Customize Your Healthcare Benefits Plan: Yes, You Can Add the Coverage You Want

The short answer is yes, but the how depends on your employer's benefits program and the type of customization you need. Traditional health plans from big carriers can feel rigid. Modern systems like WellthCare™ prove that real customization, especially adding coverage that improves health and saves money, is possible and increasingly common. You don't have to rip and replace your existing plan to get the coverage you want.

Two Paths to Customization

Most employers and employees can customize coverage through one of two approaches: adding a supplemental layer or moving to a self-funded model that gives you full design flexibility. Here are the options.

1. Add a Complementary System

You can add a system like WellthCare alongside your existing health plan. No rip-and-replace needed. This gives employees additional coverage options immediately:

• $0-co-pay preventive care used before the primary plan, reducing claims and out-of-pocket costs.
• Earned reward dollars at the WellthCare Store™, real, spendable dollars earned through verified preventive actions like scans and lab work.
• Automatic retirement contributions tied to healthy behaviors, building long-term wealth.
• Medical bill review and cost transparency tools that flag overcharges and billing errors.

This method is low-disruption and carries no new out-of-pocket cost to the employer. It is funded through employee pre-tax elections and tax efficiencies, not new employer spending, and gives employees far more than a traditional plan offers.

2. Switch to a Fully Customizable Self-Funded Plan

For organizations ready for deeper change, moving to a self-funded model like WellthCare Complete™ unlocks full customization. No more being locked into a carrier's one-size-fits-all coverage. Instead, you can:

• Design your own network using transparent, negotiated rates, with projected savings of 30-45% vs. BUCA (Blue Cross, UnitedHealth, Cigna, and Aetna).
• Integrate pharmacy benefits through WellthCare Pharmacy™, replacing opaque pharmacy benefit managers (PBMs) with transparent pricing (20-40% projected savings).
• Tailor coverage for high-cost populations, like transitioning eligible employees to WellthCare Medicare™ to reduce employer risk.
• Build prevention incentives directly into plan design, rewarding preventive care instead of only paying for sickness.

Adding Dental, Vision, HSAs, and Other Coverages

Yes, you can customize to include dental, vision, health savings accounts (HSAs), 401(k) plans, and supplemental insurance. In the WellthCare ecosystem, these can be layered on through a unified benefits administration platform. The trick is making sure incentives align, so adding coverage doesn't create waste or duplicate spending. For example:

• HSAs work well alongside a high-deductible health plan (HDHP) and give employees a tax-advantaged account for qualified medical expenses.
• Medicare supplements can be integrated so retirees stay in the same ecosystem, maintaining continuity of care.
• Prevention programs work better when tied to measurable health actions and automatic rewards.

A Quick Compliance Note

Customization must always comply with ERISA, HIPAA, and ACA regulations. When you add or change coverage:

1. ERISA requires clear plan documents and summary plan descriptions (SPDs) that outline all benefits.
2. HIPAA mandates that health information is protected, especially when using data to drive rewards.
3. ACA rules require preventive care coverage without cost sharing, and any essential health benefits a plan covers cannot carry annual or lifetime dollar limits.
4. Non-discrimination testing ensures that highly compensated employees don't receive disproportionate benefits.

WellthCare maintains compliance-grade recordkeeping with audit-ready records for every participant action, which removes much of the administrative burden from employers.

Who Can Customize

Customization has limits worth knowing before you plan. Participation in a WellthCare Plan is open to W-2 employees in the employer's Section 125 plan. Business owners are not eligible: self-employed individuals, partners, LLC members taxed as partnerships, and shareholders owning more than 2% of an S corporation. Their family members can join only if they are eligible W-2 employees themselves. Participants must also be covered under ACA-compliant employer-sponsored group health coverage, either their own employer's or a spouse's. WellthCare works alongside that coverage and is used first. It does not replace it.

How to Start Customizing Today

As an employer, start by auditing your current plan for waste and underused preventive benefits. Then consider adding a zero-net-cost, high-engagement system like WellthCare to test what works. The patent-pending Readiness Index™ will show you, using your own employees' data, exactly where customization saves money, and no upfront commitment is required.

Employees can also ask their HR department: “Can we add a program that rewards prevention and builds wealth?” WellthCare is built to be easy to adopt and prove, so the answer is increasingly, “Yes, and here’s the ROI.”

This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.