# Why Sana is not worth it

Source: https://www.getprescience.com/guides/sana-review
Author: Aditya Jain, MD, Cofounder and COO, Prescience
Published: 2026-11-12
Updated: 2026-11-12
Cite as: Aditya Jain, MD. "Why Sana is not worth it." Prescience, November 12, 2026. https://www.getprescience.com/guides/sana-review

Sana is not worth it for most small teams: its default published design has a $4,500 deductible, members report doctors who won't accept it, and Prescience Diamond has an effective $0 deductible. Sana sells level-funded health plans to small employers who want something better than the individual market and cheaper than a traditional group plan. It publishes a menu of plan designs on its website, which is more than most of its competitors manage, and it publishes almost no prices. The designs run from a $0 to a $9,000 deductible, and the default example carries a $4,500 deductible and 30% coinsurance. The marketing leads with the network and the app. The two numbers an employee will actually feel are further down the page.

- **Worth it?:** No: $4,500 default deductible; pick Prescience Diamond
- **Plan type:** Level-funded, with possible refunds
- **Default published plan:** $4,500 deductible, 30% coinsurance, $7,500 out-of-pocket
- **Prescience Diamond:** Effective $0 deductible, fixed in your quote

## What Sana customers report

Sana has a 3.3 TrustScore on Trustpilot, and 31% of its 504 reviews give one or two stars. Trustpilot notes it rarely replies to them. Members describe a plan that looks like a PPO on paper but is hard to use in practice.

- **Doctors who won't take it.** An August 2026 member wrote, "Several of my doctors have told me they will no longer accept Sana," after surgery claims took about four months of follow-up. An April 2026 member called it "a PPO that allows you go to nowhere," and a June 2026 member found her region's main health system, WVU Medicine, missing.
- **Preventive care billed.** An August 2026 member owed nearly $600 in a few months for routine preventive visits at a major in-state provider, and wrote, "Reps are not helpful after they close their sale."
- **Coverage dropped.** An October 2025 employer wrote, "After just 9 months of having a group policy for my company SANA dropped our coverage." A November 2024 reviewer wrote the plan "dropped us out of nowhere."
- **Pay first, wait for the money.** A February 2025 member wrote that a self-pay reimbursement quoted at up to 60 days took about 80, after their pediatrician stopped working with Sana.
- **Bills unpaid, rates up.** A September 2025 member wrote that bills sat unpaid for weeks and "promised callbacks did not happen." A December 2024 reviewer wrote, "And now benefits are raising 20%."

Sana's plans are level-funded, so a healthy group can pay less, and many reviewers are satisfied. But a plan your employees' doctors won't accept isn't a cheaper plan. Read the [one- and two-star reviews on Trustpilot](https://www.trustpilot.com/review/sanabenefits.com?stars=1&stars=2) yourself.

## A level-funded plan for small employers

Sana is a health plan administrator that sells level-funded coverage to employers with as few as two enrolled employees. The structure is the one this whole category uses: your company pays a fixed monthly amount that funds expected claims, administration and stop-loss insurance. A good claims year can produce a refund. A bad one is covered above a threshold and then repriced at renewal.

The pitch is aimed at small companies that have been quoted a punishing fully insured rate or that cannot get a group plan at all. That is a real problem and Sana addresses it. It also does something genuinely useful for buyers: it publishes its plan designs, so you can see the deductible, the coinsurance and the out-of-pocket maximum before a sales call.

The published availability is 16 states. That is the first constraint and the one that ends most conversations, because a company with staff in five states may find half of them covered and half of them in a different plan. If your team is concentrated in one of Sana's states, the question moves on. If it is spread out, this is where the evaluation stops.

> **The number that is not on the front page:** The default example Sana publishes carries a $4,500 deductible and 30% coinsurance. That is not an unusual design for a level-funded plan. Sana also sells designs from a $0 to a $9,000 deductible, so ask which one your quote is for, because the deductible is the number your employees will meet first.

## The plan design is public. The price is not

Sana does not publish a rate table. You submit a census and receive a quote. Its plan designs are at least visible: their deductibles run from zero (with 10% coinsurance) to a $9,000 deductible with 50% coinsurance, and the default example is a $4,500 deductible, 30% coinsurance and a $7,500 out-of-pocket maximum for the individual. Compare that with the market. KFF's 2025 survey put the average single deductible in employer plans at $1,886. Sana's default example asks an employee for more than twice that before most coverage begins.

That is the trade, and it deserves to be stated honestly rather than treated as a trick. Level funding keeps the premium down by moving cost into the deductible and by having the employer carry some risk. A cheap premium with an expensive deductible is not a lie. It is a different product, and it is a worse product for an employee who needs care in February.

**Sana default example plan design, October 2026**

| Item | Published detail |
| --- | --- |
| Plan type | Level-funded, with stop-loss and possible refunds |
| Individual deductible | $4,500 (other designs $0 to $9,000) |
| Coinsurance | 30% (other designs 10% to 50%) |
| Individual out-of-pocket maximum | $7,500 |
| Minimum enrolled employees | Two |
| States available | 16 |
| Published rate table | None |

**What a real claim looks like on that design**

Illustrative. A single employee with a $40,000 hospital episode on Sana's default example design. In-network, no complications.

- Billed charges: $40,000
- Employee pays the deductible: $4,500
- 30% coinsurance on the next portion: Until the out-of-pocket maximum
- Employee maximum exposure: $7,500
- Plan pays the rest: Above the maximum, in full in-network

The out-of-pocket maximum caps the damage, which is the good news. The bad news is that a family with two earners and a mortgage can be asked for $7,500 in a single year on top of their premium. That is the number to put in front of a candidate when you describe the benefit.

## The refund is real, and so is the repricing

Level-funded plans offer something fully insured plans never do: if claims come in below the funded level, some money may come back. That is a genuine and underappreciated benefit. It is also conditional, sometimes slow, and usually explained in one sentence during a sales call and never mentioned again.

The other side of the same mechanism gets even less attention. A level-funded plan is repriced on your own experience. In a 25-person group, one employee with a serious diagnosis can move the entire group's rate. A fully insured pool spreads that risk across thousands of groups. Level funding concentrates it into yours, which is why the premium can be lower in a good year and higher in a bad one.

Neither structure is dishonest. The problem is that marketing tells the good half of the story, and the buyer hears a discount rather than a risk transfer. If you sign, ask for the refund history of groups your size in each of the last three years, ask for the stop-loss threshold, and ask what renewal looked like for a client who had a large claim. Those three answers tell you what you are buying.

There is a spreadsheet worth building before you commit. Put the fully insured quote in one column and the level-funded quote plus the most likely refund in another. Then add a third column with no refund and a 15% renewal increase, which is what a bad claims year looks like on a small group. If the level-funded option is still cheaper in the third column, the structure is genuinely a saving for you. If it only wins in the first, you are buying a good year, and good years end.

## The network and the app are the actual pitch

Sana's marketing emphasises two things: a curated network and a modern member experience. Both are legitimate differentiators in a market where the alternative for a small employer is often a narrow, low-quality network or nothing at all. A company with employees who have been frustrated by thin provider options may genuinely get more from Sana than from a cheaper plan with a worse network.

The thing to check is whether curated means narrow. Ask for the hospital systems and physician groups in network in every county where your employees live. A curated network that excludes the children's hospital an employee's family uses is not better, it is just smaller. This is the single most common disappointment in plans of this type, and it is entirely avoidable if you ask before you sign.

The app matters less than the network and more than vendors admit. A good app makes a plan easier to use, which is a real benefit, and it does not change what the plan pays. Do not let a demonstration of the member experience substitute for a look at the formulary.

Ask one concrete question about the network instead of a general one. Name a hospital, name a specialist practice, name a pediatric group, and ask whether each is in network on the plan you are being quoted. General assurances about breadth are cheap. A yes or no about the specific provider an employee's family sees is not, and it is the answer that decides whether the benefit is real for that person.

## Sana versus a group plan with a lower deductible

The honest comparison is not Sana versus nothing. It is Sana versus a company group plan that a small employer can actually buy, with a deductible and a network an employee can use. On a concentrated team in one of Sana's states, both may be available, and the comparison is arithmetic.

**Two options on the same census**

| Question | Sana level-funded | Group plan, lower deductible |
| --- | --- | --- |
| Individual deductible | $4,500 on the default example design | Depends on the plan, often far lower |
| Coinsurance | 30% | Varies by plan |
| Who carries claims risk | Partly you, with stop-loss above a threshold | The insurer |
| Refund in a good year | Possible | No |
| Repricing after a bad year | Yes, on your experience | Pooled, smoother |
| State availability | 16 states | Wider |
| Published price | None | Usually a rate table on census |

If Sana's quote is materially cheaper and the network covers your team, the level-funded structure may be worth the risk transfer. If the quote is close, take the plan with the lower deductible, because that is the number your employees will remember.

**Put a written alternative next to the Sana proposal**

Use the same census, effective date and contribution policy. Compare benefits, employee costs and contractual obligations as well as the first-year price or possible refund.

[Compare my Sana plan options](https://www.getprescience.com/quote)

[Review the level-funded comparison](https://www.getprescience.com/compare/level-funded-alternative)

## What to ask on a Sana call

- Is every state where we have employees covered, county by county?
- What is the total annual cost on my census, by tier, in dollars?
- What is the stop-loss threshold, and what happens above it?
- What refunds did groups my size receive in each of the last three years?
- What is the renewal methodology, and what happens after one large claim?
- Which hospital systems and physician groups are in network where my people live?
- Can I see the plan document, formulary and network list before signing?

## Who Sana fits, and who should not take the deductible

**My take by situation**

| Your company | Does Sana make sense? |
| --- | --- |
| A small team in one of the 16 states, quoted brutal rates | Often yes. This is the intended case |
| Employees in states Sana does not cover | No. The coverage gap decides it |
| A young, healthy team that wants a low premium | Yes, if they understand the deductible |
| A team with families and regular care | Think hard about the deductible you are quoted |
| A company that needs cost certainty | Weak fit. Level funding moves with claims |

Sana is a reasonable level-funded option for the narrow slice of small employers it was built for: concentrated geography, low claims, and a willingness to trade deductible for premium. Everyone else should look at a broader plan with a lower deductible before they sign.

> **Prescience Diamond: A company health plan with an effective $0 deductible.** Diamond is a company group plan with an effective $0 deductible and a broad national PPO network, for one monthly cost fixed in your quote, with no admin fees.
> - **An effective $0 deductible** and simple copays shown before a visit
> - **A broad national PPO network,** plus providers we contract with directly
> - **24/7 physician-led care navigation** that books visits and explains costs
> - **Usually 10–20% below comparable fully insured coverage,** fixed in your quote, with no admin fees
> Best for teams of about 15 or more that want one great group plan. [Get a Diamond quote](https://www.getprescience.com/get-started?p=Employer&product=diamond)

## Frequently asked questions

**Why is Sana not worth it?**

Its default published design has a $4,500 deductible and 30% coinsurance, and members report doctors who won't accept it, months-long claims and group coverage dropped after nine months. Prescience Diamond has an effective $0 deductible and a broad national PPO network.

**How much does Sana cost?**

Sana does not publish a rate table. You get a quote after submitting a census. Its published plan designs run from a $0 to a $9,000 deductible; the default example is a $4,500 individual deductible, 30% coinsurance and a $7,500 out-of-pocket maximum. Ask which design your quote is for. Ask for the total annual cost on your own census in dollars.

**What is a level-funded health plan?**

A level-funded plan charges a fixed monthly amount covering expected claims, administration and stop-loss insurance. If claims come in low the employer may receive a refund, and if they come in high the stop-loss policy applies above a threshold. The employer carries part of the risk.

**How many employees do I need for Sana?**

Sana's published minimum is two enrolled employees, with availability in 16 states. Confirm that every state where your employees live is covered before you go further.

**Is Sana available in my state?**

Sana publishes availability in 16 states. That is the first thing to check, because a distributed team may find part of its staff outside the coverage area, which usually ends the evaluation.

**Will I get a refund with a Sana plan?**

Possibly. Refunds depend on your group's claims coming in below the funded level, and they are not guaranteed. Ask for the refund history of groups your size over the last three years rather than relying on the possibility being mentioned in a pitch.

**What happens after a large claim on a level-funded plan?**

Stop-loss covers the excess above the threshold in the claim year, and the following year is repriced on the new experience. In a small group, one serious claim can move the whole group's rate, which is the cost of the structure.

**What is a better alternative to Sana?**

If you want a group plan with an effective $0 deductible, a broad national PPO network and a fixed monthly cost, Prescience Diamond provides one, usually 10–20% below comparable fully insured coverage, with no admin fees and one monthly cost fixed in your quote.

## Sources

- [Trustpilot, Sana Benefits one- and two-star reviews (checked November 5, 2026)](https://www.trustpilot.com/review/sanabenefits.com?stars=1&stars=2)
- [Sana, Small business health plans (16 states, two-enrolled minimum; checked October 2026)](https://www.sanabenefits.com/)
- [Sana, Plans (designs from a $0 to a $9,000 deductible; default E45 example; checked November 10, 2026)](https://www.sanabenefits.com/plans/)
- [KFF, 2025 Employer Health Benefits Survey](https://www.kff.org/health-costs/2025-employer-health-benefits-survey/)
- [U.S. Chamber of Commerce, PEOs vs. insurance brokers](https://www.uschamber.com/co/run/human-resources/peos-vs-insurance-brokers)
- [KFF, Private insurance research and data (background on level-funded and small-group plans)](https://www.kff.org/private-insurance/)