Preventive health care is no longer simply a nice thing to do; it's a must for business. Employers that are ahead of the curve know that healthy workers use fewer sick days, are more productive, and pay less overall for healthcare. That's why preventive care is a key feature of the Lumara Plan. It combines the advantages of a Section 125 cafeteria plan with a sophisticated self-insured medical reimbursement plan (SIMRP) to provide a better, cheaper way for companies of all sizes to get health care.
In this blog post, we'll explain precisely what the Lumara Plan's preventive care program covers, how it works inside the tax-advantaged framework of Section 125, and why it's good for both employers and workers.
The Basics: How the Lumara Plan Uses Section 125 and SIMRP Together
It's necessary to know how the structure works in order to know what's covered.
The Lumara Plan is not like other benefits programs. It uses the tax benefits of a Section 125 cafeteria plan, which lets workers pay for some perks with pre-tax cash, and the strategic flexibility of a self-insured medical reimbursement plan. This two-part structure makes guarantee that:
Employers cut payroll taxes without raising costs
Employees get more money in their paychecks and are paid back for preventive care
All programs are still completely compliant with the IRS
The SIMRP section of the Lumara Plan covers preventive care services that workers may get tax-free if they take part in a qualifying care event.
What Kinds of Preventive Care Are Covered?
The Lumara Plan's preventive care approach is based on common, important medical services that assist find health issues early and encourage long-term health. These services follow ACA-compliant guidelines and may be fully reimbursed under the self-insured medical reimbursement plan.
Here are the main groups:
Yearly Health Checkups
These are the most important parts of preventive care:
Full physical exams
Assessments of health risks
Checks of vital signs
Checking blood pressure, cholesterol, and BMI
Counseling for health prevention
Why it matters: Finding chronic diseases like diabetes and high blood pressure early leads to better results and lower long-term expenses.
Shots
The Lumara Plan's preventive care program covers the following vaccines:
Shots for the flu
Vaccines and boosters for COVID-19
Tdap stands for tetanus, diphtheria, and pertussis
Hepatitis A and B
MMR (measles, mumps, and rubella)
HPV and shingles (as suitable for age)
Why it matters: Keeping your employees vaccinated helps stop epidemics and cuts down on lost work due to sickness that might have been avoided.
Tests for Cancer
Finding cancer early saves lives and makes treatment a lot less expensive. Screenings that are covered:
Pap smears and pelvic examinations (for cervical cancer)
Mammograms (to check for breast cancer)
Tests of the stool or colonoscopy (for colorectal cancer)
PSA testing, which are suggested for prostate cancer
Skin exams and assessments by a dermatologist
Why it matters: Finding malignancies early not only increases the chances of survival, but it also lowers the number of insurance claims and sick days.
Blood Tests and Lab Work
Routine blood tests are important for finding hidden risk factors like:
A lot of cholesterol
High levels of glucose or A1C (pre-diabetes or diabetes)
Function of the thyroid
Signs of good liver and kidney health
Why it matters: These tests provide doctors baseline information that lets them suggest lifestyle or treatment adjustments that will assist patients before they become sick.
Services for Women's Health
The Lumara Plan provides OB/GYN examinations and other specialized preventive care for women in addition to general health services:
Checkups for breast health
Counseling about birth control
Health care before conception
Why it matters: Women frequently put off getting treatment because of the expense or lack of coverage. The Lumara Plan gets rid of the impediments and promotes long-term health.
Health Screenings for Men
Men are less likely to go to the doctor regularly, so the scheme encourages them to get:
Prostate health exams
Exams of the testicles
Tests for heart health
Check-ins for behavioral health
Why it matters: Proactive treatment for men may help find silent killers like heart disease before they become worse.
Preventive Care for Kids and Teens
For employers that cover dependents, the plan helps keep kids healthy by offering services like:
Visits for healthy children
Vaccines by age group
Checkups for vision and hearing
Tests of growth and development
Why it matters: Keeping kids up to date on their care helps them go to school more often and keeps parents from missing work.
How Preventive Care Is Given and Paid For
Employees use their usual providers for qualifying preventive care. The Lumara Plan's SIMRP pays the employee back, tax-free, for using the service after it has been recorded.
This approach is paid for by the employer, but the costs are completely covered by the payroll tax savings that come from the Section 125 cafeteria plan's pre-tax deductions. Employers don't have to pay anything more outside the payroll taxes they already pay. Most firms really save more than they spend, which means they are more tax-efficient.
Here's a simple flow:
The employee gets a preventive care service
The Lumara platform is used to send in documents
The employee gets the reimbursement directly
Employer keeps the money they save on payroll taxes
Following the Rules Without the Stress
The IRS rules are what the preventive care program is based on. All refunds are:
Not taxable under IRC Section 105
Linked to qualifying preventive events as specified by ACA and IRS rules
Handled by the right plan documents that Lumara keeps up to date
Employers don't have to bother about filling out papers, keeping track of paperwork, or going through audits. The Lumara Plan takes care of everything, such as:
Keeping a Section 125 cafeteria plan paperwork that is up to code
Running the self-insured medical reimbursement plan in full compliance with the law
Sending out warnings and messages to employees
Doing the necessary tests for discriminating
This ready-to-use framework gets rid of risk while providing steady health and tax advantages.
Why This Program to Stop Problems Works
Other plans provide preventive care, but not many are based on behavioral involvement and direct reimbursement. That's what sets the Lumara Plan apart:
The employer doesn't have to pay any more premiums
The employee doesn't have to deal with complicated claims procedures
Clear reasons to become involved in caring
Immediate savings from pre-tax deductions and a smaller payroll tax bill
Real-time incentives hinge on preventative care, not merely "included"
Real Employers Get Real Results
Employers that use the Lumara Plan say:
More than $500 in payroll tax savings for each employee each year
Every year, more than $1,000 is paid back to each employee for preventive treatments
No further cost to the employer after tax breaks
More employees getting preventive care, which means fewer sick days and better morale
Last Thoughts: Care That Pays Out in the Long Run
Preventive care is excellent for company, but only if it is set up to save money on taxes, get employees involved, and follow the rules. The Lumara Plan is the only one that offers all three in a fully managed solution. It combines a Section 125 cafeteria plan with a self-insured medical reimbursement plan.
Employers may decrease their total healthcare expenses, cut down on tax waste, and create a healthier workforce by reimbursing workers for necessary, ACA-compliant preventive care services. They can do all of this without spending more money or making things more complicated.
Start Getting Better Care Now. Want to know how your company may save money while making your employees healthier? Set up a bespoke appointment to find out how the Lumara Plan makes preventive care a win-win for your business and your finances.
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