Quantum 125 · Section 125
Supplemental Health Benefits vs. Major Medical: What Is the Difference?
Supplemental health benefits pay fixed amounts for specific events and services; major medical pays a share of covered medical bills. Here is how the two fit together for employees.
Major medical insurance pays a share of covered medical bills after deductibles and copays. Supplemental health benefits work differently: they provide specific services, such as telemedicine visits, or pay fixed amounts when something specific happens, such as a hospital stay, an accident or a covered diagnosis. They are designed to sit beside a medical plan, not to replace it.
What does each one do?
| Major medical | Supplemental benefits | |
|---|---|---|
| What it pays | A share of covered medical bills | Fixed amounts or set services, per the policy |
| Who it pays | Usually the provider | Usually the member, for cash benefits |
| Deductibles | Usually | Usually none on the benefits listed below |
| Replaces the other? | No | No |
What is in Quantum 125?
On Plan 1500, quoted from Quantum Health Benefits' plan grid:
- Telemedicine: around the clock by phone or video, $0 copay, for the employee and family.
- Prescriptions: $0 copay on 1,000+ covered medications.
- Hospital: $1,000 on the first day of an admission, then $500 a day, up to 20 days a month.
- Emergency room: $300 a day, up to 4 days a year. Ambulance: $300 a day, up to 2 days a year.
- Surgery and anesthesia: $1,000 inpatient surgery and $400 anesthesia benefits.
- Critical illness: a $2,500 lump sum on a covered diagnosis. Accident: up to $1,000 a benefit year.
- Everyday extras: a virtual vet (4 visits a year), coaching sessions and a wellness app.
Not major medical insurance; benefits vary by plan and state; see plan documents. Limits and waiting periods apply.
Why run it through a Section 125 plan?
Because the premium comes out of pay before tax, the employer has less payroll to tax and the employee's take-home is designed to rise. See what employees get for how it shows up on a paycheck.
Go deeper: how Longtable Benefits approaches Quantum 125 · Section 125.
Illustrative examples. Confirm the specifics for your situation with your own CPA or attorney.