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FOR HEALTH PLANS

Grow Without the Growing Pains

Softheon’s Health Plan Solutions provide the only all-in-one automated healthcare solution for commercial and government-sponsored health plans.

Marketplace Cloud

Consolidate your member acquisition and retention operations across all platforms—whether on the Federally Facilitated Marketplace (FFM), State Based Marketplaces (SBMs), or off-exchange. Softheon offers an integrated platform for shopping, enrollment, and premium billing, streamlining the management of Qualified Health Plans, Dental, Vision, and other commercial lines of business.

Medicare Advantage Cloud

Softheon now supports the management of Medicare Advantage and Supplemental plans. Manage plan shopping, enrollment, premiums (where applicable) and member communications, all on the same platform that drives your ACA Marketplace success.

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Health Plans

Health plans have experienced remarkable results with Softheon:

99

average reconciliation accuracy

2X+

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

73

reduction in deployment time

95

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

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
HEALTH PLAN SOLUTIONS

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

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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