Frequently Asked Questions
Everything you need to know about Section 125 plans and Optiv Health benefits.
About Section 125 Plans
What is a Section 125 plan?
A Section 125 plan (also called a "cafeteria plan") is an IRS-approved benefit program that allows employees to pay for certain qualified expenses using pre-tax dollars. This reduces taxable income for employees and payroll taxes for employers.
How does a Section 125 plan save money?
Employees save because their contributions come out before federal income tax, Social Security tax, and Medicare tax are calculated. Employers save 7.65% on every dollar contributed (the employer portion of FICA taxes).
What benefits can be included in a Section 125 plan?
Qualified benefits include health insurance premiums, dental and vision coverage, flexible spending accounts (medical and dependent care), disability insurance, life insurance (up to $50,000), and supplemental health plans like Optiv Health.
What's the minimum company size for a Section 125 plan?
There's no legal minimum, but Section 125 plans are most cost-effective for companies with 25+ employees. The administrative costs become negligible at that scale.
Do Section 125 plans require a written document?
Yes. IRS regulations require a formal written plan document that describes the benefits offered, eligibility requirements, and election procedures. Optiv Health provides all necessary documentation.
About Optiv Health
Does Optiv Health replace my current health insurance?
No. Optiv Health is a supplemental benefit that works alongside your existing major medical coverage. Employees keep their current health insurance while gaining additional benefits like free prescriptions and telehealth.
How much does Optiv Health cost employers?
Most employers actually save money with Optiv Health. The FICA tax savings and reduced claims costs typically exceed the plan costs, resulting in net savings of $600-900 per employee per year.
What's included in the Optiv Health supplemental plan?
Our plan includes: 1,000+ free generic prescriptions at $0 copay, unlimited 24/7 telehealth visits, pre-tax premium deductions, and preventive care support. All benefits are accessible from day one with no deductibles.
Is there a long-term contract?
No. We don't lock employers into multi-year contracts. Our 98.4% renewal rate proves that clients stay because the product works, not because they're contractually obligated.
How long does implementation take?
Typically 2-3 weeks from decision to live benefits. We handle the plan documentation, employee enrollment, and system setup. Most employers spend less than 2 hours total on the process.
Free Prescriptions
Which medications are free?
Our formulary includes 1,000+ generic medications across every major category: cardiovascular, diabetes, mental health, respiratory, antibiotics, pain management, and more. These cover approximately 85% of all prescriptions written in the US.
What if my medication isn't on the formulary?
Employees continue using their regular health insurance for medications not on our formulary. Optiv Health supplements existing coverage — it doesn't replace it.
Where can employees fill prescriptions?
At any of 60,000+ participating pharmacies nationwide, including major chains like CVS, Walgreens, Walmart, and Rite Aid. Employees simply present their Optiv Health ID card.
Is there a limit on free prescriptions?
No. Employees can fill as many qualifying prescriptions as they need. There are no monthly limits, annual caps, or quantity restrictions.
Telehealth
What can be treated through telehealth?
Most common health issues: cold/flu, allergies, sinus infections, UTIs, rashes, pink eye, digestive problems, mental health consultations, and prescription refills. Approximately 85% of non-emergency issues can be resolved virtually.
Is telehealth available 24/7?
Yes. Employees can connect with licensed physicians 24 hours a day, 7 days a week, 365 days a year. Average wait time is under 10 minutes.
Can telehealth doctors prescribe medications?
Yes. Telehealth physicians can prescribe most non-controlled medications. If the prescription is on our formulary, the employee pays $0. Prescriptions are sent electronically to their preferred pharmacy.
How much does a telehealth visit cost?
$0. Telehealth visits are unlimited and free for all enrolled employees. There are no per-visit fees, copays, or hidden charges.
Enrollment & Administration
How do employees enroll?
Through a simple online portal that takes about 15 minutes. Employees can enroll from any device. We provide enrollment materials and support throughout the process.
Can part-time employees participate?
Yes. There are no minimum hours requirements for Optiv Health. Employers set their own eligibility rules within IRS guidelines.
What administrative burden falls on HR?
Minimal. We handle member support, claims processing, and ongoing administration. HR typically spends 1-2 hours per month on routine tasks like adding/removing employees.
Can employees change their election mid-year?
Per IRS regulations, Section 125 elections are generally locked for the plan year. Changes are allowed for qualifying life events (marriage, birth, job change, etc.).
Still Have Questions?
We're happy to answer any questions not covered here. Schedule a call and we'll walk through everything.
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