OACEUS — Employer Savings Assessment

Program Overview

What is the OACEUS Preventative Health Program?

The OACEUS program is a legally compliant, IRS-backed benefit strategy that allows employers to redirect existing payroll tax dollars into a self-insured supplemental medical plan — saving $650–$1,000 per eligible employee per year in FICA taxes while delivering real preventive healthcare to your workforce at zero net cost to employees.

Preventive Care Benefits

What Your Employees Receive

Every enrolled employee gains immediate access to a comprehensive suite of virtual and preventive health services — all documented under CPT and ICD codes for compliance and audit readiness.

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Virtual Primary & Urgent Care

$0 copays for doctor visits — 24/7 nationwide access with no out-of-pocket cost. Reduces ER visits by up to 40%.

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Whole Family Coverage

Coverage extends to all family members — including grandparents. Clinical coordination ensures every generation gets the care they need.

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Prescription Medications

$0 copay on over 1,000 medications — covering the most commonly prescribed drugs at no cost to employees.

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Mental Health & Behavioral Care

$0 copay for mental health visits. Licensed psychologists, therapists & board-certified psychiatrists available virtually, nationwide.

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Nationwide Coverage

Full coverage across all 50 states with clinical coordination — no referrals, no networks, no barriers to access for employees or their families.

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Musculoskeletal (MSK) Care

AI-driven digital therapy with live clinicians. Up to 66% reduction in surgical claims & 50% fewer Rx costs for back, joint & muscle conditions.

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Preventive Lab Panels (CMP)

$0 copay — comprehensive metabolic testing to identify early indicators for diabetes, liver, and kidney conditions.

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GLP-1 Weight-Loss & Metabolic Health

$249.99/month includes care team, labs — physician-supervised treatment delivering up to 15% body-weight reduction and improved metabolic markers.

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Virtual Dermatology

$0 copay — remote skin consultations, diagnoses & personalized treatment plans through a secure online platform. Get expert dermatology care without waiting weeks for an in-person appointment.

✔ Covers all major skin conditions
✔ Expert care delivered to any device
✔ 3 visits per year

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Pet Telehealth

$0 copay — connect with experienced vets 24/7 on health, behavior & wellness, nationwide.

✔ All pets covered under one plan — no per-pet limits
✔ Immediate access to licensed veterinary providers
✔ Save up to 75% on pet medications — prescriptions accepted at 68,000 pharmacies nationwide

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Guaranteed-Issue Universal Life Insurance

Average benefit: $100–$150K — permanent, portable universal life insurance with cash value & living benefits.

✔ No medical exam required — guaranteed issue
✔ Permanent coverage employees keep forever
✔ Fully portable — stays with the employee even if they leave
✔ Death benefit paid directly to the beneficiary
✔ Funded from after-tax savings at zero net cost to the employee

IRS & Legal Framework

Built on Binding Federal Guidance

The OACEUS program was designed and reviewed by nationally recognized ERISA & tax attorneys and is fully grounded in authoritative IRS and ERISA authority.

IRC § 125

Cafeteria Plan

Enables employees to fund participation with pre-tax salary reductions, reducing FICA, federal income tax, and state income tax — keeping paychecks completely neutral.

IRC § 213(d)

Qualified Medical Expenses

All services qualify as medical care under § 213(d) — covering diagnosis, prevention, treatment, and care for physical or mental conditions.

Tri-Agency Ruling 2024

IRS, DOL & HHS Guidance

Program structure reviewed under the 2024 Tri-Agency Ruling governing integrated health plan arrangements — ensuring compliance across all three federal agencies.

ACA Integration

Compliant Group Health Plan

OACEUS integrates with your existing ACA-compliant group health plan — or a MEC plan if needed — satisfying all employer-mandated coverage rules.

IRC § 105

Self-Insured §105 Structure

The OACEUS program is structured as a self-insured supplemental medical plan under IRC § 105 — not a wellness program, not a stipend, not a fringe benefit. Each of the following compliance pillars is explicitly addressed in the program's governing documents and legal opinion letter.

✅ Medical Benefit Classification

Treated as Medical Benefit — Not a Wellness Incentive

Benefit payments under the §105 plan are classified as tax-exempt medical benefits, not wellness incentives or reward bonuses. This distinction is critical — wellness incentives are taxable; §105 medical benefits are not. All plan payments are tied to documented medical services under CPT and ICD codes, ensuring they qualify as unreimbursed §213(d) medical expenses and receive proper tax-free treatment.

📜 Revenue Ruling 69-154

Preventive Education Trigger — Cited & Applied (Sections 2 & 3)

Revenue Ruling 69-154, Sections 2 and 3, is expressly cited as the governing IRS precedent for the fixed indemnity trigger structure. Under this ruling, the completion of preventive education modules qualifies as the medical-care trigger event that activates the §105 benefit payment — confirming that the program's reward mechanism is grounded in binding, precedential IRS guidance, not administrative convenience.

⚖️ Nondiscrimination Rules

Nondiscrimination Requirements Acknowledged & Addressed

Self-insured medical plans under §105 are subject to IRC §105(h) nondiscrimination rules, which prohibit discriminating in favor of highly compensated employees (HCEs) in terms of eligibility or benefits. The OACEUS plan is designed to meet these requirements — all eligible employees are offered identical benefits on identical terms, and annual nondiscrimination testing protocols are built into program administration.

🏛️ DOL Authority

DOL Permits the Opt-Out Structure

The Department of Labor explicitly allows opt-out structures within ERISA-governed benefit plans, including §105 self-insured medical arrangements. OACEUS's auto-enrollment with opt-out design is consistent with DOL guidance on voluntary participation and is reflected in the plan's Summary Plan Description (SPD) and governing documents. Employees retain the right to opt out — but must complete 3 educational modules first, consistent with informed-consent principles the DOL endorses.

ERISA

Plan Documentation & DOL Compliance

Each employer receives full written plan documents, Summary Plan Description (SPD), named fiduciary designation, COBRA compliance, and DOL Tech. Release 92-01 plan-asset treatment. The opt-out structure is expressly permitted under ERISA and DOL guidance — reflected in every employer's governing plan documents.

"When integrated with an ACA-compliant health plan and operated per its governing documents, the OACEUS Preventative Health Program satisfies the applicable requirements of the Internal Revenue Code, the Affordable Care Act, ERISA, and the Department of Labor."

— Darcy L. Hitesman, J.D. · Hitesman Law P.A. · Legal Opinion Letter, October 20, 2025

🛡️ $500,000 Employer Legal Protection 🛡️ $10,000 Per Participant Protection

FICA Savings Calculation

Side-by-Side Paycheck Comparison

The example below shows how the same $5,500 gross paycheck looks without and with the FICA plan — identical net pay, but the employer saves on every participating employee.

	Without FICA Plan	With FICA Plan
📋 Gross & Pre-Tax Deductions
Gross Pay	$5,500.00	$5,500.00
401(k) Pre-Tax	−$400.00	−$400.00
Medical (Pre-Tax)	−$250.00	−$250.00
Dental (Pre-Tax)	−$50.00	−$50.00
Sec. 125 FICA Plan Deduction	—	−$1,250.00
Taxable Gross Wages	$4,800.00	$3,550.00
🧾 Tax Withholdings
Federal Income Tax	−$367.20	−$271.57
State Income Tax	−$491.04	−$234.30
Social Security (Employee 6.2%)	−$297.60	−$220.10
⚙️ FICA Plan Items
Admin Fee	—	−$150.00
UL Insurance Premium $150,000 Benefit	—	−$279.87
Sec. 105 Benefit (Added Back)	—	+$1,250.00
💵 Net Take-Home Pay	$3,644.16	$3,644.16

FICA Taxable Wage Reduction

$1,250 / paycheck

Employer FICA Savings (7.65%)

$95.63 / paycheck

Monthly Admin Fee

−$30.00 / month

Net Annual Employer Savings

$787.50 / employee

Employee Net Pay Change

$0.00 — Identical

After the $30/month admin fee, the employer nets $65.63/month ($95.63 − $30.00) per participating employee — $787.50/year. Employee take-home pay remains exactly the same.

Employee Qualifications

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Health Insurance Offered

Employees must be offered health insurance by their employer — but they are not required to enroll. The offer of coverage is what qualifies, not participation in the plan.

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Full-Time Employees Only

Employees must work a minimum of 30 hours per week and be classified as full-time. Part-time and seasonal employees do not qualify for the FICA savings program.

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Eligibility Based on Tax Withholdings

Each employee's eligibility is determined individually based on their actual tax withholdings. To assess eligibility, the following information is collected:

✔ Gross wages
✔ Payroll deductions
✔ W-4 filing status

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Disqualification Threshold

If an employee's tax withholdings are not sufficient to cover the program benefits after the Section 125 reduction, that employee will be disqualified from participation. Eligibility is reviewed on an individual basis at enrollment.

📊 Your Estimated Savings — Live Preview

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Annual Employer Savings

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Per Employee / Year

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5-Year Projection

🎉 Your Savings Report is Ready and will be emailed to you

Based on your workforce profile, here's your estimated FICA savings opportunity with OACEUS.

Gross FICA Savings (Before Fee)

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Total employer FICA tax reduction before admin costs

Less: Admin Fee

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$30/mo × 12 months × eligible employees

Net Annual Employer Savings

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After $30/mo admin fee · Single: $512/yr · With Dep: $788/yr

5-Year Net Savings Projection

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Net of admin fee · compounded over 5 years

Net Blended Savings Per Employee

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Weighted avg after fee · single ($512/yr) & dependent ($788/yr)

Enrolled Participants (90%)

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Auto-enrollment with opt-out · 90% of eligible full-time employees

Next Step

Schedule Your Free
Strategy Consultation

Your organization qualifies for significant FICA savings.

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The OACEUS program has been reviewed and found compliant by ERISA & tax attorneys (Oct 2025). Savings estimates are projections based on program averages of $650–$1,000 per eligible employee annually, assume a 90% enrollment rate via auto-enrollment with opt-out, and are not guarantees. Individual results vary.

📋 Personalized Program Insights

Enrollment & How It Works

From Eligible to Enrolled in 35 Days

OACEUS uses auto-enrollment to achieve 90% participation. Here's how it works.

⏱ Average Time to Full Enrollment: 35 Days

Auto-Enrollment Structure

Employees Are Automatically Enrolled with Opt-Out Option

All eligible employees are enrolled by default with the option to opt out. This maximizes participation while keeping employees informed and in control. Employee take-home pay remains identical — only the tax classification changes.

3 Required Modules Before Opt-Out

Employees Complete 3 Introductory Education Modules

Employees complete 3 short modules explaining the program, their rights, and how it works. This ensures informed decisions and reduces uninformed opt-outs. On average, fewer than 10% opt out — resulting in the 90% enrollment rate.

Direct Enrollment Specialist

Your Dedicated Enrollment Specialist Drives the Process

Every employer gets a dedicated specialist who manages employee communication and onboarding. Your specialist ensures employees understand the program and complete enrollment.

HRIS & Payroll Integration

Seamless HRIS System Setup with Your Payroll Platform

OACEUS integrates directly with your existing payroll system. No duplicate data entry, no manual processes. Your specialist handles the technical setup with your payroll team.

Supported Payroll Platforms

OACEUS requires cloud-based payroll with push/pull capability for seamless data exchange. Direct API integrations with 30+ payroll vendors handle data extraction automatically — with our preferred partners delivering the fastest setup:

Paylocity

PrismHR

ADP Workforce Now

Paychex Flex

Gusto

Rippling

Ceridian Dayforce

UKG Pro

Isolved

Paycom

+ 20 more

Implementation Complexity Guide

Not all environments are equal. Here's how different payroll and HR setups affect rollout complexity — and what to expect:

3rd Party Payroll Platform and OACEUS Handles 90% of Administrative Burden — your team's lift is minimal regardless of environment

Low Employer Effort

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90% Average Enrollment Rate

Auto-enrollment with required education modules consistently delivers 9 out of 10 eligible employees enrolled and generating savings.

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35-Day Implementation Timeline

From contract signing to first active payroll with FICA savings — your dedicated specialist handles everything in under 5 weeks.

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API Feeds with 30+ Vendors

Cloud payroll integration plus OACEUS tax engine delivers zero manual data entry in most environments.

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3-Module Employee Education

Employees complete 3 short education modules before opting out — ensuring informed decisions and minimizing unnecessary opt-outs.

Ideal Enrollment Environment & Rollout Best Practices

What Makes a Rollout Succeed

The right conditions and strategy dramatically accelerate time-to-savings. Here's what the ideal OACEUS implementation looks like — both technical environment and rollout approach.

Technical Environment

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Cloud-Based Payroll

Push/pull capability is essential. Cloud payroll systems allow OACEUS's API and tax engine to extract wage data, push deduction codes, and sync changes automatically — eliminating manual reconciliation every pay cycle.

Best integrations: Paylocity, PrismHR, ADP
API feeds handle data extraction where available
Reduces employer admin to near zero

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High Paper-Check Environments

Hardest implementation scenario. Paper-check payroll lacks the digital infrastructure for API connectivity — requiring manual data exchange and increasing coordination time significantly.

Longer setup timeline expected
Additional specialist touchpoints required
Transition to cloud payroll recommended first

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No HR Team + High Turnover

More complex rollout scenario. Without a dedicated HR point of contact and with frequent workforce changes, onboarding and re-enrollment cycles require more active specialist involvement.

OACEUS specialist provides additional support
Automated HRIS feeds reduce re-enrollment burden
Still achievable — just requires more coordination

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3rd Party Payroll Platform and OACEUS Handles 90% of Administrative Burden

Low employer lift regardless of environment. OACEUS's platform, enrollment specialists, and tax engine absorb the overwhelming majority of administrative tasks — document collection, eligibility testing, deduction setup, and compliance monitoring.

APIs and tax engine automate data extraction
Employer team involvement is minimal
Compliance and audit support fully managed

Rollout Best Practices

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Start with Executives & Direct Report Managers

Leadership is enrolled and educated before any other employees. This ensures executives and managers understand the program inside and out — so they can field questions confidently and reinforce messaging rather than inadvertently creating confusion.

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Implement Outside Open Enrollment

Launching OACEUS outside of your annual open enrollment window produces the best adoption rates. During open enrollment, employees are overwhelmed with benefits decisions — OACEUS gets lost. A dedicated rollout window keeps focus sharp and questions manageable.

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Independent Legal Review Recommended

While the OACEUS program has been reviewed for compliance by ERISA & tax counsel, we strongly encourage all employers to consult with their own independent legal representative before implementing this or any tax-savings program. Your legal advisor can confirm that the program structure is appropriate for your specific workforce, state jurisdiction, and existing benefit plan design — and that your organization is fully protected prior to enrollment.

Employer FICA Savings
Assessment

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Strategy Consultation

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Employer FICA SavingsAssessment

🎉 Your Savings Report is Ready and will be emailed to you

Schedule Your FreeStrategy Consultation

Chat with CVRD

Employer FICA Savings
Assessment

Schedule Your Free
Strategy Consultation