How to Provide Health Benefits Without a Traditional Group Plan
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.
