IRC §125 · ACA §4980H

THE COVERAGE YOU NEED.
MEASURED, NOT MARKETED.

Major medical for employers who have to meet the mandate and want to choose how far they go. From the compliance floor to full coverage, Optiv calculates the plan that fits what you are trying to do, and funds it through the structure Advantage already built.

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COMPLETECARE CONSOLIDATES COVERAGE

ONE ARCHITECTURE. FOUR PLANS.

The Optiv architecture is one structural framework that supports four plans. Each builds on the next, from broadest reach to most complete coverage. Optiv Advantage is the keystone: the supplemental engine that recovers payroll tax, raises take-home pay, and delivers the care suite. The other three plans depend on Advantage to function.

PLAN 01 · ENTRY LAYER

Optiv Access

Reach the workforce traditional plans miss. The employer-funded entry-layer care benefit for part-time, contingent, and seasonal staff. Never sold standalone; its cost nets out of the Advantage recovery. Pairs with Advantage to deliver 100% workforce coverage.

PLAN 02 · SUPPLEMENTAL

Optiv Advantage

The keystone. The §125 supplemental benefits engine. Recovers payroll tax for the employer, raises take-home pay for employees, and delivers a dedicated primary care physician, the full care suite, Work Shield, Optiv Compass, and the Member App. Built for employers from 10 to 10,000.

PLAN 03 · MAJOR MEDICAL

Optiv CompleteCare

Consolidate major medical onto the architecture. CompleteCare adds ACA-compliant major medical to the Advantage foundation, funded by the savings Advantage delivers. For employers approaching the ALE threshold or consolidating a carrier relationship.

PLAN 04 · FULL SUITE

Optiv PremierCare

The complete benefits stack. PremierCare adds dental and vision to CompleteCare. The full benefits suite, on one structural foundation, funded by the same engine.

Every Optiv engagement runs through Advantage. The other plans are added or removed depending on how the configuration is engineered for your workforce.

THE COST CURVE

HEALTHCARE COSTS RISE FOR EVERYONE ELSE.

Every year, the cost of covering a workforce goes up. Premiums rise, deductibles climb, and the plan an employer renews is rarely better than the one it replaces. This is the curve every business is told to accept. Budget for the increase, pass some of it to employees, and brace for the same letter next year.

CompleteCare exists because that curve is not a law of nature. It is a function of how coverage is bought and funded. Most employers buy major medical the same way: a broker brings a quote, the carrier sets the premium, and the structure underneath never changes, so the cost only moves in one direction. CompleteCare changes the structure. It pairs ACA major medical with the Advantage layer underneath, and the §125 architecture that funds the configuration brings the real cost of coverage down, while everyone still buying the old way absorbs the increase.

That is the position. Better care, the Advantage layer plus full ACA coverage, at a fraction of what the same coverage costs bought the conventional way.

Who This Is For

There is one group this is not for. If you already carry major medical, you do not need CompleteCare, and Optiv will tell you so. The Advantage layer beneath your existing plan already recovers cost and raises your employees’ take-home pay. Adding CompleteCare on top of coverage you already have would be solving a problem you have already solved. For those employers, the Optiv ladder stops at Advantage. CompleteCare is for the employer who needs to put major medical in place, and refuses to overpay to do it.

WHAT THE PLAN DELIVERS

BETTER CARE. A FRACTION OF THE COST.

CompleteCare is not one plan. It is the full range of coverage an employer can put in place, paired with the Advantage layer underneath and funded by the structure that brings the cost down. The care is better because of what sits beneath it. The cost is lower because of how it is funded. Both are true at the same time, and that is the part the conventional market cannot match.

Why The Care Is Better, And Why It Costs Less

Start with what makes the care better. A conventional major medical plan is a single layer: you have coverage, and you use it when something goes wrong. CompleteCare runs major medical on top of the Advantage foundation, so your employees get the dedicated primary care, the everyday access, and the take-home recovery Advantage already delivers, and the major medical coverage sits above it for the larger events. Most people touch primary care all year and major medical rarely. CompleteCare covers both ends, where a standalone plan covers only the far end and leaves the everyday to chance.

Then the cost. The same coverage an employer would buy through a broker, funded the conventional way, costs what it costs and rises every year. Run through Optiv, the §125 structure funds the configuration, and the real cost of the coverage comes down to a fraction of the conventional price. Not a thinner plan for less money. The same coverage, often better, for materially less.

The Coverage Spectrum, And Your One Decision

The coverage itself runs across a full spectrum. At one end is the compliance floor: essential coverage that satisfies the employer’s obligation at the lowest cost. At the other end is full major medical: hospital, surgery, specialists, maternity, imaging, the complete protection. Between them sit the middle options that add everyday care and major-medical value in steps. A quick word on how compliance works, because it drives the choice: the floor-level option satisfies the requirement to offer coverage, while the fuller plans satisfy both that requirement and the higher standard that protects an employer completely. Which one is right depends entirely on what you are trying to do.

There is also a different shape of option. Instead of choosing one group plan for everyone, an employer can fund an allowance and let each employee choose their own individual coverage. That structure is an ICHRA, an individual coverage arrangement, and it shifts the choice from the employer to the employee while keeping the funding and the tax treatment working in the employer’s favor. For some workforces it fits better than a single group plan. For others it does not. It is one more point on the same spectrum, and the same logic decides whether it belongs in your configuration.

That is the choice, and it is the only choice you have to think about: how far up the spectrum your goals take you, and which shape fits your workforce. You do not have to learn the plan types, decode the compliance standards, or guess where you land. You tell Optiv what you are trying to accomplish and what you are working with, and Optiv calculates the point on the spectrum that fits, and sources the plan to fill it from the full market. The coverage you need, measured to the goal. Not the richest plan a broker can sell you.

THE ENGINE UNDERNEATH

THE STRUCTURE DOES THE WORK. EVERY YEAR.

A discount is an event. A structure is a condition. Most cost reduction in the benefits market is the first kind: a carrier shaves the first-year premium to win the business, and the number climbs back at renewal. CompleteCare lowers cost the second way. The Advantage layer underneath the major medical is not a promotion. It is a permanent part of how the coverage is funded, and it does the same work in year three that it does in year one.

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The Mechanism

Here is the mechanism, without the spreadsheet. The Advantage §125 structure recovers payroll cost for the employer continuously, as a function of how the configuration is built. That recovery is applied against the cost of the major medical sitting above it. So the employer is not paying full freight and hoping for a discount. The structure offsets the cost from underneath, every pay period, for as long as the configuration is in place. The major medical is real coverage from a real carrier. What changes is what it actually costs the employer to carry it.

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Why The Renewal Is Different

This is why the renewal conversation is different. For the rest of the market, renewal is the moment the cost resets upward. The carrier reprices, the broker delivers the number, and the employer absorbs it. For a CompleteCare employer, the structure that lowered the cost is still running at renewal, still recovering, still offsetting. The carrier can reprice the major medical, and the market can do what the market does, but the engine underneath does not stop working because a year went by.

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What It Asks Of You

None of this asks more of the employer. The structure runs in the background. Optiv maintains it, the carrier provides the coverage, and the recovery happens through the payroll process already in place. The employer set the configuration once. The work of holding the cost down is the structure’s, not theirs, and it does not take a renewal meeting to keep it going.

WHAT THE PLAN RETURNS

REAL COVERAGE. REAL SAVINGS. ONLY IF YOU NEED IT.

CompleteCare returns three things to the employer: real coverage in place, a cost the market cannot match, and a clear answer on whether you should be on this rung at all.

The Structural Returns

Real Coverage

Whatever point on the spectrum the configuration lands on, the result is real major medical from a real, A-rated, state-licensed carrier, with the Advantage layer running underneath it. The employer’s obligation to offer coverage is met. At the fuller levels, the obligation is met completely. This is not a stopgap or a compliance shell. It is coverage your employees can use, sitting on a foundation that makes it worth more than the same plan bought alone.

Real Savings

The employer carries that coverage for a fraction of what the conventional market charges for the equivalent, because the structure underneath offsets it and keeps offsetting it. The savings are not a first-year figure that fades. They are a standing condition of how the coverage is funded. The employer gets the coverage the workforce needs and stops funding the markup that everyone buying the old way still pays.

Only If You Need It

The third return is the one most firms will never give you: a straight answer on whether you belong here. If you already carry major medical, you do not move to this rung. The Advantage layer beneath your existing plan is already recovering cost and lifting take-home pay. Stacking CompleteCare on top would be paying to solve something already solved. Optiv will say so, and the ladder stops at Advantage for you. CompleteCare is for the employer putting major medical in place for the first time, or replacing a plan that costs too much for what it delivers. For everyone else, the right answer is to stay where you are, and that answer costs you nothing to get.

Across all of it, the employer’s role does not change. You provide the census and the signature. Everything else is supported.

COMPLIANCE AND DEFENSIBILITY

ENGINEERED FOR COMPLIANCE.

Putting major medical in place through a structure that also lowers its cost raises a fair question: is the pairing sound, or does the saving come with exposure attached? It is the right question to ask, and the answer is the reason CompleteCare is built the way it is.

Two Instruments, Two Lanes

The two pieces stay in their own lanes. The major medical is real insurance, issued by an A-rated, state-licensed carrier, filed and regulated as major medical coverage in every state where it is offered. The carrier bears the medical risk, the same as any group health plan. Nothing about the Optiv structure changes what the coverage is or who stands behind it. The §125 architecture underneath does a separate job: it governs how the configuration is funded and how the recovery is generated. One is insurance. The other is the funding structure around it. They work together, but they are not the same instrument, and the line between them is clean by design.

The Foundation Is Already Documented

That §125 foundation is the same architecture documented for Optiv Advantage, the keystone every configuration runs through. Its defensibility, the statutory basis, the separation of roles, the substantiation, and the carrier and risk-transfer structure, is set out in full in the Advantage materials and the compliance brief. CompleteCare does not introduce a different engine. It places real major medical on top of the one already built and already documented.

Closing

For the advisor, CFO, or counsel who wants to examine the structure before an employer commits, the full analysis is available in discovery. The short version is the one that matters here: the coverage is real, the carrier is real, and the structure underneath it is the same one Optiv stands behind on every plan in the ladder.

KNOW YOUR NUMBERS, BEFORE YOU MAKE THE CALL.

The whole case for CompleteCare is a number: what the same coverage costs run through Optiv versus bought the conventional way. So before you schedule anything, see the number for your own workforce. The calculator models your census, your wage structure, and your participation profile against the §125 architecture, and it returns what the coverage would actually cost you, against what the market would charge for the equivalent. With full disclosures. No commitment. No sales call required.

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The Optiv Group helps employers evaluate tax-advantaged benefits strategies, payroll-linked savings opportunities, and modern coverage paths with compliance-aware plan design.

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