News Archives - SBMA Benefits

What is the Difference Between Fully Insured and Self-Insured Health Plans?

August 22, 2025/in News

Choosing the right health insurance plan is one of the most important financial decisions an employer can make. With rising healthcare costs, increased regulatory pressure, and the need for competitive benefits, understanding your options is essential. In this guide, we break down the key differences between fully insured and self-insured (also called self-funded) health plans so you can make the most informed choice for your organization.

What Is a Fully Insured Health Plan?

A fully insured health plan is the more traditional option for employer-sponsored coverage. In this model:

The employer pays a fixed monthly premium to an insurance carrier.
The carrier assumes all financial risk and handles claims and administration.
Costs are predictable, and coverage is pre-determined by the insurer.

Benefits of Fully Insured Plans

Budget Predictability: Employers know upfront what they will pay monthly.
Administrative Simplicity: Carriers manage all claims and plan logistics.
ACA Compliance: Automatically managed by the insurer.

Drawbacks

Limited Flexibility: Employers cannot customize plan details.
Less Insight: Employers don’t have access to claims data.
Higher Costs for Some Groups: Premiums may include margin and risk charges.

What Is a Self-Insured (Self-Funded) Health Plan?

A self-insured plan allows employers to assume the financial risk for providing healthcare to their employees. Instead of paying premiums, employers:

Pay medical claims as they occur.
Set aside a reserve fund to cover expected costs.
Often hire a third-party administrator (TPA) to handle claims and compliance.

Benefits of Self-Insured Plans

Cost Savings: Avoid carrier margins and pay only for actual claims.
Customization: Tailor benefits to meet workforce needs.
Claims Data Access: Improve decision-making with real-time insights.
Wellness Integration: Incentivize healthier employee behavior.

Drawbacks

Financial Risk: Employers pay out claims directly.
Cash Flow Variability: Monthly costs may fluctuate.
Compliance Burden: Employers are responsible for ACA and ERISA compliance.

To mitigate large, unexpected claims, many employers purchase stop-loss insurance—a policy that reimburses costs above a certain threshold.

Fully Insured vs. Self-Insured: A Side-by-Side Comparison

Feature	Fully Insured Plan	Self-Insured Plan
Who Assumes Risk	Insurance company	Employer
Cost Predictability	High	Variable
Plan Customization	Low	High
Claims Data Access	Limited	Full
Stop-Loss Insurance	Not needed	Often recommended
ACA Compliance	Carrier-managed	Employer-managed (via TPA)
Admin Responsibility	Insurance carrier	Employer or TPA

Pros and Cons for Employers

Fully Insured Plan

Simpler to manage
Budget-friendly for small teams
Less flexible in design and provider options
Typically results in higher per-employee costs

Self-Insured Plan

Offers lower long-term costs for healthier employee groups
Provides greater flexibility and control over plan design
Requires sufficient cash reserves and stop-loss protection
Involves more administrative responsibility

Which Type of Plan Is Right for Your Business?

Fully insured plans tend to be better for:

Small businesses with limited cash flow
Teams needing predictable monthly expenses
Employers with little administrative bandwidth

Self-insured plans may be better for:

Mid-size to large employers
Businesses looking to control rising premiums
Companies that want to customize benefits and analyze claims trends

How to Stay ACA Compliant with Either Option

Whether you’re fully or self-insured, compliance with the Affordable Care Act is mandatory. Self-insured employers must take extra care to file 1095-C forms, ensure minimum essential coverage is met, and avoid potential penalties.

Partnering with a compliance-savvy benefits provider or TPA can take the complexity off your plate.

Still Have Questions?

At SBMA, we partner with employers who want to offer affordable, compliant benefits without the complexity. Our team makes it easy to navigate ACA requirements, implement coverage quickly, and support employees with plans that actually work for them.

What sets us apart? Personalized service, rapid implementation, and an innovative approach to benefits that puts people first.

Learn more about us and our services here.

Frequently Asked Questions (FAQs)

Q: Is self-insured only for large businesses?
A: Not necessarily. Businesses with as few as 50 employees can explore self-funded models, especially with the help of stop-loss insurance and third-party administrators.

Q: What’s the biggest risk of self-funding?
A: Unpredictable high-cost claims. But this can be managed with stop-loss coverage.

Q: Do self-insured plans cover the same services?
A: Yes—employers can mirror traditional plans but with the flexibility to adjust deductibles, copays, and provider networks.

Streamlined Benefits Administration: The Gold Standard for Employers

August 18, 2025/in News

Manage your employee health benefits better with SBMA. We deliver the Gold Standard in benefits administration through a fully streamlined system that gives employers control over cost, time, and employee experience.

Managing employee benefits shouldn’t be a daily struggle. If your HR team is buried in paperwork, chasing vendors, or fielding avoidable employee questions, it’s time to raise the standard. Our centralized platform eliminates friction, accelerates operations, and ensures every employee interaction is seamless—from onboarding to claims resolution.

The Gold Standard of Benefits Administration: A Complete System, Built for Efficiency

SBMA’s platform handles the full lifecycle of benefits management. Unlike fragmented systems that create confusion and errors, our model is unified, integrated, and built to scale. Here’s how it works:

Onboarding and Offboarding

New hires are enrolled with speed and accuracy. Former employees are transitioned out of coverage without gaps, risk, or compliance concerns. No redundant paperwork. No waiting on third parties. Just a clean, automated process that protects your time and your business.

ID Card Access

With SBMA, employees no longer wait weeks for a plastic card in the mail. Digital ID cards are issued almost immediately upon enrollment, accessible via email and the HealthWallet App. This ensures coverage is never in question—and your HR team isn’t bogged down by status inquiries.

Claims Management and Visibility

We deliver real-time access to your company’s claims data. Employers gain insight into patterns and performance, enabling better decision-making and risk mitigation. Employees can view their claim status and history directly, without involving your internal team.

Live Support

Your employees deserve answers. Our California-based support team is trained, responsive, and ready to assist—so your staff doesn’t have to. When questions arise, we handle them directly. This ensures employees are supported and your internal resources stay focused.

HealthWallet App

HealthWallet puts everything your employees need in one place—plan summaries, ID cards, provider search, claims tracking, and support access. It’s user-friendly and powerful, giving your workforce clarity and control without turning to HR for help.

Payment Management

Our billing hub consolidates your payment processes into a single, transparent platform. No more disjointed invoices or billing errors. SBMA makes payment tracking and reconciliation simple, accurate, and fast—reducing finance team burden and improving compliance.

The Business Case for Streamlined Benefits

Employers don’t invest in benefits administration because it’s easy—they do it because it’s essential. But traditional systems make it harder than it needs to be. SBMA changes the equation.

Reduce Administrative Costs

By removing inefficiencies and reducing the number of systems required to manage benefits, SBMA lowers your overhead. Fewer vendors, fewer errors, and less manual labor means a direct reduction in administrative expenses.

Improve Employee Experience

When employees know how to access care, understand their benefits, and receive timely support, they stay longer. SBMA helps you create a benefits experience that reinforces trust and reduces turnover—without adding pressure to your internal staff.

Save Time and Reallocate Resources

Your team should be focused on strategic HR, not chasing ID cards or explaining coverage. Our platform eliminates low-value tasks, giving your department time back—and your business a competitive edge.

Strengthen Compliance

SBMA’s workflows are designed to ensure ACA and ERISA compliance at every stage. From documentation to reporting, we help you stay audit-ready and legally protected without needing to monitor every detail yourself.

Empower Your Workforce Without Increasing Your Workload

SBMA’s HealthWallet App plays a critical role in reducing friction between employees and benefits teams. Employees can view their coverage, find providers, access ID cards, and track claims without placing a single call to HR.

This not only increases utilization and engagement—it decreases workload and confusion. When employees are empowered, the entire system performs better.

Designed for the Real World

Whether your business has 15 employees or 5,000, SBMA’s system scales to your needs. We offer solutions for companies across industries, sizes, and growth stages. With no minimum participation requirements, we give you the flexibility to provide real benefits without overcommitting budget or resources.

We Set the (Gold) Standard

Too many benefits providers rely on complex, slow, or outdated systems to manage health coverage. SBMA doesn’t. We provide a single source for health benefits administration that is technology-forward and easy to use, delivering the tools employers need to stay in control.

Our mission is not just to administer benefits—but to redefine how they’re delivered.

If you’re ready to eliminate inefficiency, reduce costs, and raise the bar for employee care, we lead the way.

HMO, PPO, EPO, Captive, MVP, and Restricted Benefits

August 3, 2025/in Employer Resources, News

The Employers Guide to Health Benefits

Choosing the right health coverage for your business is more than a compliance requirement. It’s a strategic decision that impacts cost management, employee satisfaction, and workforce stability. Today’s employers have a range of plan types to consider, each with distinct structures, cost profiles, and administrative requirements.

This article offers a clear, structured comparison of six major coverage options—HMO, PPO, EPO, Captive Plans, Minimum Value Plans (MVP), and Restricted Medical Coverage—designed to help employers navigate their options and select the approach that best aligns with their workforce needs and business goals.

Understanding the Plan Types

What Is an HMO?

A Health Maintenance Organization (HMO) plan emphasizes cost containment and network coordination. Employees must select a primary care physician (PCP) and obtain referrals to see specialists. Services are limited to in-network providers, except in emergencies.

Key Characteristics

Requires referrals for specialist care
Services limited to in-network providers
Typically lower premiums and out-of-pocket costs

What Is a PPO?

A Preferred Provider Organization (PPO) provides employees with more flexibility in provider selection. It allows both in- and out-of-network care and does not require PCP referrals for specialist access.

Key Characteristics

Broad provider network
No referral required for specialists
Higher premiums and more flexibility

What Is an EPO?

An Exclusive Provider Organization (EPO) blends aspects of HMO and PPO structures. It offers network-based care without requiring referrals but does not cover out-of-network services except in emergencies.

Key Characteristics

In-network only coverage
No referral required for specialists
Balanced cost and access

What Is a Captive Plan?

A Captive Plan is a form of self-funding in which a group of employers pools their resources to form a private insurance entity. Captive arrangements provide transparency, shared risk, and customizable design.

Key Characteristics

Offers long-term cost control through pooled risk
Enhanced data transparency for claims management
Requires stable claims experience and long-term commitment

What Is an MVP Plan?

Minimum Value Plans (MVPs) are designed to meet the Affordable Care Act’s definition of minimum essential coverage. MVPs typically cover at least 60 percent of the total allowed cost of benefits and include substantial inpatient and physician services.

Key Characteristics

ACA-compliant
Lower monthly premiums
Ideal for meeting mandate requirements

What Is Restricted Medical Coverage?

Restricted Medical Coverage offers essential, high-utility healthcare benefits at a lower cost. These plans often include preventive services, office visits, urgent care, basic labs, and limited prescription drug coverage.

Key Characteristics

Focused on everyday care needs
Lower premiums compared to major medical
Ideal for part-time, hourly, or high-turnover workforces
Scalable across industries and sizes

SBMA supports Restricted Medical Coverage with a comprehensive administrative platform that enables simple onboarding, ID card delivery, claims management, payment tracking, and employee support. This makes offering coverage efficient and compliant for employers of all sizes.

Plan Comparison: Key Differences

Feature	HMO	PPO	EPO	Captive	MVP	Restricted
Network Type	In-network only	In- and out-of-network	In-network only	Custom network	In-network focus	In-network, focused scope
Referrals Required	Yes	No	No	Varies	No	No
Employer Cost	Lower	Higher	Moderate	Varies based on structure	Lower monthly premiums	Lower premiums with practical coverage
Administrative Complexity	Low	Moderate	Moderate	High	Low	Low with SBMA platform

Minimum Enrollment Requirements and Administrative Efficiency

Traditional group health plans often require a minimum number or percentage of eligible employees to enroll in order to activate coverage. This can present challenges for employers with part-time or seasonal staff, high turnover, or lean operations.

SBMA offers health coverage solutions with very low or no minimum enrollment requirements, which provides significant flexibility for employers across industries. Paired with an efficient administrative system—covering onboarding, ID cards, offboarding, claims, and billing—this makes implementation and management more predictable and less resource-intensive.

Affordability: Legal Definition and Practical Impact

Under the Affordable Care Act (ACA), an employer’s offer of coverage is considered affordable if the employee’s share of the premium for self-only coverage does not exceed 8.39 percent of their household income in 2025.

This is a compliance benchmark, but practical affordability depends on more than just premium cost. Deductibles, out-of-pocket maximums, and access to everyday care all influence whether a plan is truly usable.

Plans like Restricted Medical Coverage are designed with real-world application in mind, often avoiding high deductibles in favor of more accessible first-dollar coverage for preventive and routine care.

Which Plan Is Right for Your Business?

There is no universal solution. The right health plan depends on your workforce, your cost structure, and your long-term strategy. Use the following as a guide:

Choose an HMO if your team values structure, and you want predictable, lower-cost premiums.

Choose a PPO if your employees want the freedom to choose providers and access out-of-network care.

Choose an EPO if you want in-network coverage with fewer restrictions but lower cost than a PPO.

Choose a Captive Plan if you have a stable, benefits-engaged workforce and want long-term control over healthcare spending.

Choose an MVP Plan if your goal is to meet ACA compliance with lower monthly premiums and minimal disruption to payroll.

Choose Restricted Medical Coverage if your workforce includes hourly, part-time, or high-turnover employees who benefit from simple, everyday care access at an affordable rate. With SBMA’s platform, employers can scale this coverage with confidence and efficiency.

Choosing The Right Coverage For Your Business

Employers are navigating a more complex benefits environment than ever before. With rising healthcare costs and shifting workforce expectations, plan selection must go beyond compliance and base premiums. It requires clarity, structure, and a system that supports both your business operations and your employees’ health.

SBMA provides the tools, support, and plan options that help employers lead with confidence. When the structure is clear and the delivery is efficient, health benefits become a competitive advantage—not a cost center.

2025 Employers Guide to COBRA

July 26, 2025/in COBRA, Employer Resources, Machine-Readable Compliance FIles, News, No Surprises Act

As we move into 2025, it’s important for employers to know about the Consolidated Omnibus Budget Reconciliation Act (COBRA). This law gives employees and their families the chance to keep their health insurance after certain life events. This guide will explain what COBRA is, what employers need to do, and how to make the process easier for everyone.

What is COBRA?

COBRA is a federal law that lets employees keep their group health insurance for a limited time after specific events. It applies to businesses with 20 or more employees and covers group health plans from private companies and local or state governments.

COBRA is there for employees and their families after they go through a qualifying event, like:

Losing their job (unless they were fired for bad behavior)
Having their work hours cut
Getting divorced
The death of the employee
Losing dependent status (like a child turning 26)

Why is COBRA Important?

COBRA is really important because it helps people keep their health insurance during tough times. Losing your job or going through a big life change can be stressful, and having health insurance can help ease some of that worry. COBRA gives people the time they need to find new jobs or other insurance options.

What Do Employers Need to Do?

If you’re an employer, it’s crucial to understand your responsibilities under COBRA to stay compliant and avoid fines. Here are the main things you need to know:

1. Notify Employees of Their COBRA Rights

When an employee becomes eligible for COBRA, you must inform them. This means sending a notice within 14 days of a qualifying event. The notice should include:

Information about their right to continue health coverage
How long can they keep the coverage
How much will it cost them
Instructions on how to enroll in COBRA coverage

2. Provide Coverage Options

If an employee chooses COBRA, you need to offer the same health benefits they had when they were employed. This means they should still have access to medical, dental, and vision insurance if those were part of their original plan.

3. Handle COBRA Premium Payments

You can charge employees up to 102% of the premium for COBRA coverage. This includes the total cost of the coverage plus a 2% fee for administration. Make sure to communicate clearly about when payments are due and how employees can pay.

4. Keep Records

It’s essential to keep records of all COBRA notifications, elections, and payments. Good record-keeping helps with compliance and can be useful if there are any disputes later.

5. Understand Reporting Requirements

If your business is required to file Form 5500, you must report COBRA enrollment and compliance. This form gives the Department of Labor (DOL) information about your employee benefits plan, including COBRA.

How Long Does COBRA Coverage Last?

COBRA coverage doesn’t last forever. The duration of coverage depends on the qualifying event:

18 months: For employees who lose their jobs or have their hours reduced.

29 months: If a person is disabled (this must be determined within the first 60 days of COBRA coverage).

36 months: For dependents who lose coverage due to the employee’s death, divorce, or legal separation.

Employers should notify former employees when their COBRA coverage is about to end, so they have time to find other options.

Best Practices for Employers

To stay compliant and help employees during transitions, consider these best practices:

1. Create a COBRA Compliance Plan

Make a clear plan that outlines how you will notify employees, manage elections, and handle payments. Assign specific roles to ensure everyone knows what they are responsible for.

2. Use a Third-Party Administrator (TPA)

Think about hiring a TPA that specializes in COBRA administration. They can help manage notifications, elections, and payments, making the process easier for your HR team.

3. Communicate Clearly with Employees

Make sure your communication about COBRA coverage is simple and easy to understand. Provide employees with written materials that explain their rights and responsibilities. Designate HR representatives who can help answer questions.

4. Stay Updated on Changes in the Law

Keep an eye on any changes in COBRA regulations, as laws can change. Regularly review your policies and practices to ensure they are up-to-date.

5. Provide Resources for Alternative Coverage

Help employees transition from COBRA to other health insurance options. Share information about state health insurance marketplaces, Medicaid, or private insurance plans they can consider.

Common Misconceptions about COBRA

Let’s clear up some common misunderstandings about COBRA:

Myth 1: COBRA is Free: COBRA allows employees to keep their health coverage, but they have to pay for it. The cost may be higher than what they paid while employed.

Myth 2: Employers Can Deny COBRA Coverage: Employers must offer COBRA coverage unless the employee was fired for serious misconduct.

Myth 3: COBRA Coverage is Indefinite: COBRA coverage is temporary and has set time limits based on the qualifying event.

Final Notes

Understanding COBRA is essential for employers as we head into 2025. By meeting your obligations to notify employees, provide coverage, and keep accurate records, you can help ensure compliance and support your employees during their transitions.

COBRA provides important health insurance continuity for employees facing significant life changes, allowing them to access necessary healthcare services. By proactively managing COBRA responsibilities, you create a supportive workplace that helps employees feel valued and cared for.

For personalized help with COBRA regulations and compliance, consider reaching out to a healthcare benefits expert or legal advisor. They can offer guidance tailored to your organization’s needs and help you implement effective strategies for managing COBRA.

What Does the Marketplace Integrity and Affordability Proposed Rule Mean for Qualified Applicable Large Employers?

July 21, 2025/in News

What Does the Marketplace Integrity and Affordability Proposed Rule Mean for Qualified Applicable Large Employers?

In March 2025, the Centers for Medicare & Medicaid Services (CMS) introduced the “Marketplace Integrity and Affordability Proposed Rule,” aiming to enhance the integrity of the Affordable Care Act (ACA) Marketplaces. While the rule primarily targets individual and small-group markets, its implications extend to Qualified Applicable Large Employers (ALEs) under the ACA. This article delves into the proposed changes and their potential impact on ALEs.

Understanding the Proposed Rule

The proposed rule encompasses several key provisions:

Income Verification Enhancements: CMS proposes stricter income verification processes to ensure eligibility accuracy for premium tax credits (PTCs). This includes removing exceptions that allowed self-attestation of income when tax data was unavailable.
Special Enrollment Period (SEP) Modifications: The rule suggests reinstating pre-enrollment verification for SEPs and eliminating the monthly SEP for individuals with incomes below 150% of the Federal Poverty Level (FPL).
Open Enrollment Period (OEP) Adjustment: CMS aims to shorten the annual OEP from November 1 through December 15, reducing the window for individuals to enroll in coverage.
Premium Payment Policies: Insurers may be allowed to require payment of past-due premiums before effectuating new coverage, and the rule proposes eliminating fixed-dollar and gross percentage-based premium payment thresholds.
Exclusion of DACA Recipients: The rule seeks to remove Deferred Action for Childhood Arrivals (DACA) recipients from the definition of “lawfully present,” affecting their eligibility for Marketplace coverage.

Implications for Qualified Applicable Large Employers

Qualified ALEs, defined as employers with 50 or more full-time employees, are subject to the ACA’s Employer Shared Responsibility Provisions. The proposed rule’s changes could impact ALEs in several ways:

Increased Employer Plan Participation: With stricter income verification and reduced SEPs, employees may find it more challenging to obtain or maintain Marketplace coverage, potentially leading to increased enrollment in employer-sponsored plans.
Potential for Increased Penalties: If employees lose Marketplace coverage due to the proposed changes and the employer’s plan is deemed unaffordable or lacks minimum value, ALEs could face penalties under the ACA’s Employer Shared Responsibility Provisions.
Administrative Adjustments: ALEs may need to reassess their health coverage offerings and communication strategies to ensure compliance and to accommodate employees who might be affected by the Marketplace changes.

Strategic Considerations for ALEs

To navigate the potential impacts of the proposed rule, ALEs should consider the following actions:

Review Health Plan Offerings: Ensure that employer-sponsored plans meet affordability and minimum value standards to mitigate potential penalties.
Enhance Employee Communication: Provide clear information about health coverage options, especially in light of the shortened OEP and changes to SEP eligibility.
Monitor Regulatory Developments: Stay informed about the finalization of the proposed rule and any subsequent guidance to adjust strategies accordingly.

Action is months away but information is always timely

While the Marketplace Integrity and Affordability Proposed Rule primarily targets individual and small-group markets, its ripple effects could influence the dynamics of employer-sponsored coverage. Qualified ALEs should proactively assess and adapt their health coverage strategies to align with the evolving regulatory landscape and to support their workforce effectively.

How to Provide Health Benefits Without a Traditional Group Plan

July 13, 2025/in News

Traditional group health plans are no longer the only path to offering comprehensive employee benefits. For many employers, especially those managing variable or part-time workforces, group plans introduce unnecessary cost, complexity, and restrictions. There is a more efficient way to provide meaningful coverage, without compromising compliance or quality.

SBMA delivers restricted health benefits packages that include well care visits, telehealth, dental, vision, and hospitalization support. These plans are structured for real-world use, priced for practical application, and administered with SBMA’s Gold Standard benefits infrastructure.

The Problem with Traditional Group Health Plans

Group plans were built for a different kind of workforce—large, salaried, stable. Today’s employers operate with a different reality: high turnover, hybrid labor models, and rising insurance costs that often outpace budgets.

Common issues with traditional group coverage:

High premiums that reduce plan accessibility
Low employee utilization due to high deductibles and confusing networks
Delayed claims processing and limited transparency
Strict participation minimums that exclude many employers
Little to no data on actual benefit usage

This model fails when cost and value drift too far apart.

A Structured Alternative: Restricted Health Benefits

Restricted health plans offer targeted, high-utility benefits at a significantly lower cost. These are not watered-down offerings. When built and administered correctly, they provide reliable coverage for high-frequency care needs.

SBMA designs restricted medical packages that include:

Preventive care and annual well visits
Virtual and in-person urgent care
Dental and vision coverage
Mental health and teletherapy
Prescription drug benefits
Diagnostic labs and imaging
Hospital indemnity or limited inpatient support

These packages are modular and adaptable, allowing employers to tailor coverage to match budget, workforce type, and utilization trends.

Designed for Flexibility. Built for Scale.

SBMA plans are not constrained by major medical carrier participation requirements. We offer coverage with low or no minimum enrollment thresholds, making it viable for small employers, high-turnover industries, and decentralized teams.

This model supports:

Hospitality and food service
Agriculture and field labor
Cleaning and facility services
Logistics, distribution, and warehousing
Part-time and hourly retail teams

Where traditional group plans overextend, restricted plans deploy precisely, matching benefit spend with workforce needs.

Administration Matters

A plan is only as effective as its delivery. SBMA ensures every benefit is structured, compliant, and accessible through a centralized, automated platform.

Our administrative infrastructure includes:

Real-time digital onboarding and offboarding
Instant ID card generation and delivery
Integrated claims tracking and reporting
Employer-level data on usage and enrollment
Consolidated billing and payment management
Live U.S.-based support
The HealthWallet App for 24/7 employee access to benefits, providers, and plan documents

Every step is designed to reduce administrative lift and ensure plan performance. Complexity is eliminated, not transferred.

What Makes This Work

Many benefits fail because they are either too expensive to offer or too confusing to use. SBMA eliminates both problems. Plans are priced for implementation, built for practical use, and supported by data-driven systems that show what works and what doesn’t.

Key advantages of SBMA’s restricted benefits model:

Lower monthly premiums for employers and employees
Immediate access to high-utility care services
Reduced pressure on HR and finance teams
Fully ACA-compliant when paired with a MEC
High adoption rates due to usability and accessibility

This is not an alternative to major medical coverage. It is a more targeted, more efficient, more scalable benefits model for the employers who need it.

Case Application

A 300-person national restaurant group with 70% part-time staff implemented SBMA’s restricted medical package with telehealth, preventive care, vision, dental, and hospitalization support.

Cost per employee: Under $80/month
Enrollment rate: Over 60% in the first 90 days
Support tickets: Reduced by 80% with HealthWallet adoption
HR admin time: Cut in half due to digital onboarding and auto-generated cards

Coverage was deployed across locations within four weeks. Employee feedback focused on clarity and ease of access. Finance reported consistent monthly costs with no surprise billing.

This is the model. It works.

FAQs

Can I provide employee benefits without a traditional group health plan?

Yes. You can implement restricted medical coverage paired with a MEC to meet ACA requirements and provide access to commonly used care—without the cost structure or participation rules of a group plan.

What’s included in a restricted medical plan?

These plans typically include telehealth, wellness exams, urgent care, labs, dental, vision, and hospitalization benefits. The focus is on care employees actually use, at costs employers can sustain.

Does this meet ACA compliance?

When paired with a Minimum Essential Coverage (MEC) plan, restricted medical packages satisfy ACA Employer Mandate requirements and protect businesses from penalties A and B.

Are restricted plans only for large employers?

No. SBMA serves employers of all sizes, with no minimum participation requirements. The model is especially effective for small-to-midsize companies with part-time, hourly, or rotating staff.

How do employees access their benefits?

Through SBMA’s Gold Standard platform and the HealthWallet App. Employees receive digital ID cards, access providers, view claims, and download plan documents—all in one place.

Conclusion

SBMA delivers a structured, scalable way to offer health benefits without the complexity of traditional group plans. With practical coverage, simplified administration, and complete compliance support, restricted medical benefits are not just possible—they are proven.

This is how employers take control of benefit costs while delivering real value to their workforce.

How to Stay Healthy at Work

July 7, 2025/in Healthy Living, News

The modern workplace, whether behind a desk or on your feet all day, can take a toll on your health. From prolonged sitting to repetitive labor, both sedentary and physically demanding jobs come with wellness challenges. The good news? A few consistent habits can help protect your health, energy, and productivity.

Why Preventative Wellness at Work Matters

Poor posture, low energy, and stress-related fatigue aren’t just inconvenient—they can lead to long-term health issues. Preventative wellness focuses on simple, proactive steps to reduce these risks before they escalate. Whether you’re at a desk or on a job site, small adjustments can make a big difference.

Wellness for Desk-Based Employees

Create a Movement-Friendly Workspace

A static desk setup can encourage poor posture and physical stagnation. Consider these changes:

Use a standing desk or sit-stand riser to alternate your posture.
Adjust your screen to eye level and sit in a chair with lower back support.
Keep resistance bands or small weights nearby for quick strength exercises.

Move More Throughout the Day

Stand up and stretch every hour.
Take phone calls while pacing or marching in place.
Switch one meeting a day to a walking meeting.
Set reminders to walk a lap around the office or do a quick stretch.

Add Micro-Workouts

Try 5-minute movement breaks between tasks: squats, push-ups, or chair dips.
Use stairs instead of the elevator when possible.
Keep comfortable shoes or sneakers at your desk to encourage spontaneous movement.

Wellness for Active Laborers: Hospitality, Cleaning, and Outdoor Work

Physically demanding roles come with their own challenges—like fatigue, joint strain, and hydration needs. Preventative wellness here means working smart, not just hard.

Support Recovery and Mobility

Start each day with dynamic stretching to reduce injury risk.
Use foam rollers or simple stretches after shifts to support recovery.
Wear supportive footwear and rotate job tasks when possible to avoid repetitive strain.

Prioritize Hydration and Nutrition

Drink water regularly, especially in hot or outdoor environments.
Choose high-energy snacks (nuts, protein bars, fruit) to stay fueled on the go.
Avoid sugary drinks or heavy meals that can drain your energy.

Make Breaks Count

Use breaks to elevate your feet and relax your joints.
Deep breathing or short mindfulness practices can reduce stress and improve focus.
If available, find shaded or quiet areas to recharge during breaks outdoors.

Tips to Stay Energized at Work

Breathing Exercises

Boost focus with the 4-7-8 method: inhale for 4 seconds, hold for 7, exhale for 8.

Smart Snacking

Keep healthy snacks nearby—like yogurt, almonds, or apples—to stabilize energy levels.

Stay Hydrated

Keep a refillable bottle with you throughout the day. Even mild dehydration can reduce alertness and stamina.

FAQ: How to Stay Active in a Sedentary Job

How do you stay active when you have a sedentary job?

Incorporate short movement breaks, walking meetings, and desk stretches throughout your day. Use a sit-stand desk and set reminders to move every hour.

How to avoid a sedentary lifestyle at work?

Create a routine that includes light activity, hydration, and ergonomic support. Break up your day with micro-workouts and consider walking or biking to work if possible.

How do I start being active after being sedentary?

Start with small, sustainable actions like stretching daily or walking for 10 minutes. Gradually build up to more structured movement or fitness routines.

How can people stay fit in a 9 to 5 desk job?

Plan short activity bursts during your day, use your breaks to walk or stretch, and integrate wellness tools like resistance bands or a standing desk into your routine.

FAQ: How to Stay Healthy in Physically Demanding Jobs

Why are regular breaks important in active roles?

Even when your job keeps you moving, your body still needs rest. Short, scheduled breaks help prevent overexertion, reduce fatigue, and improve focus—especially for repetitive or physically intense tasks.

How does sleep affect physical performance?

Quality sleep is essential for muscle recovery, energy levels, and injury prevention. Aim for 7–9 hours of sleep each night to help your body recover from physical labor and prepare for the next day.

Is exercise necessary if I already have a physically demanding job?

Yes—light, targeted exercises can improve flexibility, core strength, and joint stability, helping to prevent workplace injuries. Stretching or walking during breaks can also reduce stiffness and support recovery.

How much water should I drink during a physically active shift?

Hydration is critical, especially in outdoor or hot environments. Aim to drink water regularly throughout the day—not just when you’re thirsty—to maintain energy, focus, and body temperature.

What are the benefits of bringing a packed lunch?

Bringing your own lunch allows you to control portion sizes and nutritional value. A balanced meal with lean proteins, healthy fats, and complex carbs supports sustained energy and faster recovery.

What does a healthy diet look like for physically active workers?

Focus on whole foods: lean meats, vegetables, fruits, whole grains, nuts, and healthy fats. Avoid high-sugar snacks and energy drinks that can lead to energy crashes and dehydration.

What does “listen to your body” mean in a labor-intensive job?

Don’t ignore signs of strain like joint pain, muscle fatigue, or dizziness. These are signals to slow down, hydrate, or rest to avoid injury or long-term health issues.

How can I manage stress in a fast-paced physical job?

Practice stress-reducing habits like deep breathing, mindfulness during breaks, and setting boundaries around work hours. Chronic stress can affect both your physical and mental well-being.

Why is posture important, even if I’m not sitting at a desk?

Poor posture while lifting, bending, or standing can lead to muscle strain and long-term injuries. Use proper body mechanics and switch tasks when possible to avoid repetitive stress.

Creating healthy habits isn’t just about avoiding sitting—it’s about choosing activity, recovery, and small wellness wins throughout the day. Whether you’re at a desk or on your feet, the key is consistency. Movement is medicine, and your workday is full of opportunities to protect your health—one habit at a time.

ACA Tax Laws and Provisions 2025

June 23, 2025/in News

The Affordable Care Act (ACA) introduced several tax provisions that significantly impact Applicable Large Employers (ALEs)—generally defined as organizations with 50 or more full-time employees, including full-time equivalent employees. These provisions encompass employer shared responsibility mandates, reporting obligations, and affordability thresholds. 2025 legislative changes have further refined these requirements, aiming to streamline processes and reduce administrative burdens.

Employer Shared Responsibility Provisions

Under the ACA, ALEs are required to offer minimum essential coverage that is both affordable and provides minimum value to their full-time employees and their dependents. Failure to comply may result in employer shared responsibility payments. Specifically, if an ALE does not offer coverage to at least 95% of its full-time employees (and their dependents), and at least one full-time employee receives a premium tax credit for purchasing coverage through the Health Insurance Marketplace, the employer may be subject to a penalty.

ALE Reporting Obligations

Qualified Applicable Large Employers (ALEs) have specific annual reporting responsibilities to the Internal Revenue Service (IRS) regarding the health insurance coverage offered to their full-time employees.

Traditionally, this involved providing Form 1095-C to each full-time employee and filing copies, along with Form 1094-C, with the IRS.

However, recent legislative developments, particularly the enactment of the Paperwork Burden Reduction Act, have modified these requirements. As of the 2024 tax year, ALEs are no longer mandated to automatically distribute Form 1095-C to full-time employees unless the employee explicitly requests a copy. Despite this change, ALEs must still file Forms 1094-C and 1095-C with the IRS by the stipulated deadlines:

Furnishing Forms to Employees: March 3, 2025 (extended by one day due to March 2 falling on a Sunday).

Filing with the IRS (Paper Filers): February 28, 2025.
Filing with the IRS (Electronic Filers): March 31, 2025.

Affordability Threshold Adjustment

The IRS annually adjusts the affordability threshold, which determines the maximum percentage of an employee’s household income that can be required for self-only coverage under an employer-sponsored plan to be considered affordable.

For the 2025 tax year, the affordability threshold has been increased to 9.02%, up from 8.39% in 2024.

This adjustment provides employers with greater flexibility when setting employee contribution rates for health coverage.

Enhanced Premium Tax Credits

The American Rescue Plan Act initially enhanced premium tax credits to make ACA marketplace plans more affordable. These enhancements were extended through 2025 by the Inflation Reduction Act. These tax credits reduce the insurance premiums that enrollees pay based on their projected income for the next year. The credits are paid directly to health insurers, who in turn lower the monthly amounts they charge. The credit amounts then need to be reconciled with actual income at year’s end when enrollees file their federal taxes.

Key 2025 ACA Takeaways for ALEs

Determine ALE Status:
- Annually assess your organization’s ALE status based on the preceding year’s employee count to understand your obligations under the ACA. IRS
Offer Compliant Coverage:
- Ensure that the health coverage offered meets the minimum essential coverage criteria, provides minimum value, and remains affordable under the updated 9.02% threshold for the 2025 tax year.
Adhere to Reporting Deadlines:
- While the requirement to furnish Form 1095-C to all employees has been relaxed, ALEs must still file the necessary forms with the IRS by the specified deadlines to remain compliant.

By staying informed about these provisions and adjustments, ALEs can effectively navigate their responsibilities under the ACA, ensuring compliance and optimizing the health benefits offered to their employees.

Pros and Cons of COBRA vs. Private Health Insurance

June 16, 2025/in COBRA, News

When seeking out health insurance coverage past when it is partially covered by your previous employer, how do you choose between picking COBRA or Private Health Insurance? Both have pros and cons. The right choice, however, depends on your unique circumstances.

Let’s discuss COBRA vs. Private Health Insurance.

Why Benefits Drive Retention, Morale, and Productivity

June 8, 2025/in Employee Engagement, Employee Retention, News, Worksite Benefits

Employee Health Starts with Usable Health Coverage

In industries where turnover is high and margins are tight, the simplest way to retain great people may also be the most overlooked: give them benefits they can actually use.

At SBMA, we specialize in Minimum Essential Coverage (MEC) benefits, voluntary add-ons, and workforce health solutions that make a measurable impact. Our goal? Help employers offer usable, affordable benefits that employees opt into — because they want them, not just because they have to.

Here’s how SBMA’s benefits lead to better business outcomes.

Benefits That Work—For Your People and Your Bottom Line

Gallup’s 2024 State of the Global Workplace Report found that highly engaged teams drive 23% higher profitability than disengaged teams. And benefits are a major piece of that engagement. In fact, 88% of employees say they’d consider a lower-paying job with better health, dental, and vision coverage over one with higher pay and fewer benefits.

The takeaway? Benefits matter—especially when they’re designed around real-world needs.

That’s where MEC and voluntary benefits come in. Preventive care, telemedicine, mental health support, dental, vision, and financial wellness tools help employees stay healthy, stay productive, and stay longer.

A Healthier Workforce Is a More Engaged Workforce

When employees feel supported, their productivity increases—and so does their loyalty. A few key benefits directly linked to morale and performance include:

MEC plans: ACA-compliant, budget-conscious, and preventive-focused to keep employees on track.
Mental health support: Reduces burnout, absenteeism, and disengagement.
Wellness programs: From fitness to nutrition, these programs reinforce healthier habits and better energy at work.
Voluntary benefits: Including dental, vision, accident, life, and critical illness, offering employees flexibility and choice.

When basic needs are met, employees bring more energy, focus, and enthusiasm to work.

Morale Can’t Be Mandated—But It Can Be Supported

Happy workers are 13% more productive. And that productivity grows when employers invest in the full employee experience—especially benefits.

Morale is shaped by what employees experience every day:

Do they feel supported when they’re sick?
Do they have tools to manage stress and financial uncertainty?
Do they feel valued for what they bring to the team?

When the answer is yes, they don’t just stay—they thrive.

Lower Morale Costs More Than You Think

The hidden cost of poor engagement is staggering. In 2023, Gallup found that 60% of global workers were “going through the motions”—leading to an estimated $8.8 trillion in global economic losses.

Meanwhile, companies that prioritize benefits and employee wellbeing see:

Reduced turnover and training costs
Improved team dynamics
Higher customer satisfaction
Better long-term profitability

At SBMA, we help employers avoid these losses by delivering real, usable benefits designed for the modern workforce.

Retention Starts with Usable Coverage

Turnover isn’t just expensive—it’s preventable. One in six U.S. employees leave their company for better pay or benefits. But with comprehensive MEC and voluntary plans, you can offer employees the coverage they want while staying within budget.

Even better? You don’t need to break the bank to offer meaningful care. Affordable options like MEC and telehealth give employees real coverage without overwhelming employers with costs.

Let’s Build a Plan That Keeps Your Team Together

At SBMA, we work with employers to build benefit strategies that:

Stay ACA-compliant
Support physical and mental health
Offer real value to employees
Boost retention, morale, and productivity

Support your people, and your business will follow. Let’s talk about how to deliver benefits your team actually uses—and that your company truly benefits from.