — primary health coverage |
| COBRA Required? | No | Yes (20+ employees) |
| Legal Basis | IRC §105(b), §125, ACA §2705 | ACA, ERISA, state insurance laws |
Key Takeaway
The Preventive Care Benefits Program is not a replacement for health insurance. It is a supplemental program that works alongside existing coverage (or independently if no coverage exists). The Kaiser Family Foundation reports that the average employer-sponsored family health plan costs $23,968 per year. For employers who want to provide meaningful benefits without the cost of traditional group health insurance, or who want to add benefits on top of existing coverage, the PCBP delivers exceptional value with $0 out-of-pocket expenses to employers.
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