YES. The CHAMP Plan is not a wellness plan nor a reimbursement plan. Therefore, Section 105 is not applicable towards this plan. The CHAMP plan is a complementary healthcare plan that overlays the traditional benefit plan. It is a qualified Section 125 cafeteria plan. It is set up as a self-funded employer sponsored plan that is 100% funded by the employees through a pre-tax payroll deduction. The amount deducted represents the maximum claims for the policy year. The Third Party Administrator (TPA) holds the monies in a custodial account and pays claims as they incur in accordance with the plan document and the schedule of benefits. The definition of a claim is defined as 1. Claims made to Providers, 2. Claims made to Facilities, 3. Claims made to Pharmacies, and 4. Claims made to Employees. Claims made to employees are triggered when an applicable CPT code is triggered with a corresponding explanation of benefits (EOB). Examples of these claims are preventive examinations, biometric screens, health risk assessments, chronic medication fulfillment, etc.. Claims made to employees are not taxable nor considered ordinary income. The amount of premium charged to the employees is actuarially set to cover the claim risk on the plan while meeting a desired medical loss ratio (MLR). At the end of the plan year and the runout period, any surplus left in the claim account is considered a plan asset to the employer. 

NO. The CHAMP Plan is a separate medical plan with it’s own plan document and benefit schedule. Any claim processed through the CHAMP will follow suit in accordance to those outlined rules. Claims processed through the traditional HDHP w/HSA will need to meet the minimum first dollar cost share requirements by the employee to remain qualified. 

YES. The CHAMP Plan is an employer sponsored health plan and meets the definition of Minimum Essential Coverage.

$573 Per Employee Annually!