Our solution
MERP solutions that reduce healthcare costs
The most comprehensive cost-saving solution imaginable: a Medical Expense Reimbursement Plan that bolts onto the benefits you already offer, lowers your claims risk, and gives participants 100% coverage with $0 out of pocket.
Tax savings
Reimbursements under a compliant Section 105 plan are tax-free to the employee and deductible for the employer.
Employee retention
Participants get the best coverage of their careers. Better benefits reduce turnover and free up budget for training, recruitment and more.
Compliance, handled
Plan document, SBC, SPD, reporting and compliance are part of every engagement. AICPA SOC compliant and Validation Institute validated.
Uniquely effective
Catilize Health® offers opportunities for savings and enhanced coverage by transitioning employees, spouses, and dependents (children) from your group medical plan to another employer-sponsored plan. Catilize Health has developed unique insights from administering our program for 17 years for all size employers around the country. Our market-leading experience means that we have the proven track record of delivering a turnkey solution that you can have confidence in when you decide to engage us.
New to the concept? Read our plain-English guide: What is a MERP?
How Section 105 plans work
Section 105(h) of the Internal Revenue Code allows an employer to fund a plan that reimburses employees for eligible medical expenses. Catilize Health’s program pairs that MERP with spousal-plan enrollment: eligible employees and their dependents enroll in the spouse’s employer-sponsored plan, waive your group medical plan, and the MERP reimburses the family’s copays, coinsurance and deductibles on the spouse’s plan, up to the out-of-pocket limits set by the Affordable Care Act. Your plan sheds the claims risk for that family; the spouse’s insurer carries the large claims.
Spousal carve-out options
Employers managing working-spouse costs usually reach for a spousal carve-out or a spousal surcharge. Both take something away, and employees feel it. The spousal MERP is the incentive version of the same strategy: employees move to the spouse’s plan because their family is better off, with 100% coverage and $0 out of pocket, and the employer still captures the savings. Participation is voluntary and the benefit is visible every time a bill is reimbursed.
Tax deductions
When the plan is properly documented and administered in compliance with IRS rules, reimbursements are tax-free to the employee and deductible to the employer. Catilize Health provides the plan document, SBC, SPD and compliance support as part of its turnkey administration.
Claims process
Participants show the spouse’s plan ID card first and the MERP ID card second. Where the provider accepts the MERP card, the plan pays the out-of-pocket cost. Otherwise the participant pays up front and submits the EOB with the receipt or bill; Catilize verifies eligibility and in-network status and reimburses, typically within two weeks and never longer than 30 days.
Risk management
Measurable, predictable, repeatable reductions in the number, size and frequency of claims.
Explore risk management →Economic value
Convert OpEx into EBITDA with a program that is cash-flow positive in the first 30 days.
Explore economic value →NetZero Health Plan
Perfect for the employee. Ideal for the employer. Zero out-of-pocket for the whole family.
See the NetZero plan →Common questions
What is a MERP?
A MERP is a Medical Expense Reimbursement Plan: an employer-funded plan under Section 105 of the Internal Revenue Code that reimburses employees for eligible medical expenses. Catilize Health administers a spousal MERP, where eligible employees and dependents enroll in a spouse’s employer-sponsored plan and the MERP reimburses their out-of-pocket costs.
Does the MERP replace our current health plan, carrier or broker?
No. The MERP is a bolt-on. You add it to your current menu of medical plans without changing your broker, advisor, consultant, insurance carrier or TPA. Catilize Health does the rest.
What does Catilize Health handle?
The full turnkey engagement: plan document, SBC, SPD, communications, enrollment, claims adjudication, customer service, reporting, compliance and security. There is no new administrative burden for your HR team and no loss of control.
How is the program priced?
On savings. Our compensation model is built on complete alignment: you pay based on the money you’ve saved. If the program is not creating savings, you are not paying for it.
Who can participate?
Employees currently enrolled in your medical plan whose spouse has access to coverage through his or her own employer’s plan. Spouses on Medicare, Tricare, Medicaid, individual Marketplace plans, HDHPs with active HSA contributions, stand-alone HRAs, short-term or limited-benefit plans are not eligible, nor are self-employed spouses.
Surprisingly different.
Convert healthcare liability into evergreen enterprise value.