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Preventative Care Management Program

(Wellness Program)
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The Preventative Care Management Program (PCMP) is an innovative workplace initiative that allows employers to enhance their employees' benefits package with an Affordable Care Act (ACA)-compliant wellness program. At the same time, it offers tax advantages by reducing both the employer’s and employee’s tax liabilities.

Key Program Advantages

The PCMP helps employers lower payroll taxes while providing valuable wellness and supplemental benefits to employees—without incurring additional out-of-pocket costs for either party.

Employer Benefits

  • $650 per employee, per year in net payroll tax reduction for each participating employee.
  • Improved employee retention, loyalty, and productivity.
  • Immediate financial impact on the company’s bottom line.
  • Claim cost reduction of approximately $1,400 over three years.
  • Operational within 30-45 days and fully automated to reduce administrative burden.

Employee Benefits

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  • Wellness Benefits:

    24/7 access to telehealth services, including doctors, nurses, health coaches, addiction recovery support, and counseling—at no co-pay. Access to Mayo Clinic wellness programs and a Personal Health Dashboard to support healthier lifestyle choices.
  • Supplemental Benefits:

    Coverage options for Universal Life Insurance, Short-Term Disability, Accident Coverage, and Critical Illness Insurance.

Why the Government Benefits from Implementing Wellness Programs

Government agencies can significantly benefit from implementing wellness programs in the workplace and across communities. Here's how:

  • Healthier Workers and Citizens:
    By promoting wellness programs, the government helps employees and citizens adopt healthier lifestyles, which can lead to a reduction in preventable diseases and health conditions. Healthier individuals are more likely to be productive, experience fewer sick days, and require less frequent medical care, which ultimately lowers healthcare costs for both the government and the public.

  • A More Stable and Higher Tax Wage Base:

    As wellness programs improve the overall health and well-being of workers, they are more likely to remain employed, be productive, and contribute to the economy. Healthy workers are less likely to face long-term disability or early retirement due to health issues, resulting in a more stable, engaged workforce. This, in turn, helps maintain or even grow the tax wage base, as a healthier population can contribute to tax revenues through sustained employment and higher earning potential.

In short, wellness programs not only enhance the health and productivity of government employees but also promote a healthier, more economically active citizenry, benefiting the broader economy and ensuring a more stable tax base.

Program Eligibility

  • Available to employers with 20 or more full-time employees.
  • Employees must be full-time, W-2 workers. Part-time or freelance employees do not qualify.

Program Details

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The PCMP integrates a Section 125 Cafeteria Plan and a Self-Insured Medical Expense Reimbursement Plan (SIMERP) to ensure compliance with IRS guidelines, specifically Section 213(d) of the tax code. Participating employees can be reimbursed for eligible medical expenses on an after-tax basis, maximizing tax savings for both employers and employees. The program requires a formal plan document, a Section 125 Plan, and a SIMERP to remain compliant and effective. The PCMP has been carefully reviewed by CPAs and ERISA attorneys to ensure legal compliance and effectiveness.

Why Choose Sure Advisors for Your PCMP?

When it comes to implementing a compliant and effective Preventative Care Management Program (PCMP), Sure Advisors offers unparalleled expertise and support. Here’s why partnering with us is the best choice for your business and employees:

  1. 1. Expert Compliance with IRS Guidelines
    Our PCMP is fully aligned with IRS regulations, including the critical Section 125 Cafeteria Plan and relevant subsections. This ensures your wellness program is tax-efficient and meets all necessary legal requirements. We work closely with top tax attorneys to guarantee compliance, and we hold opinion letters from trusted legal experts to back up our approach. With Sure Advisors, you can be confident that your program is structured to meet the highest standards.
  2. 2. Proven Track Record with U.S. Health Center
    We’ve partnered with U.S. Health Center , who has been running the PCMP in full compliance for over 12 years. Their extensive experience and established success in the industry ensure that the program you implement is both effective and legally sound. This longstanding partnership gives you peace of mind knowing that you're working with a company that understands the nuances of regulatory compliance and program execution.
  3. 3. Comprehensive Protection with EO Coverage
    Sure Advisors offers comprehensive Errors and Omissions (EO) Insurance for both businesses and employees. This added layer of protection safeguards against any potential claims related to the program, giving you extra security and peace of mind throughout the process.
  4. 4. Partnerships with Leading Insurance Providers
    We collaborate with some of the country’s most trusted insurance companies, including Combined Insurance, a Chubb company, to offer robust life, accident, and supplemental insurance coverage. These partnerships ensure that your employees receive top-tier benefits, giving them access to the best coverage options available in the market. At Sure Advisors, we take pride in delivering a PCMP that’s both legally compliant and operationally effective, with the expertise and partnerships that ensure your business and employees benefit from the best program possible.

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2015- March 2024

Validation in Predictive Modeling

The Validation Institute, an independent, objective, third-party organization established by the Intel-GE Care Innovations Institute focused on changing healthcare, has validated and continues to validate US HealthCenter’s PredictiMed™ AI’s ability to identify and lower the pre-disease high-risk level in thirteen major disease categories, preventing a higher use of emergency room and hospital services. Their data shows that preemptive intervention enabled by PredictiMed™ can reduce the incidence of ER visits and hospitalizations by 80% to 93%.

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2019

Health Value Gold Award for Care Navigation

The Institute awarded US HealthCenter and its PredictiMed™ AI Population Health and Wellness Analytics, Predictive Modeling, Engagement, and Care Navigation Solution with the highest honor “Gold” Award in the category of Care Navigation. Care Navigation is a sub-discipline of care coordination that aspires to steer patients to the most appropriate and effective clinical provider.

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2020 & 2023

Health Value Gold Award for Population Health Management

The Institute awarded US HealthCenter with the highest level honor of a Gold Award in Population Health Management: “Utilizing their proprietary US HealthCenter’s PredictiMed™ AI technology and service platform, US HealthCenter was able to demonstrate their ability to predict and reduce risk. In its application, over 3,200 cases were mitigated, resulting in a savings of over $28M.”

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2022-Present

Validation in Financial Risk Burden Predication

The Institute validated PredictiMed™ AI’s ability to predict the amount of Financial Risk Burden, or potential spending for future patients, with a margin of error of 8%.



For more information, we offer a no-obligation proposal to estimate potential savings for your company.





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