A fresh approach to health benefits
A fresh approach to health benefits
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We are not a traditional broker; we are your health plan architect. Instead of selling you off-the-shelf, fully insured plans with built-in carrier profit margins, we build custom, self-funded health strategies. We unbundle the components of your plan like pharmacy benefits and network access to eliminate hidden markups and secure direct, cash-based pricing.
Our sweet spot is growing companies with 50 to 500 employees and at least $500K in annual healthcare spend. However, we also offer specialized solutions, like Health Share plans and Section 125 programs, specifically designed for companies under 50 employees seeking credible alternatives to expensive group health plans.
No, we empower them. We provide a fully integrated platform from enrollment to payment, reducing their administrative burden. Our Smart Health Concierge acts as your employees' first point of contact, handling all their questions, care coordination, and provider billing issues directly so your HR team doesn't have to.
If you are on our SmartHealth plan then yes. If you are on one of our other share plans then you mey be limited to the network associated with the plan chose by the employer. However, even if you are on a plan with a network most care providers are still available and there should not be too much disruption to how you get care.
On average, our clients save between 20% and 60% compared to traditional fully funded insurance plans. For a 100-employee company, this often translates to over $1M in annual savings. We achieve this by negotiating direct cash rates and eliminating carrier profit margins.
Absolutely.
Because we unbundle the plan and negotiate directly, we frequently see massive reductions. For example, we've negotiated a $48,000 appendectomy down to a $21,000 direct-pay procedure, and we've taken a $10,000/month specialty Tier IV prescription down to just $500/month. And we've done that twice. A single prescrition savings like the previously mentioned will save the plan $100,000 per year on that alone.
Stop-loss insurance provides financial protection for your company against catastrophic or unexpectedly large medical claims. It ensures that while you enjoy the massive savings of a self-funded plan, your maximum financial exposure is strictly capped and predictable.
No, they will almost always pay less. While a typical family on a traditional plan spends $2,000 to $4,000 a year out-of-pocket, our custom plans and Smart Health Concierge often bring employee out-of-pocket costs down to $0 for planned care and prescriptions.
Our Smart Health Concierge negotiates directly with providers to secure meaningful cost savings by paying them directly in cash. Because we bypass the expensive insurance billing maze, providers give us steep discounts. We pass a portion of those savings directly to your employees as $0 out-of-pocket costs.
If they need a planned procedure or expensive medication, they call the Concierge at 877-763-4955. We coordinate the care and pay the provider directly. At the office, the employee presents their card as a "Self-Pay" transaction. There are no mystery bills, no confusing EOBs, and often $0 costs.
This is rare, but if it happens, the employee simply calls the Concierge while still at the office. Our team will contact the provider directly to explain the direct-payment model and resolve the issue in real time. If the employee chooses to pay upfront, Smart Health will reimburse them for eligible services.
Federal law requires you to satisfy a $1,700 individual deductible before benefits begin. You will pay the cash price for services using your HSA card until you meet that deductible. Once met, your $0 copay and $0 deductible benefits apply for covered services.
Section 125 (Cafeteria Plan) is a government-sanctioned, ACA-aligned program that allows employers to offer minor medical health benefits and wellness coaching at no cost. It utilizes pre-tax payroll deductions to fund the benefits, creating tax advantages for both the company and the employee.
By utilizing pre-tax deductions for the health benefits, the employee's taxable income is lowered. This in turn reduces the employer's matching FICA tax liability, effectively lowering your overall payroll costs while simultaneously boosting the employee's take-home pay.
Employees gain access to real minor medical benefits. This includes zero-copay telehealth visits, unlimited urgent care visits with a $0 fee, personalized clinical coaching, and sometimes even life insurance options, ensuring they get routine care without financial hesitation.
To remain eligible and unlock the tax benefits, employees must complete one qualifying health activity each month via our app. This can be as simple as taking a health education quiz, completing a comprehensive health screening, or completing a covered telehealth visit.
A Health Share plan is a community-based, cost-effective alternative to traditional insurance. Instead of paying high premiums to a carrier, your business contributes a set amount per employee into a shared care fund. When medical needs arise, the community funds are used to share the cost.
No, health sharing is not traditional insurance. However, it provides the financial safety net your employees need for unexpected medical events. It delivers the benefits of health coverage—like major medical, virtual care, and mental health—with none of the insurance headaches.
Share plans offer real care, covering essentials like major medical events, hospitalizations, surgeries, doctor visits, labs, telehealth, mental health, and prescriptions. There are no restrictive HMOs or PPOs, so employees have the freedom to choose their providers.
Share plans are specifically designed for small businesses with under 50 employees who are often priced out of the traditional group health market. They are easy to implement and provide a flexible, affordable alternative to rigid carrier requirements.