Healia

What do they actually do

Healia helps employers offer a specific health benefit—the Total Care Option (TCO)—that reimburses employees’ premiums and out‑of‑pocket costs when they enroll in a spouse’s employer plan. The company packages the HRA design, plan documents, employee education, and an AI decision tool that can read a spouse’s benefits PDF and compare household costs across plans, so families can pick the cheaper option without coordinating across two employers Healia – Employers, Healia – Employees, YC profile.

Day to day, employees submit claims through Healia’s portal and get reimbursed directly to their bank accounts, while HR teams get plan docs, SPD preparation, and HRIS integrations handled by Healia. Pricing is enrollment‑based—employers pay only for households that enroll in the TCO, with no separate setup fees or monthly minimums when offered with TCO Healia – Employers. Y Combinator reports 50+ employer customers and 40k+ employees using Healia’s product nationally, indicating early but real adoption YC profile.

Who are their target customer(s)

• HR benefits manager at a mid-size employer: Needs competitive family benefits without paying for duplicative coverage when an employee can move to a spouse’s plan; lacks tooling to educate employees and handle cross‑employer reimbursements.
• CFO / head of finance at an employer: Wants predictable, controllable benefits spend; seeks enrollment‑based costs and a clear reimbursement flow when employees switch to a spouse’s plan.
• Benefits broker or consultant: Needs a concrete answer for dual‑income households and an easy way to compare household costs and reduce client administrative work.
• Payroll / benefits administrator or HRIS integrator: Overloaded by plan docs/SPDs, compliance, and reconciling claims across systems; needs integrations and outsourced administration to reduce manual work.
• Dual‑income employee (end user): Unsure which spouse’s plan is cheaper for the household; wants simple reimbursements if leaving their employer plan and clear, side‑by‑side plan comparisons.

How would they acquire their first 10, 50, and 100 customers

• First 10: Run concierge pilots with a few mid‑size employers sourced via broker partners and trusted referrals, using enrollment‑based pricing to reduce buyer risk and capture concrete savings and time‑to‑reimbursement proof points Healia – Employers.
• First 50: Formalize broker co‑selling and revenue shares, offer a co‑branded decision tool demo, and add a small direct sales motion to HR/CFO buyers at similar mid‑market employers; prioritize HRIS/payroll integrations to lower implementation friction Healia – Employers.
• First 100: License or white‑label the decision engine to benefits platforms and large brokerages, list TCO in broker/benefits marketplaces, and run ROI‑led demand gen using anonymized benchmarks; support scale with lightweight customer success and event sponsorships YC profile, Terms.

What is the rough total addressable market

Top-down context:

Employer coverage is the dominant channel in the U.S., with about 153 million nonelderly people enrolled in employer-sponsored insurance; among firms with 50+ workers, most offer benefits, representing a large buyer base KFF 2023. Additionally, ~73.8M people work at establishments with 50+ employees BLS QCEW.

Bottom-up calculation:

BLS reports ~30.45M married‑couple families with both spouses employed; using a private‑sector offer rate proxy of 86% implies ~26.2M households where both spouses likely have employer coverage options—Healia’s core addressable households BLS, Census/MEPS‑IC.

Assumptions:

• Applies the MEPS‑IC private‑sector offer rate (86%) as a proxy for households where both spouses likely have access to employer plans.
• Uses BLS married‑couple, dual‑employed families as the base for “dual‑income households.”
• Focuses employer selling on establishments with 50+ employees where benefits are commonly offered.

Who are some of their notable competitors

• WEX (Benefits / WEX Health): Large benefits administrator that offers end‑to‑end HRA administration and benefits platforms, including decision support—overlapping with Healia’s HRA administration and integrations focus WEX HRA, WEX Benefits Admin.
• HealthEquity: Major administrator of HSAs/FSAs/HRAs; provides HRA administration and integrations with health plans and payroll—competing on reimbursement operations and employer integrations HealthEquity HRA.
• Take Command: Specialist in HRA administration (ICHRA/QSEHRA) with software and enrollment support—close substitute when employers prefer HRA‑based alternatives to group coverage Take Command, PR.
• PeopleKeep: HRA administration software focused on small and mid‑size employers (ICHRA/QSEHRA), competing on simplicity and low‑lift setup PeopleKeep.
• Jellyvision (ALEX): Benefits decision support tool used by employers and brokers to guide plan choices; overlaps with Healia’s AI comparison capability for household plan selection Jellyvision – Benefits Decision Support.