Detego Health

What Detego Health does

Detego monetizes as a managed-services TPA: plan sponsors (employers) and individual members pay administrative fees for claims processing, eligibility and enrollment management, benefits administration, regulatory compliance, network coordination, and member support services, with pricing quote-based and not publicly disclosed per Transparency in Coverage Rule machine-readable files. Go-to-market is sales-led and multi-channel — direct employer outreach, a broker and recruiter channel operated through Iron Health Benefits, and paid digital, social, email (Salesforce Marketing Cloud), SMS, and television/CTV campaigns — supported by in-house Care Guides and AI-assisted claim advocates. The operating model is built on an ecosystem of strategic partners rather than in-house development of every capability: Iron Health (member advocacy and broker channel), GuideCM (care coordination and case management), NaviClaim (claims resolution), ScriptAide (prescription savings), MedClaim Saver (billing review), MyLiveDoc (virtual care), Green Imaging, and ClaimInformatics (fiduciary separation for self-funded plans). The company completed independent SOC 2 Type II, HIPAA, and HITECH assessments in 2026, has no disclosed external funding rounds, and is led by a C-suite of healthcare veterans including CEO Richard W. Haldeman and President & Chief Legal Officer Alan W. Wilson.

Name

Detego Health

Legal name

Detego Health, LLC

Website

https://detegohealth.com

Company type

Private

Founded year

2021

Operating status

Operating

Headcount range

11–50 employees

Short description

Detego Health is an Omaha-based third-party administrator that administers health benefit plans for small and mid-sized employers and individual working owners and gig workers across the United States, via the Covered365 mobile platform, multiple plan tiers, and an integrated ecosystem of care, claims, and pharmacy partners.

Ownership category

akta.pro rank

Product category

Health Benefits Administration (Third-Party Administration Services)

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Self-Funded Employer Plan TPA (ASO Administration) (HLAEALAA)

akta.pro secondary industries

Eligibility, Enrollment & Benefits Administration (HLAEALAH), Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ), Individual Health Insurance Administration (TPA/ASO) (FSAIAEAK)

Keywords

• Third party administration
• Health benefits administration
• Self-funded health plans
• Claims processing services
• Group health insurance

Headquarters

HQ city

Omaha

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Third-Party Administrator Services: Detego Health generates revenue as a third-party administrator providing administrative services to employer-sponsored health and welfare benefit plans. The company handles claims processing, eligibility, enrollment, benefits administration, regulatory compliance, network coordination, and member support. Revenue comes from fees charged to plan sponsors (employers) for these administrative services.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels8 records

Core offering

Detego Health is a third-party administrator (TPA) that administers self-funded employer-sponsored health and welfare benefit plans for small and mid-sized businesses and individual working owners. The company handles claims processing, eligibility and enrollment, benefits administration, regulatory compliance, network coordination, and member support, delivered through the Covered365 mobile app, a Member Portal, a Provider Portal, and AI-supported claims advocacy backed by an integrated partner ecosystem.

Product overview

Detego Health operates as a third-party administrator (TPA) delivering a unified platform of health benefit administration services supported by multiple product tiers and partner integrations. The core product ecosystem centers on the Covered365 mobile app and Member Portal for member-facing benefits management, complemented by a Provider Portal for administrative tasks. The company offers plan products under multiple sub-brands including WellGuard Assurance (captive insurance model for employers), Population Science Management (for gig workers and independent contractors), and various limited medical and MEC plan tiers (GigCare, Core Guard, MaxGuard, Smart Choice, Unity Guard, Insight, TDK). These products are delivered through strategic partnerships including MyLiveDoc for virtual care, MyMedicalShopper/Talon for pricing transparency, Availity for provider transactions, and Green Imaging for diagnostic services, with Care Guides providing dedicated member support throughout the benefits experience.

Differentiator

Problem solved

Functional benefit

Products and services

• Covered365 Mobile App

Quantifiable outcome

• Replacing an employee can cost up to 150% of their salary
• +1 more outcomes

Named customers2 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

AI capability1 record

Feature5 records

Partnerships

16 partnerships are on record, tiered core.

• ClaimInformaticscoreStrategic or Co-development Partner · 22 October 2025ClaimInformatics and Detego Health partnered to improve claims processing transparency and accountability by separating fiduciary oversight from payment operations for self-funded health plans. The collaboration addresses conflicts inherent in traditional models, reducing costs, administrative burden, and enhancing compliance for plan sponsors. The integrated platform is now operational across Detego Health's nationwide networks.
• Iron Health BenefitscoreGTM or Marketing PartnerIron Health Benefits supports brokers and recruiters in matching clients with appropriate health plans. The partnership provides brokers with tools, education, and support to build stronger client relationships and grow their business.
• Iron HealthcoreStrategic or Co-development PartnerIron Health delivers member-first health plan support focused on clarity, advocacy and cost-conscious care to help individuals confidently navigate their benefits.
• GuideCMcoreTechnology or IntegrationGuideCM supports members with complex or ongoing care by helping coordinate treatment, manage chronic conditions and navigate care involving multiple providers. Provides pre-certification support and nurse-led case management.
• NaviClaimcoreTechnology or IntegrationNaviClaim helps members understand, track and resolve health care claims by providing expert guidance, provider search support and advocacy for complex benefits and bills.
• ScriptAidecoreTechnology or IntegrationScriptAide helps members understand their prescriptions, identify lower-cost medication options when available, and get support with pharmacy-related questions or issues. Offers Patient Assistance Program, Personal Importation Program, and Self-Pay Importation Program.
• MedClaim SavercoreTechnology or IntegrationMedClaim Saver helps members make sense of medical bills and insurance claims by reviewing charges, identifying errors and working with providers to resolve billing issues that may lead to unexpected costs.
• MyLiveDoccoreTechnology or IntegrationMyLiveDoc gives members convenient access to board-certified doctors through virtual visits, offering care for everyday health needs anytime, anywhere.
• Talon / MyMedicalShoppercoreTechnology or IntegrationMyMedicalShopper, powered by Talon, provides members with a health care price comparison tool supporting the Transparency in Coverage Rule. Members can compare costs, review provider options, and choose services aligned with budget and network.
• Blue Cross and Blue Shield of NebraskacoreTechnology or IntegrationBCBSNE provides provider network access through HealthSparq for Detego Health members in Nebraska.
• First Health NetworkcoreTechnology or IntegrationFirst Health Network provides a national provider network for members.
• Cigna HealthcarecoreTechnology or IntegrationCigna Healthcare provides a national provider network option for WellGuard PPO plans.
• PHCS (MultiPlan)coreTechnology or IntegrationPHCS (MultiPlan) provides a national provider network for WellGuard PPO and RBP plans.
• HealthSmartcoreTechnology or IntegrationHealthSmart provides a provider network option for WellGuard PPO and PSM PPO plans.
• AetnacoreTechnology or IntegrationAetna provides a national provider network option for members.
• WellGuard AssurancecoreStrategic or Co-development PartnerWellGuard Assurance is a captive insurance organization within the VerraCare health care ecosystem. Detego Health serves as third-party administrator to help employers, particularly small and mid-sized organizations, gain greater control over health care costs through a captive insurance model.

Scale indicators2 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Corecare: Corecare is a third-party administrator providing self-funded health plan administration, claims processing, and member support to small and mid-sized employer groups — directly comparable to Detego Health's core TPA offering and target segment.
• Imagine360: Imagine360 is a TPA specializing in self-funded health plans for small and mid-sized employers, leveraging cost-management programs and provider network strategies — directly comparable in business model, customer segment, and value proposition to Detego Health.
• Health EZ: Health EZ is a third-party administrator providing self-funded health plan management, claims administration, and member services to small and mid-sized employer groups — directly comparable to Detego Health's TPA focus and customer segment.
• Allied Benefit Systems: Allied Benefit Systems is an independent TPA providing health benefits administration for self-funded employer plans, including claims processing and member services — closely comparable to Detego Health's TPA operations and SMB/mid-market employer target.
• WebTPA: WebTPA is a third-party administrator delivering self-funded health plan administration, network access, and member tools to employer groups — directly comparable to Detego's TPA model and self-funded employer focus.
• Pareto Intelligence: Pareto Intelligence provides data-driven health plan administration and analytics services to self-funded employers and TPAs — overlapping with Detego Health's self-funded TPA positioning and analytics-enabled administration approach.

Broad incumbents

• Justworks: Justworks is a PEO offering health benefits administration (among other HR/payroll services) to small and mid-sized businesses — overlapping with Detego Health's SMB health benefits administration focus but operating as a broader PEO.
• Sequoia One: Sequoia One is a PEO providing HR, payroll, and benefits administration (including health benefits) to small and mid-sized businesses — broadly comparable to Detego's SMB health benefits administration positioning.

Emerging players

• SimplyInsured: SimplyInsured is a digital broker/platform helping small businesses and individuals purchase health insurance — overlapping with Detego's SMB and individual worker segments but focusing on brokerage distribution rather than TPA administration.

Regional players

• Surency: Surency is a TPA providing self-funded health and benefit plan administration, primarily serving employer groups — directly comparable TPA model to Detego Health with a more regionally concentrated footprint.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/detegohealth
• LinkedInlinkedin.com/company/detegohealth
• Instagraminstagram.com/detegohealth

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Subsidiaries4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Detego Health