HealthEZ

What HealthEZ does

HealthEZ (legally America's TPA, LLC) is an independent third-party administrator founded in 1982 and headquartered in Bloomington, Minnesota, providing administrative services for employer-sponsored self-funded and level-funded medical benefit plans. The company's core technology stack combines claims administration, provider network access (anchored by America's PPO, the nation's first preferred provider organization), pharmacy benefit management (EZrx), specialty infusion cost containment (MICO), and member-facing tools including the myHealthEZ mobile/web app with digital ID cards, bill payment (EZpay), and a cost-comparison tool (EZchoice). Analytics are powered by the Deerwalk platform — deployed in 2020 — providing 70+ standard reports and predictive risk scoring through Milliman's MARA model. In 2025, the company was acquired by Horizon Blue Cross Blue Shield of New Jersey and launched its TPA platform in New Jersey on May 5, 2026, extending its operating footprint to a Horizon-network state.

HealthEZ generates revenue through multiple streams: per-employee-per-month administrative fees on self-funded plans, commissions on stop-loss insurance placement, network access fees (America's PPO, Cigna OAP, Cigna Local Plus, and reference-based pricing), and pharmacy benefit management economics. The target customer is mid-to-large employers with 50-2,000 employees seeking alternatives to fully-insured plans, with documented savings of up to 25% versus fully-insured benefits, average 3% annual renewals, and >95% retention. Distribution is anchored by insurance brokers and consultants as the primary channel; the 2025 Horizon acquisition adds a carrier-mediated distribution channel in New Jersey where HealthEZ operates as the exclusive TPA. Care Advocacy services — including utilization review, case management, and member outreach — produce a 71% engagement rate, more than double industry benchmarks.

The product portfolio spans self-funded plans (EZfunding levels the premium and returns 100% of surplus to employers, backed by Nationwide and AccuRisk), specialty pharmacy (EZrx delivers 38-50% drug-cost savings; MICO delivers 30-70% specialty infusion savings), and supplementary programs (LiveEZ wellbeing suite, Boost Your Baby maternity program, Elite high-value network). Leadership is headed by CEO Jeff Bakke, CRO Jim Wachtel, CPO Josh Schreiner, CFO Chuck Kelly (joined Dec 2024), and CMO Dr. Jackie Conley. The company supports clients across all 50 states and is in active expansion mode, with three senior sales hires added in September 2024 adding more than 90 years of combined health-plan experience.

Name

HealthEZ

Legal name

America's TPA, LLC

Website

https://healthez.com

Company type

Private

Founded year

1982

Operating status

Operating

Headcount range

251–500 employees

Short description

HealthEZ is an independent third-party administrator (legal entity America's TPA, LLC) founded in 1982 and based in Bloomington, Minnesota, that administers self-funded and level-funded employer health benefit plans for mid-to-large employers (50-2,000 employees) across the United States. Since its 2025 acquisition by Horizon Blue Cross Blue Shield of New Jersey, it has launched TPA services in New Jersey.

Ownership category

akta.pro rank

Product category

Third-Party Health Plan Administration (TPA)

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Insurance and Employee Benefit Funds (5251)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Self-Funded (ERISA) Employer Plans (HLAEAAAC)

akta.pro secondary industries

Flexible Benefits Administration (FSA/HSA/HRA) (HLAEALAK), Employer Health Reimbursement Arrangements (HRA/ICHRA/QSEHRA) Administration (HLAEAAAG), Behavioral Health Benefit Administration (MBHO Core) (HLAEAHAA)

Keywords

• Self-funded health plans
• Third-party administration
• Level-funded benefit plans
• Pharmacy benefit management
• Healthcare cost containment

Headquarters

HQ city

Bloomington

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Third-Party Administration Fees: Administrative services fees for managing self-funded and level-funded health plans. These are typically charged as fixed costs per employee per month or as a percentage of claims.
2. Stop-Loss Insurance Services: HealthEZ facilitates stop-loss coverage arrangements for self-funded employers, earning commissions or fees from stop-loss carriers. The company works with A-rated stop-loss carriers.
3. Network Access Fees: Fees for access to provider networks including America's PPO, Cigna OAP, and reference-based pricing models. Revenue derived from negotiated discounts and network access.
4. Pharmacy Benefit Management: Revenue from pharmacy programs including EZrx and specialty pharmacy through cost savings on drug spend. Programs demonstrate 29% lower costs than industry benchmarks.

Pricing tiers

Go-to-market motion3 records

Distribution channels4 records

Marketing channels8 records

Core offering

HealthEZ is an independent third-party administrator of employer-sponsored self-funded and level-funded medical benefit plans. It administers claims, designs customized plans, manages provider networks (including its own America's PPO and partner networks such as Cigna OAP), and delivers pharmacy benefit management and specialty drug programs for mid-to-large U.S. employers. Members access benefits through the myHealthEZ mobile and web application, while brokers and employers are supported with analytics via the Deerwalk platform and dedicated account management.

Product overview

HealthEZ is a national independent third-party administrator (TPA) offering a comprehensive platform for self-funded and level-funded health benefit plans. The company's core architecture centers on America’s PPO (the nation's first preferred provider organization), supported by the myHealthEZ member application as the primary member-facing digital interface. The product suite is organized around core TPA administration capabilities (self-funding, level funding, plan design, cost containment, medical management, provider network management, and member experience) augmented by specialized sub-products including EZpay (bill payment), EZchoice (cost comparison), EZfunding (level-funded variant returning 100% surplus), EZrx (pharmacy benefit management), and MICO (medical infusion carveout). Additional network products include Cigna OAP and Cigna Local Plus. The company serves employers, brokers, members, and providers across all 50 states.

Differentiator

Problem solved

Functional benefit

Brands

• America's PPO: The nation's first preferred provider organization, originally created as Family Health Plan in 1982.
• EZrx
• EZfunding
• EZpay
• EZchoice
• LiveEZ
• Boost Your Baby
• Elite Network
• MICO

Products and services

• Third-Party Administration (TPA) Services Full-service third-party administration of self-funded and level-funded employer health benefit plans, including claims processing, plan design, cost containment, and member experience management.
• Self-Funding Plans Self-funded health benefit plans where employers directly pay employee healthcare claims instead of fixed premiums, delivering up to 25% savings versus fully-insured benefits with transparent claims data.
• EZfunding Level-Funded Plans All-in-one level-funded product offering predictable monthly payments combined with self-funding benefits, no health questionnaire, no minimum attachment point, and 100% surplus return to employers versus the traditional 50%.
• Cost Containment Services Cost management solutions leveraging reference-based pricing, provider network optimization, and expense control strategies to reduce employer healthcare spending by up to 25% versus fully-insured benefits.
• Custom Plan Design Custom plan design services that build benefits around each employer's unique situation using unbundled plan components that flex as needs change.
• Medical Management Services Medical management services including utilization review, case management, and proactive outreach for members with complex needs; HealthEZ is among the first TPA medical management programs (since 1983) and holds triple URAC accreditation.
• America's PPO Network HealthEZ's proprietary preferred provider organization providing discounted-rate access to providers nationwide; the nation's first PPO.
• Cigna Open Access Plus (OAP) Network Exclusive Cigna network offering discounts 4% better than standard PPO networks, integrated into HealthEZ's national network solutions.
• Cigna Local Plus Network Strategic network of top-tier, lower-cost providers across 30 national markets, potentially reducing plan costs by up to 9% compared to traditional PPO.
• Elite High Value Network High-value curated provider network established in 2018, optimizing for provider quality and cost efficiency.
• EZrx Pharmacy Program Pharmacy benefit management program delivering 38–50% average savings on pharmacy claims through smart formulary management, biosimilar adoption, and white-glove drug carve-out services.
• MICO (Medical Infusion Carve-Out) Specialty infusion cost management program covering 275+ high-cost medications in oncology, Crohn's Disease, Psoriasis, Rheumatoid Arthritis, and more, achieving 30–70% savings through manufacturer assistance programs, specialty pharmacy dispensing, and cost-plus reimbursement.
• Precision Pricing Reference-based pricing model that prices medical claims against a benchmark or reference price to control healthcare costs for self-funded employers.
• myHealthEZ Member App Mobile and web application for plan members to view benefits, manage and pay bills, get support, locate providers, track deductibles and out-of-pocket costs, and access digital insurance cards.
• EZpay Bill Payment Claims payment and bill-pay platform allowing members to review, confirm, and pay medical bills, with multi-step claims audit and support for credit, debit, HSA, and FSA payments.
• EZchoice Cost Comparison Tool Cost-comparison estimator tool integrated within the myHealthEZ member app, allowing members to accurately estimate and view detailed cost breakdowns for healthcare services.
• Care Advocacy Program Care Advocacy program providing proactive clinical support including care navigation, utilization reviews, case management, and member outreach, achieving a 71% member engagement rate — more than double the industry average.
• LiveEZ Wellbeing Suite Wellbeing services suite focused on employee wellness, health coaching, and lifestyle improvement programs offered to employer clients.
• Boost Your Baby Maternity Program Maternity program supporting expecting mothers through pregnancy and postpartum care, including education and clinical guidance.
• Stop-Loss Insurance Coordination Coordination of stop-loss insurance coverage with A-rated stop-loss carriers to protect self-funded employers against catastrophic claims losses.
• Deerwalk Analytics Platform Health plan analytics and reporting platform providing Executive Analytics and Plan Analytics dashboards with 70+ standard reports, predictive risk scoring via Milliman's MARA model, and integration with PBM partner data for employers and brokers.
• Member Experience Services Member support services including 24/7 access to knowledgeable support representatives, care navigation, and advocacy to help members through their healthcare journeys.

Quantifiable outcome

• Clients save up to 25% compared to fully-insured benefits
• +7 more outcomes

Named customers2 records

Segments5 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability1 record

Feature8 records

Partnerships

Eight partnerships are on record, tiered flagship, core and minor.

• Horizon Blue Cross Blue Shield of New JerseyflagshipStrategic or Co-development Partner · 1 January 2025Horizon BCBSNJ acquired Minnesota-based HealthEZ in 2025 and is deploying the TPA platform in New Jersey. HealthEZ serves as the only TPA in NJ with access to Horizon's provider network and stop-loss, dental, and vision products. Launch date May 5, 2026 targeting self-funded employers with 50-2,000 employees for January 1, 2027 effective dates.
• Cigna Health PlanscoreStrategic or Co-development Partner · 1 July 2024HealthEZ expanded national network solutions by introducing Cigna Open Access Plus (OAP) and Cigna Local Plus networks. Cigna OAP delivers discounts 4% better than standard PPO networks. Cigna Local Plus includes top-tier, lower-cost providers across 30 national markets, potentially reducing plan costs by up to 9% vs. traditional PPO.
• AlignRxminorStrategic or Co-development Partner · 1 March 2024AlignRx Chief Pharmacy Officer Beckie Frenwick co-presented with HealthEZ executives on biosimilars webinar, indicating partnership in pharmacy benefit management education and strategy.
• Nationwide (Insurance)coreStrategic or Co-development Partner · 1 January 2024Nationwide provides financial backing and stop-loss coverage for HealthEZ's EZfunding level-funded product. Partnership enables no health questionnaire enrollment and no minimum attachment points for employers.
• PBM PartnerscoreStrategic or Co-development Partner · 1 January 2024HealthEZ integrates with pharmacy benefit manager partners for data and drug utilization analysis. Deerwalk platform integrates with PBM partners' data for clearer drug utilization trend reporting to clients.
• AccuRiskcoreStrategic or Co-development Partner · 1 January 2023AccuRisk partners with HealthEZ on EZfunding level-funded product, providing stop-loss coverage and supporting the program's features including 100% surplus return to employers.
• DeerwalkcoreTechnology or Integration · 1 January 2020HealthEZ implemented Deerwalk's health plan analytics and reporting platform, providing Executive Analytics and Plan Analytics dashboards. Platform includes over 70 standard reports, predictive risk scoring using Milliman's MARA model, and integrates with PBM partner data.
• A-rated Stop-Loss CarrierscoreStrategic or Co-development PartnerHealthEZ works with A-rated stop-loss insurance carriers to provide coverage protecting self-funded employers against catastrophic losses. Stop-loss is a key component of the self-funding risk management solution.

Scale indicators11 records

Recent moves8 records

Expansion highlights5 records

Direct peers

• CoreSource: Trustmark-affiliated TPA providing administrative services for self-funded employer health plans. Direct peer in the independent/mid-market TPA space with overlapping products in claims, network management, and member engagement.
• WebTPA: Independent TPA serving self-funded employer plans with national reach and integrated analytics capabilities. Comparable business model and target market to HealthEZ, competing primarily through broker distribution channels.
• Meritain Health: Aetna/CVS Health-owned TPA administering self-funded health plans for employers. Direct competitor with carrier-backed scale, integrated PBM capabilities, and a comparable product set spanning claims, network, and member engagement.
• UMR: UnitedHealthcare's TPA subsidiary and the largest third-party administrator in the US. UMR directly competes with HealthEZ for self-funded employer business across all size tiers, including the mid-market 50-2,000 employee segment.
• Key Benefit Administrators: Mid-sized independent TPA focused on self-funded group health administration for employers across multiple industries. Comparable to HealthEZ in customer profile, distribution approach via brokers, and emphasis on cost-containment solutions.
• HealthSmart: Independent TPA providing self-funded plan administration, PBM, and network solutions to mid-market and large employers. Closely comparable to HealthEZ in operating model, target segment, and integrated cost-containment focus.
• Allied Benefit Systems: Independent TPA administering self-funded employer health plans nationally. Competes head-to-head with HealthEZ for mid-market employer accounts via broker channels, with similar reliance on integrated PBM and cost-containment programs.

Broad incumbents

• Sun Life Financial: Large diversified insurer with significant U.S. group benefits and stop-loss capabilities, and a TPA presence through acquired platforms. Broader incumbent competing with HealthEZ in the self-funded/stop-loss value chain, though not focused exclusively on mid-market TPA.
• Anthem (Elevance Health): Large national carrier with affiliated TPAs (including Anthem Blue Cross plans) serving self-funded employer business. Competes with HealthEZ as a broad incumbent across fully-insured, ASO, and self-funded plan administration.
• Cigna Group: Major carrier that supplies HealthEZ with OAP and Local Plus networks but also operates its own self-funded and ASO businesses. Overlaps with HealthEZ's network and stop-loss offerings as a broad incumbent in employer health benefits.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/HealthEZ
• LinkedInlinkedin.com/company/healthez
• Instagraminstagram.com/myhealthez/?hl=en
• Xx.com/HealthEZ

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 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 HealthEZ