Priyang Shah's founding mistake was boring, expensive and instantly familiar: he picked the wrong health plan. Shah had spent years around insurance and healthcare technology, including early roles at Root Insurance and Olive AI. Yet when his own family had two employers, two sets of premiums and two menus of deductibles, the ostensibly informed customer still got it wrong. That is the small domestic comedy behind Healia Health - a Columbus company built to answer a question most benefit systems barely acknowledge: whose employer should cover the family?
The first answer was software. Healia's plan-selection tool lets an employee upload both sets of plan documents, estimates the household's true costs and recommends a combination in roughly two minutes. But a recommendation is not a changed behavior. Families stay with familiar coverage because moving feels risky; HR teams bury unfamiliar benefits in one open-enrollment email; a spouse's network may look good until somebody needs a specialist. Healia's more consequential product became the machinery that makes the recommended move feel safe.
The trick is moving the risk
Healia calls its flagship benefit the Total Care Option, or TCO. In benefits language, it is a spousal health reimbursement arrangement. An eligible worker waives some or all coverage from their own employer and joins a spouse's employer-sponsored plan. The original employer funds an HRA that can reimburse premiums, copays, coinsurance and deductibles. Healia creates the documents, coordinates enrollment, checks eligibility, processes claims and sends reimbursements to the family's bank account.
The employer's attraction is not mysterious. Healia estimates that adding a spouse to the company plan costs about $20,000 a year on average. A TCO household costs around $4,000. That is not free money: the spouse's employer and insurer still carry the primary coverage, while the first employer funds a capped reimbursement. But from one buyer's ledger, an open-ended insurance liability has become a controlled expense. Healia says the average customer saves 76 percent for each household that enrolls.
Illustrative annual employer cost per participating spouse
Reported averages, not a universal quote. Actual savings depend on plan rates, family mix, networks, utilization and HRA design.
For the family, the offer can be unusually legible: move to a qualifying spouse plan and have eligible health costs covered, in some designs up to 100 percent. Healia says its tool alone saves families an average $2,100 annually by improving plan selection. The company reports up to $26,000 in additional coverage for households with greater needs. This is the rare benefits pitch in which the CFO's savings do not require a worse deductible for employees.
What failed first: information by itself
Healia's own operating data contains the most useful correction to the tidy software story. A good recommendation tool is necessary, but it does not guarantee enrollment. The company says an HRA funded near the federal out-of-pocket maximum can attract roughly 2.5 times the enrollment of an $8,000 design, for only about $166 more in average annual utilization per household. Covering premiums as well as medical expenses can lift enrollment two to four times compared with out-of-pocket coverage alone.
A better answer did not change behavior until Healia also changed the incentive.The product lesson hiding inside open enrollment
Education matters just as much. Employees encounter new benefits through postcards, webinars, on-demand video, one-to-one sessions, coworkers and the benefits portal. Betting on a single channel leaves the program invisible. Healia now treats employer kickoff, benefits-platform setup, trusted internal messaging, claims tutorials, new-hire outreach and life-event reminders as parts of the product. Software people may call that services. Families call it knowing what happens next.
Then comes the first claim, where credibility is won or lost. Healia says more than 95 percent of claims are reviewed within two business days, followed by ACH payment in another one or two. A fast reimbursement becomes lunchroom proof that the benefit works. A three-week wait becomes the story that suppresses next year's enrollment. The claims queue, not the recommendation algorithm, may be the company's most effective retention feature.
Who buys it - and who has to believe it
Healia sells to employers, usually with help from benefits brokers. HR needs a benefit employees can understand. Finance wants a measurable reduction in healthcare spending. Brokers want something credible enough to win and retain clients. The family has veto power: nobody switches if the spouse's network, premium or paperwork looks worse. That makes Healia a three-sided enterprise product whose end user is technically a household.
Public customer references include Bethel University, Bloomreach, Adswerve, NREMT and the University of St. Thomas. In a 2025 industry interview, Healia reported more than 50 customers across over 25 states. By its 2026 funding announcement, it said it served hundreds of employers. The company also reports more than 1,250 brokers actively quoting its product. One unnamed commercial-real-estate employer reported $1.25 million in net savings and a 16.5-times return; a healthcare employer saw 134 of 152 registered users finish recommendations.
The business model borrows the best sentence in performance pricing without promising magic. Employers pay a flat monthly fee only for households enrolled in the TCO. There are no setup fees or monthly minimums, and decision support is included. A 2023 public board record listed one employer's rate at $125 per enrolled employee per month; Healia's current pricing is quote-based, so that figure is history, not a price card. If nobody enrolls, Healia says the employer owes it nothing.
A focused wedge in a crowded market
Healia sits beside several familiar categories without fitting neatly into one. Jellyvision's ALEX, Nayya, Flimp, Healthee and other decision-support tools help employees evaluate benefits. HRA administrators process reimbursements. Consultants design plans. Brokers distribute them. Healia's difference is the bundle: compare plans across two employers, attach a targeted HRA to the best alternative, then run the education and claims operations needed to make the switch real.
The low-tech alternatives are a spousal surcharge, a carve-out that excludes working spouses, a taxable cash payment for waiving coverage or a higher deductible. Each can reduce employer costs. Each also introduces an obvious employee complaint. Healia's product is the carrot version: offer more usable coverage if the family moves to a cheaper source of primary insurance. It does not eliminate cost. It rearranges who carries which portion, then shares part of the employer's savings with the family.
What another founder can copy
The stealable idea is not “build an HRA.” It is a sequence. First, find an expensive default created by two systems that do not talk to each other. Second, model the savings at the level where a buyer controls budget. Third, give the end user enough value to change behavior. Fourth, charge only when that behavior happens. Finally, own the ugly operational steps that determine whether the promise survives contact with reality.
Families renew familiar coverage because cross-employer comparison is hard.
Use part of the employer's savings to cover the family's real costs.
Bill for enrolled households, not software seats or unused access.
Documents, education, eligibility, claims and ACH make the product believable.
The fundraising follows the wedge. Healia joined Y Combinator's Winter 2024 batch. In July 2026, it raised a $14 million Series A led by 111° West Capital, with Y Combinator, First Round Capital, Pioneer Fund, GoAhead Ventures and North Coast Ventures participating. The company says it has raised $18 million in total. Shah is keeping the operating team in Central Ohio, where he argues in-person work shortens communication loops and the alumni networks of Root and Olive supply experienced builders.
When the math stops working
This is not a universal benefits escape hatch. A worker needs access to a qualifying spouse or partner's employer-sponsored plan. Medicare, Medicaid, marketplace coverage and TRICARE do not satisfy the integration rules Healia describes. The other plan needs suitable doctors, prescriptions and geography. An employer that sets a timid HRA cap, excludes premium reimbursement or communicates once will save less because fewer families will move.
| Works best when | Breaks down when |
|---|---|
| A meaningful share of workers has access to qualifying spouse coverage. | Most households have only one employer plan available. |
| The HRA covers enough real cost to make switching feel safe. | The allowance leaves premiums or a large deductible exposed. |
| Networks and prescriptions are compared, not merely premiums. | The cheaper plan excludes care the family relies on. |
| Education and claims service continue all year. | The benefit appears once in an open-enrollment email. |
There is also a strategic boundary: Healia depends on another employer continuing to provide primary insurance. Its savings are real from the customer's perspective, but they come from routing a household across a fragmented system, not repairing the underlying price of American healthcare. If every employer optimized the same way at once, the tidy bilateral math would become messier. Today, the opportunity exists precisely because coordination is rare.
That caveat does not shrink the company so much as locate it. Healia is an enterprise health-benefits operator using software to expose a hidden option, finance to make it attractive and service to make it trustworthy. The cheerful two-minute comparison gets attention. The plan design, broker channel and two-day claims review turn it into a business. For a family staring at two benefits booklets, that may be exactly the amount of ambition the problem needs.
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