Sample Executive Physical Programs

Sample_Documents

DISCLAIMER: This is a sample template provided for informational purposes only. It does not constitute legal, tax, or financial advice. Organizations should consult their own legal and tax advisors and tailor this document to reflect their specific business needs, geographies, and applicable laws.

Executive Physical Programs

Document Type: Executive Physical Programs

Category: Perquisites & Programs

Document Header

Field	Details
Title	Executive Physical Programs Policy and Guidelines
Company	<Company Name>
Version	<Version Number>
Effective Date	<Date>
Last Reviewed	<Date>
Next Scheduled Review	<Date> or 12 months from Effective Date
Document Owner	<Total Rewards Leader Name and Title>
Executive Sponsor	<CHRO/Head of HR>
Approver(s)	<Approver Name/Committee>
Regions Covered	<Country/Region List>
Confidentiality	Internal Use Only

Purpose and Objectives

Provide a comprehensive preventive health assessment to eligible executives, aiming to detect risk factors early and reduce long-term health risks.
Offer a consistent, equitable program aligned with market practices for executive health benefits.
Support business continuity and leadership effectiveness by improving access to proactive care.
Establish clear rules, controls, and compliance standards for operating the program across <Company Name>.
Define roles, processes, and reporting to monitor cost, utilization, and outcomes.

Scope and Applicability

In Scope

Annual or biannual evidence-based executive physical evaluations delivered through approved providers.
Covered services such as medical history and risk assessment, age and risk-based screenings, laboratory tests, vaccinations, physician consultations, and follow-up care coordination.
Program administration, vendor management, cost management, and data privacy controls.
Participation by eligible executives and board members as specified in the Eligibility section.
Global coverage in <Country/Region List>, subject to local legal, tax, licensure, and insurance rules.

Out of Scope

Emergency care, treatment for acute illness or injury, and elective medical procedures not part of preventive screening.
Ongoing disease treatment and prescriptions beyond initial preventive consultation and short-term incidental needs.
Cosmetic procedures, non-medically necessary imaging or testing, and services not evidence-based.
Dependents or spouses unless explicitly stated in the Benefit Design section.
Reimbursement for personal wellness items unrelated to the executive physical.

Applicability

Applies to executives in <Business Units/Functions> and board members where permitted.
Applies to regular, active employees; does not apply to temporary workers, interns, or contractors unless explicitly approved.
Local country participation is subject to compliance with <Country> health, tax, and data privacy laws.

Program Principles

Prevention First: Emphasize evidence-based screening consistent with recognized guidelines (for example, <National Guideline Body> in <Country>).
Equity with Flexibility: Maintain consistent program tiers globally while allowing modest local adaptations for regulatory or clinical standards.
Privacy by Design: Protect personal health information and limit employer access to aggregated, de-identified data.
Cost Value: Use negotiated rates, caps, and standard panels to manage costs and maximize preventive impact.
Simplicity: Provide straightforward scheduling, coverage, and reimbursement processes.

Eligibility and Participation

Eligibility Tiers

Tier	Eligible Roles	Frequency	Geographic Eligibility
Tier 1	CEO, Executive Chair, Board Members	Annual	Global
Tier 2	Executive Leadership Team (ELT), direct reports to CEO	Annual	Global
Tier 3	Vice Presidents, Business Unit Heads	Once every 18–24 months	Global, with local adaptation
Tier 4 (Optional)	Select critical-role Directors with succession designation	Once every 24 months	Where legally and fiscally supported

Eligibility Rules

Participation is by invitation based on job level, fiduciary accountability, and criticality of role to business continuity.
Employees must be on active status and have completed at least <Number> months of service, unless waived for external hires transitioning into eligible roles.
Eligibility changes are effective the first of the month following a role change or upon written approval from <Approver Name/Title>.
Retirees and alumni are not eligible unless a separate board policy covers them.
Board members are eligible when permitted under corporate governance guidelines and local regulations.

Opt-In and Declinations

Participation is voluntary. Eligible individuals may opt in or decline annually.
Declinations should be recorded by <HRIS/Total Rewards System Name> for compliance tracking.

Program Design and Covered Services

Standard Clinical Components

Comprehensive medical and lifestyle history
Physical examination and vitals
Laboratory panel tailored to age, sex, and risk (for example, lipid profile, A1C, CBC, CMP)
Cardiovascular screening as clinically indicated (for example, resting ECG, stress test when risk-appropriate)
Cancer screening per guidelines and risk (for example, colon cancer, cervical, prostate, breast) aligned to <National Guideline Body>
Imaging based on risk or symptoms (for example, low-dose CT for qualified high-risk individuals per local guidelines)
Vaccination review and recommended immunizations
Mental health and sleep assessments
Nutrition, fitness, and lifestyle counseling
Personalized prevention plan with documented action steps
Coordination of referrals for any findings requiring follow-up

Optional Add-Ons (By Tier or Medical Necessity)

Advanced imaging when medically warranted (for example, coronary calcium scoring)
Executive travel consult and vaccinations for travel to <Country/Region>
Hearing and vision screening beyond standard
Genetic screening limited to evidence-based indications and with separate informed consent
Women’s and men’s health specialty consults

Program Frequency and Caps

Tier	Max Frequency	Coverage Cap per Visit	Notes
Tier 1	1 per 12 months	<Amount> in <Currency>	Includes optional add-ons with pre-authorization
Tier 2	1 per 12 months	<Amount> in <Currency>	Add-ons require medical necessity
Tier 3	1 per 18–24 months	<Amount> in <Currency>	Standard panel only unless approved
Tier 4	1 per 24 months	<Amount> in <Currency>	Local adaptation as needed

Coverage Rules

The program covers medically appropriate, evidence-based preventive services. Non-medically necessary testing will not be covered.
When optional services are elected at the participant’s request without medical necessity, costs above the cap are the participant’s responsibility.
Travel to a center of excellence may be covered according to the Travel and Expense section.
Coordination with the employee’s regular primary care provider is encouraged; results may be shared only with employee consent.

Spouse/Partner Inclusion (Optional)

<Company Name> may offer spouse/partner coverage for Tier 1 and Tier 2 as a business continuity practice.
Coverage level: up to <Percentage>% of the same per-visit cap shown for the executive, once every <Number> months.
Tax impacts for spouse/partner coverage are addressed in the Taxation section.

Vendors and Service Delivery

Vendor Selection Criteria

Accreditation by recognized bodies in <Country/Region> and appropriate physician licensure.
Demonstrated experience with executive physicals and corporate programs.
Ability to provide standardized clinical protocols aligned with evidence-based guidelines.
Data privacy and security compliance, including data processing agreements and appropriate international data transfer safeguards where applicable.
Capacity and geographic coverage to serve <Number> eligible executives annually.
Competitive, transparent pricing and service level commitments.

Service Level Expectations

Scheduling availability within <Number> business days of request.
Visit duration of approximately <Number> hours with same-day consolidated results when feasible.
Final report delivery within <Number> business days.
Customer satisfaction rating of at least <Percentage>% aggregated across participants.
Issue resolution within <Number> business days for non-clinical concerns.

Approved Providers and Channels

Primary vendor: <Vendor Name> with centers in <City/Region List>.
Secondary vendor(s) for overflow or specific geographies: <Vendor Name(s)>.
Local providers in countries without a contracted vendor, using <Company Name>’s reimbursement process and pre-authorization.

Cost, Funding, and Taxation

Funding Model

Centrally funded by <Company Name> under the Total Rewards budget line: <Cost Center>.
Standard rate cards negotiated with <Vendor Name>, with tiered pricing by volume.
Annual budget set at <Amount> in <Currency> with a utilization target of <Percentage>%.

Employee Cost Sharing

No out-of-pocket cost for covered services within the cap for Tier 1 and Tier 2.
Tier 3 and Tier 4 may have a cost share of <Percentage>% for optional add-ons.
Non-covered elective services are 100% employee-paid.

Taxation Considerations

In <Country: United States>, employer-paid executive physicals may be taxable unless they qualify as de minimis or job-related working condition benefits. <Company Name> will apply imputed income per IRS guidance as interpreted by <Tax Advisor Name> effective <Date>.
In <Country>, employer-paid medical benefits may be tax-exempt when provided through approved medical schemes; otherwise, imputed income rules may apply per <Tax Authority>.
For multi-country operations, apply the local tax treatment based on residency, place of service, and vendor invoicing location.
Gross-up policy: <Company Name> will gross-up imputed income for Tier 1 and Tier 2 at <Percentage>% to maintain intended benefit value; Tier 3 and Tier 4 are not grossed up unless required.
Payroll processing cadence: Imputed income and gross-up posted in the payroll period following the visit or when the invoice is processed, whichever occurs first.

Accounting and Controls

Expense recognition in the month of service completion, coded to <GL Account>.
Pre-authorization required for services expected to exceed the cap.
Three-way match control among pre-authorization, vendor invoice, and attendance confirmation.

Privacy, Security, and Ethics

Personal health information is managed by the provider. <Company Name> receives only de-identified, aggregated utilization reports.
Individual clinical results are disclosed only to the participant unless the participant consents in writing to share with a designated physician or family member.
Data processing agreements with vendors will define roles as controller/processor in each <Country> and include cross-border transfer safeguards where applicable.
Records retention: administrative records retained for <Number> years; no storage of clinical records by <Company Name>.
Conflict of interest: selection of providers follows <Company Name>’s procurement policy, with disclosure of any potential conflicts.

Administration and Process

End-to-End Process Overview

Eligibility file generated from <HRIS Name> on <Date/Frequency> and securely transmitted to <Vendor Name>.
Invite sent to eligible participants with instructions and available locations.
Participant selects preferred location and time; vendor confirms appointment within <Number> business days.
Pre-visit questionnaire and labs arranged as clinically indicated.
Participant attends visit; vendor records services rendered and collects consents.
Vendor delivers summary and results to participant and, with consent, to their primary care provider.
Vendor invoices <Company Name> per agreed rate card, referencing pre-authorization number.
Total Rewards reviews invoice, validates against cap and attendance, and approves for payment.
Payroll applies any imputed income and gross-up as required by local law.
Program metrics are updated and reviewed monthly and quarterly.

Scheduling and Pre-Authorization

Pre-authorization is required for:
- Advanced imaging beyond the standard panel
- Services expected to exceed the per-visit cap
- Spouse/partner visits where offered
Authorization number issued by <TR Contact> within <Number> business days of request.
Rescheduling permitted up to <Number> business days prior to the appointment.

Travel and Expense Guidelines

Travel is covered according to <Company Name> Travel Policy when the nearest provider is more than <Number> miles/km from the participant’s work/home location.
Covered travel includes economy air or rail, up to <Amount> per night for hotel, ground transportation, and reasonable meals per diem.
No alcohol reimbursement. Companion travel not covered unless the participant requires assistance documented by a physician.

Cancellations and No-Shows

Cancellations within <Number> business days may incur vendor fees. <Company Name> may charge back fees to the participant in case of repeated late cancellations or no-shows.
No-show fees up to <Amount> may apply and are not eligible for gross-up.

Reimbursements for Out-of-Network Services

Where a contracted provider is unavailable, participants may use a qualified local provider with pre-authorization.
Reimbursement requires itemized receipt, proof of payment, and clinical summary showing covered services.
Currency conversions use <FX Source> spot rate on the service date.
Reimbursements processed within <Number> business days of complete submission.

Post-Visit Follow-Up

Vendor provides a personalized prevention plan with clear next steps.
The program covers one follow-up telehealth consultation within <Number> days of the visit.
Ongoing treatment is referred to the participant’s regular physician and is outside the program scope.

Program Governance

Roles and Responsibilities

Total Rewards
- Design program and benefit tiers, set budgets, and maintain policy.
- Manage vendor relationships, SLAs, and performance reviews.
- Oversee compliance with taxation and payroll reporting with support from Payroll and Tax.
HR Operations
- Manage eligibility data feeds and appointment support.
- Process reimbursements and maintain administrative records.
Payroll and Finance
- Apply imputed income and gross-up rules by country.
- Reconcile vendor invoices, track spend to budget, and accrue expenses monthly.
Legal and Compliance
- Review contracts, data processing agreements, and local legal requirements.
- Advise on governance for board participation and conflicts of interest.
Information Security
- Assess vendor security posture and monitor adherence to data security controls.
Executive Assistants
- Coordinate scheduling in line with the executive’s calendar when asked by the participant.
Vendor(s)
- Deliver services per clinical and service standards, protect privacy, and issue accurate invoices.
Participants
- Complete pre-visit requirements, attend appointments, and follow up on recommended care with their physician.

Decision Rights and Exceptions

Total Rewards may approve exceptions to caps, frequency, or coverage for medical necessity or business continuity, up to <Amount> per case.
Exceptions exceeding <Amount> require approval by <Approver Title/Committee>.
Appeals related to taxation treatment are handled by Payroll in consultation with Tax and Legal.

Risk Management and Controls

Annual policy review with Legal and Tax to reflect changes in laws or clinical guidelines.
Cap management and pre-authorization to prevent unnecessary or non-evidence-based testing.
Quarterly audit sampling of invoices, attendance logs, and authorizations.
Separation of duties between authorization, invoice approval, and payment processing.
Incident response process for privacy or service failures with defined timeframes for remediation.
Continuity planning to maintain access if a vendor location is unavailable.

Metrics and Reporting

Utilization rate: percentage of eligible participants completing a visit within the cycle.
Average cost per visit by tier and by country versus cap.
Clinical quality indicators as provided in aggregate (for example, proportion with cardiovascular risk counseling).
Participant satisfaction score and net promoter score where available.
Scheduling lead time and report turnaround time versus SLA.
Tax and payroll accuracy rate for imputed income postings.
Trend reports by quarter and fiscal year to support budgeting and design decisions.

Budgeting and Forecasting

Baseline utilization assumption: Tier 1 at <Percentage>%, Tier 2 at <Percentage>%, Tier 3 at <Percentage>% each cycle.
Sensitivity analysis for plus/minus <Percentage>% change in participation rates and price inflation of <Percentage>% per year.
Allocation of budget by region based on eligible headcount and vendor pricing.
Contingency reserve of <Percentage>% for exceptions and travel costs.

Implementation Guidelines

Implementation Steps

Confirm eligibility lists and tiers in <HRIS Name> and validate with Business HR.
Finalize vendor contracts, SLA, data processing agreement, and rate cards with <Vendor Name>.
Configure pre-authorization workflow in <Ticketing/Workflow Tool> with approval thresholds.
Build payroll codes for imputed income and gross-up per <Country> with effective dates.
Publish policy and manager toolkit on <Intranet Site> and train HR partners.
Pilot with <Number> participants across <Country/Region List> for <Number> weeks.
Review pilot feedback and adjust processes and communications.
Launch company-wide and begin monthly operational reviews.

Timeline Example

Phase	Start	End	Owner
Design and Contracting	<Date>	<Date>	Total Rewards and Procurement
Configuration and Payroll Setup	<Date>	<Date>	HR Operations and Payroll
Pilot	<Date>	<Date>	Total Rewards
Launch	<Date>	<Date>	Total Rewards and Vendor
First Review	<Date>	<Date>	Total Rewards and Finance

Review and Approval Process

Policy owner drafts updates and circulates for review to Legal, Tax, Payroll, and Information Security.
Approval required from <Approver Name/Committee> before effective date changes.
Review cadence is annual or upon material changes in law, vendor capability, or benefit design.
Version control maintained in <Policy Repository> with change log entries.

Legal Notices and Disclaimers

This program is a company-sponsored benefit and not a replacement for health insurance.
Availability may vary by <Country> due to local law, licensing, and facility availability.
<Company Name> reserves the right to modify, suspend, or terminate the program at any time, with or without notice, to the extent permitted by law.
Participation is voluntary and does not alter the at-will employment relationship where applicable.
Medical decisions are between the participant and their healthcare provider; <Company Name> does not direct clinical care.
Tax treatment may vary by individual circumstances; participants should consult their personal tax advisors.

Glossary

Executive Physical: A comprehensive preventive health evaluation designed for senior leaders, typically completed in a single day at a specialized facility.
Cap: The maximum amount <Company Name> will pay per visit for covered services.
Imputed Income: The taxable value assigned to an employee for employer-provided benefits.
Gross-Up: An additional payment to offset taxes associated with imputed income so the employee’s net position remains unchanged.
Center of Excellence: A clinic or facility recognized for high-quality, integrated preventive services.
Pre-Authorization: Approval required by <Company Name> before certain services can be scheduled or reimbursed.
PHI: Personal health information subject to privacy laws in <Country>.
SLA: Service level agreement defining performance expectations for vendors.

Documentation and Records

Maintain versioned policy documents, approval records, vendor agreements, and SLA performance reports for at least <Number> years.
Store administrative records in <Document Management System> with access restricted to authorized personnel.
Do not store individual medical records; rely on vendor systems and participant-held copies.

Change Log

Version	Date	Summary of Changes	Approved By
<Version Number>	<Date>	Initial release	<Approver Name/Title>
<Version Number>	<Date>	Updated tax treatment for <Country> and added spouse coverage option	<Approver Name/Title>

Contacts

Program Questions: <TR Contact Name, Title, Email>
Authorization Requests: <Workflow Tool or Email>
Payroll Tax Questions: <Payroll Contact>
Privacy Questions: <Data Protection Office Contact>
Vendor Scheduling: <Vendor Name> at <Phone/Email/Portal>

Communication to Employees and Managers

Audience: Eligible executives, board members where applicable, and their managers

Welcome to the <Company Name> Executive Physical Program. This program gives eligible leaders convenient access to a comprehensive, preventive health assessment with top-tier clinicians. Our goal is simple: help you stay healthy, catch issues early, and support your focus on leading the business.

What the program includes You will complete a personalized, one-day visit that brings together medical history, a physical exam, targeted labs, and age and risk-based screenings. You will receive same-day feedback when possible and a written plan with clear next steps. The program typically covers cardiovascular risk checks, cancer screenings based on guidelines, mental health and sleep assessments, and practical guidance on nutrition, fitness, and lifestyle. If you need specialty referrals, the clinic will guide you, and you can share results with your personal physician.

Who is eligible Eligibility is based on your role. Tier 1 includes CEO, Executive Chair, and Board members; Tier 2 includes the Executive Leadership Team; Tier 3 includes Vice Presidents and certain Business Unit Heads; and some locations may include additional roles. Your invitation will confirm your tier and how often you can attend, typically annually or every other year.

What it costs For covered services within your tier’s cap, <Company Name> pays the full cost for Tiers 1 and 2. Tier 3 may have a modest cost share for optional add-ons. If you choose elective services that are not medically necessary, those are your responsibility. In some countries, the program may be treated as a taxable benefit. Where applicable, we will add imputed income to your payroll and, for certain tiers, cover the taxes through a gross-up so that you are not out of pocket. Local rules vary, and we will apply the correct approach for your location.

How scheduling works You will receive an invitation with a link to book at an approved center near you. If there is no center nearby, we will help you schedule with a qualified local provider or arrange travel under the <Company Name> travel policy. Please complete any pre-visit forms and labs requested by the clinic. If you need to reschedule, let us know as early as possible to avoid late cancellation fees.

Privacy and confidentiality Your medical information stays between you and the clinic. <Company Name> does not receive your individual results. We only receive de-identified statistics to improve the program. If you want your primary care physician to receive your results, you can authorize that with the clinic.

Travel and time away If you need to travel, the program can cover reasonable travel expenses under our travel policy. Visits are designed to be efficient and typically take several hours. Please coordinate timing with your Executive Assistant or manager to minimize business disruption.

After your visit You will receive a summary and a prevention plan. A follow-up telehealth check-in may be available to review results and next steps. For any ongoing treatment or prescriptions, please work with your personal physician. The clinic can help you with referrals if needed.

How to get started When you receive your invitation:

Review your tier, coverage, and any local notes for your country.
Choose your preferred clinic and book your appointment.
Complete the pre-visit questionnaire and any requested labs.
Attend your visit and discuss your goals with the clinicians.
Review your plan and schedule any follow-ups with your personal physician.

Need help If you have questions about eligibility, booking, or coverage, contact <TR Contact Email>. For tax and payroll matters, contact <Payroll Contact Email>. For privacy questions, contact <Data Protection Office Contact>. For appointment logistics, work directly with <Vendor Name> using the contact information in your invitation.

A final note Your health is personal, and participation is voluntary. We designed this program to make preventive care easier, more coordinated, and respectful of your time and privacy. Thank you for helping us build a healthy leadership team for <Company Name>.

Document Information:

Document Type: Executive Physical Programs
Category: Perquisites & Programs
Generated: August 28, 2025
Status: Sample Template
Next Review: <Insert Review Date>

Usage Instructions:

Replace all text in angle brackets < > with your company-specific information
Review all sections for applicability to your organization
Customize content to reflect your company's policies and local regulations
Have legal and HR leadership review before implementation
Update document header with your company's version control information
At bottom of the document you find a short example on how the content could be communicated to end-users, for instance employees.

This sample document is provided for reference only and should be customized to meet your organization's specific needs and local legal requirements.