Compliance & Legal

Built for Compliance.

Every Wimper Wellness program is designed from the ground up to comply with IRS, HIPAA, ACA, and ERISA requirements — protecting your organization and your employees in all 50 states.

AM Best A+ Rated Carriers

All 50 States

IRS Section 125 Compliant

AM Best A+ Rated Providers

Licensed in All 50 States

COMPLIANCE

Medical services are a key component

The Program is always paired with an ACA-approved medical plan to make an integrated 105 plan.

Deduction of the plan is pre-tax eligible

The deduction of plan cost from an employee's gross wages complies with IRC regulations and creates significant taxable income reduction for employees.

Plans designed for compliance

The plan is purposefully created to comply with IRC 213(d), 106(a), 105(b), HIPAA, ACA and all applicable IRS regulations.

Post-tax program reimbursements

Reimbursements for qualified medical expenses are tax-free and excluded from employee gross income.

Reimbursement allowances

Allowable pre-tax reimbursements are based upon fair market value and applicable IRS regulations.

WELLNESS

IRCS106(a) - ERISA
IRC213(d) - ADA
IRCS105(b) HIPAA
IRC 5125
IRC105.11

MEDICAL

IRC213(d) ACA

PRE-TAX

IRC 213(d)
IRC106(a)
IRC s125

POST-TAX

IRC213(d)
IRC105(b)
1.105.11(i)
104.(A)(3)
1.105.11(k)(1)
1.105.11(k)(2)

AM Best A+ Rated

Highest-Rated Insurance Carriers

All life insurance and benefit programs are backed by top-rated carriers, ensuring strong financial stability and reliable claim support.

Nationwide Coverage

Available in All 50 States

Fully licensed and available across the U.S., ensuring employees are covered wherever they are located.

Preventative Care Management Program

Legal & Tax Overview:

These Preventative Care Management programs operate as an integrated Section 125 medical reimbursement plan, allowing for an annual reimbursement (divided & allocated per pay period) that is excludable from taxable income under IRC Section 105(b), even if the employee incurs or documents no specific medical expenses during a particular month. This is permissible because the program is structured to provide qualified medical care as defined in IRC Section 213(d), which encompasses services for diagnosis, cure, mitigation, treatment, or prevention of disease, including wellness and preventive care.
Under IRS guidelines for Section 105 plans, the minimum requirement to maintain the plan's tax-favored status is at least one qualified Section 213(d) medical care activity per year. However, these programs typically exceed this threshold by delivering a robust suite of services. The Preventative Care Management Programs ensure a conservative approach that aligns reimbursements with the substantial benefits provided.
A key aspect of compliance is the provision of continuous 24/7 access to qualified Section 213(d) medical care. This can include on-demand primary care, urgent care, mental health support, nutritional consultations, fitness coaching, prescription access, and more - all available irrespective of whether an employee actively uses them in any given period. This ongoing availability satisfies the "irrespective" test outlined in Treasury Regulation § 1.105-1, which allows benefits from an employer-sponsored accident or health plan to be excluded from gross income without requiring proof of specific expenses incurred at the time of reimbursement. The reimbursements are thus treated as payments for medical care furnished by the plan itself, rather than as taxable wages, because the program's design directly ties them to the delivery of substantive, always-accessible medical services that qualify under the statute.
This framework mitigates risks of wage recharacterization under IRC Section 3121 and related provisions, as the benefits are rooted in the plan's provision of verifiable medical value, not arbitrary cash payments, protecting against potential penalties.
This framework mitigates risks of wage recharacterization under IRC Section 3121 and related provisions, as the benefits are rooted in the plan's provision of verifiable medical value, not arbitrary cash payments, protecting against potential penalties.

The WIMPER (with SIMERP) Program is firmly grounded in established

federal tax law and IRS guidance:

01

Qualified Structure - The program meets the definition of a Self-Insured Medical Reimbursement Plan (SIMERP) under Treasury Regulation §1.105-11, as it is a written plan providing reimbursement for medical expenses.

02

Non-Taxable Employer Reimbursements - Under IRC §105(b), reimbursements for qualified medical care (as defined in §213(d)) are excluded from employee income. The services provided—ranging from physician access to medications and mental health care—clearly fall within this definition.

03

No Itemization Requirement - Congress has repeatedly declined IRS proposals (2023 and 2024 Greenbooks) to require itemization of reimbursed medical expenses under §105(b). As a result, no itemization is required under current law.

04

Tax Treatment Based on Access, Not Usage - Federal tax treatment hinges on access to medical care, not the level of utilization. This is consistent with IRC §106(a), which excludes employer-provided health coverage from income regardless of whether services are used.

05

Insurance Costs Qualify as Medical Care - IRC §213(d) explicitly includes amounts paid for insurance covering medical care within the definition of medical care.

06

Program Qualifies as “Insurance” Under Federal Law - While not regulated as insurance at the state level, the Program meets the federal definition of insurance established in Helvering v. Le Gierse. The program involves real risk transfer, including variability in utilization, frequency, and severity of claims—hallmarks of an insurance arrangement.

In conclusion, the WIMPER/SIMERP Program delivers significant, measurable value to employees while aligning squarely within established federal tax law and IRS guidance. Its structure as a self-insured medical reimbursement plan, combined with the clear statutory definitions of medical care and longstanding tax treatment principles, provides a strong legal foundation.

Final thoughts directly from the CPA Journal article previously mentioned, the WIMPER concept provides an opportunity for employees to receive cash reimbursements for participation in health and wellness programs with the tax saving benefit of reducing FICA tax liability for both the employee and employer. In addition, employees can save income taxes because, when part of a WIMPER program, pretax contributions of gross pay are made to an IRC section 125 cafeteria plan.

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