Engineered employee benefit plans.
Custom built for your company's unique needs.
We use self-funded plans to give employers the flexibility to build an employee benefits package that is both affordable and valuable to every employee. Then we place the risk, administer every claim and support every member, all on one operating architecture.
Custom-built health and benefit plans for employers.
Self-funded ERISA plans built around your workforce, budget and risk profile. You get the flexibility to design a benefits package that's affordable for the company and valuable to every employee, on SOTA's own plan designs and backed by aligned stop-loss.
SOTA plan designs
Tiered structure: Tier 1 high-performance network, Tier 2 network access, Tier 3 out-of-network protection.
$0 primary care
Assigned virtual and direct primary care with chronic-care management.
Clinical pharmacy
Transparent pass-through PBM plus pharmacist-led care for high-risk members.
Direct purchasing
Cash prices, bundles, single-case agreements and Centers of Excellence.
Risk placement
Specific and aggregate stop-loss, marketed, placed and aligned to the plan.
Plan documents
ERISA plan document, SPD and SBC written to match administration and stop-loss.
Compliance
ACA, COBRA, No Surprises Act and HIPAA built in from day one.
Pricing & funding
Rates and funding set on your real data for predictable costs.
Voluntary & ancillary coverage: dental, vision, life, disability, accident, critical illness and hospital indemnity, added to the plan and enrolled by our licensed team.
Alternative plan types: the same architecture can be configured as Minimum Essential Coverage (MEC), Enhanced MEC or Minimum Value plans for hourly, seasonal and variable-hour workforces.
Ask us which combination fits your group.
Plan availability and design options vary by group size, state and underwriting. MEC plans cover preventive services and are not comprehensive major medical coverage.
Cost containment isn't an event. It's built into every claim.
Administration runs through our affiliated Texas-based TPA, with claims experience dating to 1996, on a modern platform configured to your plan.
Adjudication by design
Payment rules configured to your plan document, tiers and pricing method.
Intelligent claims routing
Each claim sent to the right network, repricing or review path before payment.
Hospital bill review
Coding audits and nonprofit-hospital financial-assistance screening.
Medical management
Precertification, utilization review, case management, Centers of Excellence.
Out-of-network protection
Repricing, No Surprises Act IDR, appeal defense and balance-bill resolution.
Reporting & data
Real-time claims and membership data, EDI and API integrations.
The claim lifecycle, managed at five stages.
Before the claim
Primary care, pharmacist outreach, chronic-care management, navigation.
Point of care
Tier 1 providers, Centers of Excellence, bundles, lower-cost sites of service.
Before payment
Routing, repricing, claim editing, bill review, out-of-network pricing.
Pharmacy & chronic care
Formulary, specialty economics, adherence, therapy optimization.
After payment
Subrogation, recovery, appeals, analytics and plan refinement.
Services are provided under the governing plan document and applicable contracts. SOTA Benefits does not provide legal or tax advice.
Service is the product. Quality is the standard.
An in-house, bilingual enrollment and member service team that carriers, agencies and employers rely on. We hold every call to a higher bar, without trading away accuracy or care to get there.
In an industry where service is usually the first thing cut, our members tell us we get it right.
An extension of your service team
Licensed enrollment, member support and outreach under your programs.
Enrollment capacity on demand
We run enrollment and follow-up so your producers can focus on clients.
Support your people can reach
New-hire and open enrollment, benefit questions and claims help, from our own office.
Inbound support
Enrollment help, benefit explanations, ID cards, claims and provider questions.
Outbound campaigns
New-hire and open-enrollment outreach, follow-up on incomplete elections.
Every line of coverage
Health plans, custom builds and supplemental: dental, vision, life, disability, accident, critical illness.
Quality, measured
Every advisor coached weekly on accuracy, resolution and member feedback.
¹ Net Promoter Score from SOTA post-interaction member surveys, Aug–Sept 2026 (about 120 responses weekly). ² Qualtrics XM Institute, Q3–Q4 2024 U.S. Consumer Benchmark Study, which measures consumers' overall rating of their health insurer. The two scores could use different survey methods. Past performance does not guarantee future results.