SIHO Insurance Services

What SIHO Insurance Services does

SIHO Insurance Services is a private, hospital-owned health plan administrator headquartered in Columbus, Indiana, founded in 1987 by local physicians, hospitals, and employers to address rising healthcare costs in southern Indiana. The company operates as a third-party administrator (TPA) serving small, medium, and large employer groups through three product architectures: "Classic" fully insured plans, "Transitional" level funded plans, and "Select" self-funded plans, supported by chamber-endorsed products (Columbus, Jackson County, Knox County), a Medicare Advantage offering under MytruAdvantage, and ChamberCare. SIHO also runs Corporate Administrative Services (CAS), a wholly-owned subsidiary offering privately-labelable claims processing, customer service, medical management, provider network management, and IT support to outside health plans, ACOs, provider networks, and employer groups.

The underlying technology is an integrated platform combining claims adjudication (processing over 2 million medical and dental claims annually with an 85% electronic capture rate and 4-6 day turnaround), member and provider portals via the HealthX system, automated call distribution, online provider directories, and a population health data layer that drives medical management interventions shared with providers and employers. Provider network coverage exceeds 90% in served communities, augmented since January 2025 by a UnitedHealthcare Options PPO partnership for out-of-state access. HIPAA-compliant operations, monthly machine-readable JSON MRF publishing, and integration with the Hercules Health search platform round out the technology stack.

Revenue is generated through managed-services fees on TPA arrangements, recurring premiums on fully insured and level funded plans, professional-services fees for wellness, COBRA, and 340B pharmacy consulting, and CAS administrative fees. Go-to-market is sales-led via direct employer relationships and a dedicated broker portal, complemented by chamber-of-commerce endorsements and partner channels (UHC, MytruAdvantage). Primary customer segments are small-to-large employers and insurance brokers/agents in the Midwest, with secondary segments including healthcare providers, plan members, and hospitals/health systems seeking strategic health plan and ACO development support.

Name

SIHO Insurance Services

Legal name

SIHO Insurance Services

Website

https://siho.org

Company type

Private

Founded year

1987

Operating status

Operating

Headcount range

101–250 employees

Short description

SIHO Insurance Services is a private, hospital-owned health plan administrator founded in 1987 in Columbus, Indiana, providing third-party administration, fully insured and level funded plans, and related administrative services to small, medium, and large employers across the Midwest via direct sales, broker channels, and chamber endorsements.

Ownership category

akta.pro rank

Product category

Health Plan Administration (Third-Party Administration)

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Insurance Carriers, Nec (6399)

akta.pro primary industry

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

akta.pro secondary industries

Eligibility, Enrollment & Benefits Administration (HLAEALAH), Flexible Benefits Administration (FSA/HSA/HRA) (HLAEALAK), Small Group Health Insurance (2–50/100) (FSAIAFAD)

Keywords

• Health plan administration
• Third-party administration
• Self-funded insurance
• Fully insured plans
• Employer health benefits

Headquarters

HQ city

Columbus

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. Third-Party Administration (TPA) Services: Administrative services for self-funded employer health plans including claims processing, customer service, medical management, and provider network management. SIHO's TPA plan provides services common to national carriers at a local TPA price with over 90% provider coverage in served communities.
2. Fully Insured Health Plans: Fully insured product offerings where SIHO assumes risk for employer group health coverage. These include Classic plans with various benefit designs (High Deductible Health Plans, Health Reimbursement Accounts, Health Savings Accounts, comprehensive plans).
3. Level Funded Plans: Aggregate-only plans combining self-funding advantages with fixed premiums and limited liability of fully insured plans. Employers pay fixed monthly premiums covering claims fund, stop-loss insurance, and administrative costs.
4. Wellness Programs: Optional Wellness Works program offering customizable wellness plan designs to help employers improve employee health and productivity.
5. COBRA Administration: COBRA continuation coverage administration services for employers.
6. Corporate Administrative Services (CAS): Subsidiary offering high quality, comprehensive, and cost-competitive services to Health Plans, ACOs, Provider Networks, and Employer Groups including claims processing, customer service, medical management, provider network management, and IT support.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels7 records

Core offering

SIHO Insurance Services is a Midwest-based health plan administrator offering a three-tier portfolio of group health plans — "Classic" Fully Insured Plans, "Transitional" Level Funded Plans, and "Select" Self-Funded (TPA) Plans — to small, medium, and large employers. The company provides third-party administration services including claims adjudication, customer service, medical management, provider network management, and IT support, plus value-added offerings such as chamber-endorsed plans, a Medicare Advantage product (MyTruAdvantage), and CAS administrative services for health plans, ACOs, and provider networks.

Product overview

SIHO Insurance Services operates as a health plan administrator offering a multi-tiered portfolio of products organized across three plan architectures — 'Classic' Fully Insured Plans (traditional fully insured), 'Transitional' Level Funded Plans (aggregate-only level funded), and 'Select' Self-Funded Plans (TPA Plan) — supported by a suite of administrative and advisory services. The core SIHO TPA Plan is the primary service offering providing claims processing, customer service, medical management, provider network management, and IT support at a local TPA price point. Supporting services include Health Plan Administration, TPA Services, Corporate Administrative Services (CAS — a privately labelable subsidiary), Health System Development (including population health, wellness, ACO development, employer clinics, and 340B pharmacy programs), and an Out-of-State Network Solution via UnitedHealthcare Options PPO. The company also offers branded chamber-endorsed products (Columbus, Jackson County, Knox County), Medicare Advantage under the MyTruAdvantage brand, and ChamberCare for chamber members. Services are branded for hospital partners or delivered under the SIHO name.

Differentiator

Problem solved

Functional benefit

Brands

• SIHO Signature Series: Product line designed to meet the needs of small, medium and large employers, including Classic (Fully Insured Plans), Transitional (Level Funded Plans), and Select (Self-Funded Plans)
• ChamberCare
• Wellness Works
• SIHO Plus Network
• MytruAdvantage

Products and services

• SIHO TPA Plan (Self-Funded Plans) Third-party administrator (TPA) plan for self-funded employer groups, providing claims processing, customer service, medical management, provider network management, and IT support at a local TPA price. Encompasses over 90% of providers in served communities with access to rental networks in Indiana and nationally, enabling custom benefit plans.
• "Classic" Fully Insured Plans Fully insured health insurance products offering High Deductible Health Plans, Health Reimbursement Accounts, Health Savings Accounts, and comprehensive rich-coverage plans, matched to employer group preferences.
• "Transitional" Level Funded Plans Aggregate-only level funded plans ideal for employers transitioning from fully insured to self-funded. Combines self-funding advantages with fixed premiums and limited liability of fully insured plans.
• Health Plan Administration Comprehensive administrative services including claims adjudication (over 2 million medical and dental claims per year), member services, and network services with a dedicated provider relations team.
• TPA Services Third-party administration services covering efficient and accurate claims adjudication, account management, employer services, provider relations, medical management, and member services teams.
• Corporate Administrative Services (CAS) A subsidiary of SIHO Holdings providing comprehensive administrative services (claims processing, customer service, medical management, provider network management, and IT support) to health plans, ACOs, provider networks, and employer groups. Services are privately labelable.
• Health System Development Strategic services for hospitals including health plan development, network development, medical management, population health management, ACO development, employer clinics, and 340B pharmacy program support.
• Out-of-State Network Solution (UnitedHealthcare Options PPO Network) Out-of-state network solution available for eligible SIHO plans, providing broader healthcare coverage for employees and families living or traveling outside Indiana, particularly for multi-site businesses and remote employees.
• ChamberCare A product endorsed for chamber of commerce members, offering group health plan options tailored to chamber member employers.
• Medicare Advantage (MyTruAdvantage / MTA) Medicare Advantage plan offered under the MyTruAdvantage brand, listed as a SIHO product and service.
• Columbus Chamber Endorsed Health Plans Health insurance plans endorsed by the Columbus Chamber of Commerce, available to chamber member employers.
• Jackson County Chamber Endorsed Health Plans Health insurance plans endorsed by the Jackson County Chamber of Commerce, offering SIHO Plus Network and EncoreCombined Network provider options.
• Knox County Chamber Endorsed Health Plans Health insurance plans endorsed by the Knox County Chamber of Commerce, including preventive health benefits and pharmacy formulary.
• Wellness Works Optional wellness program within population health services. Employers select from three wellness plan designs; program includes coordination, health management, and reporting.
• 340B Pharmacy Program Program helping hospitals evaluate and implement 340B drug pricing program eligibility and savings, including community-wide prescription drug programs with consulting, network development, IT, legal, and administrative support.

Quantifiable outcome

• Over 2 million medical and dental claims processed annually with 4-6 day average turnaround
• +3 more outcomes

Segments5 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

One partnership is on record.

• UnitedHealthcarecoreTechnology or Integration · 1 January 2025UnitedHealthcare Options PPO Network serves as an out-of-state network solution for eligible SIHO clients. This provides broader healthcare coverage and convenience for employees and families residing or traveling outside Indiana. Particularly beneficial for multi-site businesses with locations outside Indiana, remote employees, and traveling employees. Available for eligible SIHO plans effective January 1, 2025.

Scale indicators7 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• UMR (UnitedHealthcare): The third-party administration arm of UnitedHealth Group, UMR is the largest U.S. TPA serving self-funded employer health plans with integrated PPO networks and stop-loss. It is the most direct functional competitor to SIHO's TPA/ASO model, operating at vastly greater scale.
• WebTPA Holdings: Independent national TPA providing claims administration, network management, and customer service for self-funded employer plans. Comparable to SIHO's TPA offering across mid-market and large employer segments.
• Allied Benefit Systems: Mid-sized TPA offering self-funded plan administration, PPO networks, and stop-loss support to employer groups. Closely matches SIHO's service mix, scale band, and go-to-market through brokers and consultants.
• MedCost: Regional TPA serving self-funded employers across the Carolinas and Southeast with claims, network, and care management services. Comparable to SIHO as a regional, hospital/provider-affiliated health plan administrator.
• HealthSCOPE Benefits (Cigna): TPA subsidiary of Cigna/Evernorth providing self-funded plan administration to mid-market and large employers. Direct functional peer for SIHO's TPA services across multi-state employer accounts.
• CoreSource (Trustmark Companies): TPA offering self-funded health plan administration, stop-loss, and integrated provider network solutions to mid-market employers. Functionally analogous to SIHO across claims, network, and ASO services.
• Star Administrative Services: Independent regional TPA focused on self-funded employer plans with claims, network leasing, and care management. Comparable to SIHO in scale band, broker-distribution model, and multi-tier product mix.
• Benefit Administrative Systems (BAS): Mid-market TPA providing self-funded health plan administration, PPO network access, and stop-loss coordination. Closely comparable to SIHO's mid-sized TPA operating model and employer-target profile.

Broad incumbents

• Anthem Blue Cross Blue Shield (Elevance Health): Major national health insurer and TPA competitor with broad PPO networks, ASO services, and stop-loss capabilities. Competes with SIHO in the fully insured and self-funded employer markets, particularly where Anthem's network and brand reach dominate.
• UnitedHealth Group (UnitedHealthcare): Largest U.S. health insurer and parent of UMR (TPA) and Optum, with national PPO networks, stop-loss, and integrated care capabilities. Sets the competitive ceiling on what regional TPAs like SIHO must out-execute against for self-funded accounts.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/SIHOInsuranceServices
• LinkedInlinkedin.com/company/sihoinsuranceservices
• Instagraminstagram.com/sihoinsuranceservices

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Subsidiaries1 record

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 SIHO Insurance Services