A medical expense reimbursement plan that works beside your group plan
A MERP, or medical expense reimbursement plan, sits beside your group medical plan and pays employees back for some of their out-of-pocket costs, like part of the deductible. The group plan still does the heavy lifting. You decide what the MERP covers, employees get care as usual, and the company funds what is used.
You want your people to feel covered when they need care. You also want a say in how the medical budget gets spent. A MERP lets you keep a group plan people feel good about and choose how much the company helps with out-of-pocket costs.
Coverage people feel good about, with a budget you shape
Sound familiar?
- Your renewal went up and you’re looking for room.
- A higher-deductible plan makes sense on paper, but you know employees will see that deductible and worry.
- You want people to go to the doctor when they need to, without thinking twice about the bill.
- You’d like more say in where the money actually goes.
What a MERP is
A medical expense reimbursement plan, or MERP, is a plan you set up beside your group medical plan. It pays employees back for some of their out-of-pocket medical costs, like part of the deductible. The group plan still does the heavy lifting. The MERP sits next to it and covers the piece you choose.
How a MERP works, step by step
Picture two layers. The bottom layer is your group medical plan. The top layer is the MERP, which picks up part of what employees would otherwise pay themselves.
1. Choose the group medical plan
We start with the group medical plan. Often it’s a plan with a higher deductible.
2. Decide what the MERP covers
You pick which costs the MERP pays back, like part of the deductible or coinsurance, and how much of it the company picks up.
3. Employees get care as usual
Your people use their medical plan and their ID card the same way they always do. Nothing changes at the doctor’s office.
4. Claims are reimbursed
When a covered out-of-pocket cost comes up, the MERP pays back the amount the company chose. That runs through the plan administrator after the claim.
5. The company funds what is used
Reimbursements go out as claims happen. So the company funds what people actually use, instead of setting aside a fixed amount up front.
Who a MERP fits
Employers facing a renewal increase who want to keep coverage strong
If your renewal jumped and you don’t want to just cut benefits, a MERP is one of the options worth pricing. Here’s more if you’re facing a renewal increase.
Companies moving to a higher-deductible plan who want to soften the deductible
The higher deductible stays on the plan, but the company can pick up part of it so employees don’t feel the whole thing.
Owners who want more say in how out-of-pocket costs land on their people
You decide what’s covered and how much. If you want to help most with the deductible, you can set it up that way.
Growing companies building a fuller package
A MERP can be one piece of a bigger package. If that’s where you are, read about building a fuller package. It can also come up when you’re combining plans after a deal.
When a different approach fits better
A MERP isn’t the right fit for everyone. Some teams want the simplest plan possible, with one card and nothing else to explain. Some employers want a fully fixed monthly amount with no reimbursements going out during the year. If that’s you, we’ll look at group medical plans on their own, or you can keep medical and add the extras like dental and vision, voluntary benefits, and HealthiestYou by Teladoc Health.
How we set it up together
1. Hear your goals
We talk about your people, your budget, and how you want to help with out-of-pocket costs.
2. Bring the market
I compare group plans in your market that pair well with a MERP. Whether you’re looking at a MERP for employers in Austin, in Dallas Fort Worth, or around Houston, the plans available where your people live shape what makes sense.
3. Fit the strategy to your goals
We choose what the MERP covers and how much the company picks up, and you see it side by side with the group plan.
4. Explain it to employees
Clear launch materials and meetings, so your people know how the reimbursement works before they ever need it.
5. Stay with HR
Questions about claims and reimbursements come to me and my team. More on how I work.
What you walk away with
- A group plan and MERP designed together
- A plain-language explainer for employees
- Enrollment help
- A person to call with questions all year
Who this is for
This is for owners, CFOs, and HR leaders weighing a higher-deductible plan or staring at a renewal. I’m based in the Austin area, Texas, and I work with employers along the I-35 corridor from Austin to DFW and in the Houston, Conroe and The Woodlands area.
Questions about MERPs
How is a MERP different from just picking a lower-deductible plan?
With a lower-deductible plan, the lower deductible is built into the plan and the premium. With a MERP, you keep a higher-deductible plan and the company pays back part of the deductible when people actually use care. You choose how much.
Do employees have to do anything differently when they get care?
No. They use their medical plan and ID card the same way. The only new piece is the reimbursement step, and we explain that at launch so nobody's surprised.
How do employees get reimbursed?
After the claim, the reimbursement runs through the plan administrator. Employees get back the amount the company chose to cover.
Can we choose which costs the MERP covers?
Yes. The company chooses which out-of-pocket costs are covered and how much it picks up.
Can a MERP be added at renewal?
Yes. It's usually designed alongside the group plan at renewal, so the two fit together. If your renewal just came in, start with what to do when your renewal goes up.