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Turn Complexity into Convenience

Save millions in operational costs while increasing effectuation rates. Softheon is the leading platform for automating an end-to-end experience that goes beyond quote-to-card. Softheon empowers you to do more, faster – from more enrollments through Enhanced Direct Enrollment (EDE), to finding and keeping more subsidy dollars through AI-powered automated enrollment and payment reconciliation.

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Health Plans

Health plans have experienced remarkable results with Softheon:


average reconciliation accuracy


ROI (in the first year), as much as 1,075% ROI


reduction in deployment time


average effectuation rate (vs 94% national benchmark)

Keep up with Compliance and Complexities

Changing compliance requirements and multiple vendors can mean disaster in government-sponsored markets. But with Softheon, you get more than just tools; get the expertise that protects you. We work closely with CMS and often test proposed changes before they hit the market. Stay in compliance, maintain good relations with CMS, and reduce member abrasion.

Health Plans

Improving Outcomes and Reducing Costs with Softheon + AI

Softheon’s AI capabilities layers with core enrollment, billing, and payment processes, resulting in better business outcomes. From improved effectuation rates to lower costs, Softheon uses your data to make the most out of your operations.


Shopping & Enrollment

Shopping on Your Terms.

You’ve worked hard to get prospects on your site. So stop rerouting them to your competitors. If you’re in a Federally Facilitated Marketplace (FFM) state, Softheon offers Phase III EDE. Keep prospects on your site throughout the entire member journey.

View Shopping & Enrollment

Billing & Payments

Easier Billing

Offer your members their preferred payment methods and reduce admin costs. Unlike other solutions, Softheon integrates all billing and payments with enrollment so you have a single system that handles complex or changing CMS and SBM rules.

Billing & Payments

Member Renewal

Higher Retention and Renewal Rates.

Retain more members with personalized communication that reaches the right members at the right time. Integrated systems create a cohesive member journey and lets you know who is delinquent before it’s too late.

Member Renewal

Reporting & Governance

Better Reconciliation.

Secure more subsidy dollars and close your books faster. Take reports and upload them directly to your general ledger for ease of accounting and forecasting.

Reporting & Governance

Softheon +AI

Better Outcomes with Your Data.

Our AI solution enhances data usability, offering personalized member engagement, intuitive call center support, self-guided knowledge for members, and real-time performance insights. Elevate healthcare operations using data your already have.

Softheon +AI

Softheon’s Health Plans

vs. Competitors

Health Plans
Adaptable and flexible design Meets all CMS requirements
Supports Phase 3 EDE Supports real-time enrollments Supports SBEs
Plug-and-play billing and payments PCI-compliant Processes complex business rules to support compliance and member experience
Integrated systems Automatically reconciles and syncs enrollment and payment data
Adaptable and flexible design Meets all CMS requirements
EDE may be available No support for real-time enrollments No support for SBEs
Not included
Not included
Not as user-friendly Not as adaptable
EDE may be available No support for real-time enrollments
May only offer billing or payments, but not both May rely on patched-on third party vendors
Limited admin Tools Software not designed for ACA and Commercial
Separate shopping portals for each product Double redirect to exchange puts enrollment at risk Overnight 834 files only No real-time API
Separate shopping portals for each product Double redirect to exchange puts enrollment at risk Overnight 834 files only No real-time API
Relies on a vendor must maintain tough PCI-compliance audits Vendor not connected with other systems
Data silos make reporting and automation difficult

Why Health Plan Leaders
Trust Softheon

“Softheon’s expert knowledge of the ACA marketplace coupled with their leading enrollment and billing technology has made them the perfect partner during Hometown Health’s first open enrollment period on the exchange.”

David Hansen | CEO, Hometown Health

“[Softheon has] a fantastic solution and its performance has been great… the strength of the vendor relationship isn’t whether you have problems or not, it’s how you go about solving them and those issues.”

Paul Wingle | CVS/Aetna

Additional Resources: Expand your footprint in the ACA Marketplace

The ACA Marketplace is expanding. Are you getting your share?

Smarter Automation,
Smoother Operations.

See what Softheon can do for your health plan.

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