SIMERPU RESEARCH · SOURCE RECAP
SIMERP for Self-Funded Employers: Cut Health Plan Costs With Claim Diversion
SIMERPU recap and commentary: Mardy Gould
Opened — main text retrieved
Quick recap
Markets a combination of payroll-tax savings and shifting care away from the primary self-funded plan. Distinguishes direct payroll assumptions from projected claims and operational savings.
SIMERPU’s viewpoint
The self-funded-employer pitch separates payroll assumptions from projected claims and operational savings. SIMERPU would preserve that separation and evaluate how employees obtain the proposed alternative care. A meaningful financial case should distinguish direct calculations from utilization-dependent projections and avoid counting the same benefit twice.
What this source contributes
The pitch distinguishes direct payroll calculations from projected claims and operational effects.
What remains unanswered
Claim-diversion results depend on utilization, actual service substitution and costs; overlapping savings need to be identified.
Mardy Gould’s take
I would keep separate scorecards for payroll effects and claims experience. Show what is calculated directly and what depends on employees using different care. That makes the proposal easier to assess and later measure. The employer should understand how the care pathway works before treating projected claim reductions as an achieved result.
Questions I would bring to the conversation
1. Which savings are calculated versus utilization-dependent?
2. What evidence supports the projected care substitution?
3. How are overlapping savings and added service costs handled?
Mardy Gould · Co-Founder, SIMERPU →
What would change our assessment?
Actual utilization and claims results, measured against a clear baseline with complete costs, could materially change the projections.
Read the original source
The original author and publisher are credited below. Continue to their article, document or source page for the complete context.
Original Author: SIMERP Qualify
Publisher: SIMERP Qualify
Original Publication Date: Not stated
Read this alongside…
Each connection has a specific purpose. Compare the sources’ facts, positions and publication dates as you read.
Savings Estimate, Preventive Care Management Solution Proposal
City of Chicago
Source position: Neutral / explanatory
Compare the discipline of workforce-specific financial modeling.
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26 CFR § 1.105-11 - Self-insured medical reimbursement plan
Cornell Legal Information Institute (reproduction)
Source position: Neutral / explanatory
Keep the underlying reimbursement-plan framework clear.
Read the SIMERPU recap →
26 CFR §1.105-2 — Amounts expended for medical care
eCFR / Office of the Federal Register
Source position: Neutral / explanatory
Examine payroll reimbursement treatment separately from projected claims savings.
Read the SIMERPU recap →
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About this source
Original Updated Date: Not stated
Source Type: Vendor / adviser marketing or advocacy
Model Discussed: SIMERP / §125 savings plus claim diversion
Position: Promotional
Period: Undated / current reference
Retrieved: October 31, 2026
Each record identifies the material retrieved. SIMERPU’s viewpoint and Mardy Gould’s take are editorial commentary; the source-position label describes the original source’s stance. Read the original and its qualifications when evaluating a particular arrangement.
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