Harvard Pilgrim Health Care
Harvard Pilgrim Health Care is a not-for-profit health insurer serving nearly 900,000 members across Maine, Massachusetts, New Hampshire, and Rhode Island. Operating as a subsidiary of Point32Health, it offers HMO, PPO, EPO, Medicare Supplement, and tiered network plans through direct, broker, employer, and exchange channels.
- Company typePrivate
- Founded1969
- HeadquartersHartford, United States
- Headcount1,001–5,000
- GTM typeB2B and B2C
- OfferingServices
What Harvard Pilgrim Health Care does
Harvard Pilgrim Health Care is a not-for-profit health insurance company founded in 1969, currently operating as a subsidiary of Point32Health — the entity formed in 2021 through the combination of Harvard Pilgrim and Tufts Health Plan. The company serves nearly 900,000 members across Maine, Massachusetts, New Hampshire, and Rhode Island, offering a full portfolio of health plans including HMO, PPO Access, National Access EPO (new for 2026), Focus Network HMO, Maine's Choice Plus tiered network products, and Medicare Supplement plans. Distribution runs through direct-to-consumer website and phone enrollment, state ACA marketplaces (HealthCare.gov, MA Health Connector, CoverME.gov), broker partnerships, and employer-sponsored group plans. The core technology stack includes the HPHConnect member portal, mobile applications (iOS and Android, the latter built on HealthTrio), pharmacy benefits management through OptumRx, and the CMS Patient Access API for interoperability. Value-added programs include Doctor On Demand (24/7 telehealth), Reduce My Costs (shopping concierge with cash rewards up to $75 per service), behavioral health coverage, fitness reimbursement, and HSA/FSA/HRA account administration. Harvard Pilgrim also operates the Harvard Pilgrim Health Care Institute, a 1992 collaboration with Harvard Medical School that is the first U.S. medical school department based on a health plan, contributing to academic and clinical research credibility.
Revenue is generated primarily through recurring health insurance premiums paid by individuals, families, employers, and via government marketplace subsidies across metal tiers (Platinum, Gold, Silver, Bronze, HSA). The company also derives income from ancillary services such as fitness reimbursement programs and administrative services for self-funded employer plans. The parent Point32Health has reported significant operating losses in 2025 driven primarily by GLP-1 weight-loss drug costs, prompting a 6.7% workforce reduction (254 employees) in October 2025 and proposed premium rate increases of 9% in Maine (2026) and 7.9% in Massachusetts (2027).
Harvard Pilgrim Health Care firmographics
Firmographics- Name
- Harvard Pilgrim Health Care
- Legal name
- Harvard Pilgrim Health Care, Inc.
- Website
- https://harvardpilgrim.org
- Company type
- Private
- Founded year
- 1969
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- Harvard Pilgrim Health Care is a not-for-profit health insurer serving nearly 900,000 members across Maine, Massachusetts, New Hampshire, and Rhode Island. Operating as a subsidiary of Point32Health, it offers HMO, PPO, EPO, Medicare Supplement, and tiered network plans through direct, broker, employer, and exchange channels.
- Ownership category
- akta.pro rank
Harvard Pilgrim Health Care industry classification
Industry- Product category
- Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Off-Exchange Individual Major Medical Plans (FSAIAEAB)
- akta.pro secondary industries
- Medicare Supplement (Medigap) (FSAIAEAG), High-Deductible Health Plans (HDHP) with HSA-Eligible Coverage (FSAIAFAM)
Keywords
Where Harvard Pilgrim Health Care is headquartered
LocationHeadquarters
- HQ city
- Hartford
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Harvard Pilgrim Health Care business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Health Insurance Premiums: Harvard Pilgrim generates revenue primarily through health insurance premiums paid by individuals, families, employers, and through government marketplace subsidies. Plans include HMO, PPO, EPO products with various coverage tiers.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Individual and family health insurance plans across metal tiers |
| Subscription | Monthly | Employer-sponsored health insurance plans |
| Subscription | Monthly | Medicare Supplement plans for seniors |
| Subscription | Annual | Fitness reimbursement program |
Go-to-market motion1 record
Distribution channels5 records
Marketing channels5 records
Harvard Pilgrim Health Care product offering
Product offeringCore offering
Harvard Pilgrim Health Care is a not-for-profit health insurance company that sells individual and family health plans, employer-sponsored group plans, and Medicare Supplement plans across Maine, Massachusetts, New Hampshire, and Rhode Island. Plans are offered in HMO, PPO Access, EPO (including new National Access EPO for 2026), and tiered-network variants (Maine's Choice Plus), underwritten on metal tiers from Platinum to Bronze HSA. Members access integrated services such as Doctor On Demand telehealth, Reduce My Costs savings concierge, OptumRx pharmacy benefits, and behavioral health coverage.
Product overview
Harvard Pilgrim Health Care is a health insurance company providing a comprehensive portfolio of health plans and care-based programs to nearly 900,000 members across New England. The product portfolio includes individual and family plans for Maine, Massachusetts, and New Hampshire; employer-sponsored plans; and Medicare Supplement plans. Plan types include HMO, PPO Access, National Access EPO (new for 2026), Focus Network HMO, and Maine's Choice Plus tiered network products. The company differentiates through integrated care programs including Doctor On Demand telehealth, the Reduce My Costs shopping concierge service, behavioral health coverage, fitness reimbursement, and prescription drug benefits through OptumRx. As a Point32Health company, Harvard Pilgrim operates alongside Tufts Health Plan under a unified parent organization.
Differentiator
Problem solved
Functional benefit
Products and services
- Massachusetts Individual and Family Plans Health insurance plans for individuals and families in Massachusetts, offered directly through Harvard Pilgrim or via the Massachusetts Health Connector marketplace. Plan options include HMO, PPO Access, Focus Network HMO, and the new National Access EPO.
- New Hampshire Individual and Family Plans Health insurance plans for individuals and families in New Hampshire, offered directly or on the federal health care exchange (HealthCare.gov). Features NH Local HMO and NH Local Choice HMO networks with tiered provider options; earned 5-star CMS quality rating.
- Maine Individual and Family Plans Health insurance plans for Maine residents including HMO, PPO Access, and Maine's Choice Plus tiered network products. Network expanded in 2026 with Northern Light Health providers designated as Preferred in Maine's Choice Plus.
- Employer-Sponsored Plans Health insurance plans for employers in Maine, Massachusetts, New Hampshire, and Rhode Island, offering comprehensive group coverage options for businesses and their employees.
- Medicare Supplement Plans Medicare Supplement insurance plans for Maine, Massachusetts, and New Hampshire residents who are Medicare beneficiaries, providing additional coverage beyond original Medicare to reduce out-of-pocket costs.
- National Access EPO 2026 Plans Exclusive Provider Organization plans providing affordable care through extensive regional and national networks. No PCP required, no referral required, in-network coverage only. Includes prescription drug coverage via Core MA 3-Tier or Core MA 5-Tier formularies.
- Maine's Choice Plus HMO Network Expansion Tiered network product with Preferred Network (lower cost sharing) and Standard Network (higher cost sharing). Expanded in 2026 with Northern Light Health providers at the Preferred (lowest cost) tier.
- NH Local Choice HMO and NH Local HMO 2026 Plans New Hampshire 2026 plan year health plans featuring tiered provider/hospital networks, $0 virtual urgent care, $0 prescription drug list options, and 5-star CMS quality rating.
Quantifiable outcome
- Reduce My Costs program saves members average over $1,000 for services such as lab work or MRI
- +1 more outcomes
Companies that use Harvard Pilgrim Health Care
Customer profileNamed customers1 record
Segments4 records
Ideal customer profiles3 records
Harvard Pilgrim Health Care technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration10 records
Feature5 records
Harvard Pilgrim Health Care partnerships and signals
Strategic signalPartnerships
Two partnerships are on record, tiered core.
- Northern Light HealthcoreHarvard Pilgrim Health Care and Northern Light Health partnered in November 2025 to improve healthcare access and affordability in Maine by extending Harvard Pilgrim's Maine's Choice Plus product to rural areas and small businesses. The partnership provides Northern Light Health providers at lower costs through a tiered network, expanding access in Aroostook, Hancock, Piscataquis, Penobscot and Somerset counties. Northern Light Health operates nine hospitals with more than 1,000 providers at 127 locations across Maine.
- Point32HealthcoreIn 2021, Harvard Pilgrim Health Care combined with Tufts Health Plan and their family of companies to create Point32Health, a leading not-for-profit health and well-being organization. Point32Health serves as the parent company delivering improved healthcare experiences to members and communities.
Scale indicators4 records
Recent moves6 records
Expansion highlights6 records
Harvard Pilgrim Health Care competitors and assessment
Company assessmentBroad incumbents
- Humana: National carrier with leading Medicare Advantage and Medicare Supplement positions that compete directly with Harvard Pilgrim's Medicare Supplement products in MA, ME, and NH.
- UnitedHealthcare: National incumbent that provides Harvard Pilgrim's national PPO network access and competes broadly on individual, group, and Medicare products across all four of Harvard Pilgrim's operating states.
- Aetna (CVS Health): National health insurer competing in New England employer-sponsored and individual markets, with added retail-health integration through CVS that differentiates its distribution model.
- Cigna Group: Large national carrier competing for employer-sponsored group business across New England, with a heavier focus on commercial/SMB and stop-loss products that overlap with Harvard Pilgrim's offerings.
Regional players
- Health New England: Non-profit regional health plan based in western Massachusetts serving employer groups and individuals in territory adjacent to Harvard Pilgrim's core market.
- ConnectiCare: Connecticut-based regional health plan serving similar individual marketplace and employer customers in the adjacent New England market, with overlapping distribution through state exchanges.
- Anthem Blue Cross Blue Shield: Operates Blue Cross Blue Shield plans in New Hampshire and adjacent states, competing head-to-head with Harvard Pilgrim on individual marketplace and employer group products in overlapping regions.
Direct peers
- Tufts Health Plan: Sister company under Point32Health offering comparable individual, employer, and Medicare plans across the same New England footprint; effectively a co-managed peer within the same parent organization.
- Blue Cross Blue Shield of Massachusetts: The largest health insurer in Massachusetts and Harvard Pilgrim's primary in-state competitor, offering overlapping HMO/PPO products to individuals, families, and employers in the same core geography.
Emerging players
- Kaiser Permanente: Integrated non-profit payer-provider that competes on quality and care-coordination narratives similar to Harvard Pilgrim's whole-person positioning, with limited but growing New England presence.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
Harvard Pilgrim Health Care social profiles
Digital presenceHarvard Pilgrim Health Care compliance and trust
Trust signalCompliance1 record
Harvard Pilgrim Health Care financial estimates
Financial estimateRevenue estimate
Valuation estimate
Harvard Pilgrim Health Care leadership team
Management profileNumber of profiles
Profiles3 records
Harvard Pilgrim Health Care funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Harvard Pilgrim Health Care M&A and investment
M&A and investmentM&A1 record
Investments1 record
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Harvard Pilgrim Health Care
What does Harvard Pilgrim Health Care do?
Harvard Pilgrim Health Care is a not-for-profit health insurance company that sells individual and family health plans, employer-sponsored group plans, and Medicare Supplement plans across Maine, Massachusetts, New Hampshire, and Rhode Island. Plans are offered in HMO, PPO Access, EPO (including new National Access EPO for 2026), and tiered-network variants (Maine's Choice Plus), underwritten on metal tiers from Platinum to Bronze HSA. Members access integrated services such as Doctor On Demand telehealth, Reduce My Costs savings concierge, OptumRx pharmacy benefits, and behavioral health coverage.
Is Harvard Pilgrim Health Care a public or private company?
Harvard Pilgrim Health Care is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was Harvard Pilgrim Health Care founded?
Harvard Pilgrim Health Care was founded in 1969. It employs 1,001 to 5,000 people.
Where is Harvard Pilgrim Health Care based?
Harvard Pilgrim Health Care is headquartered in Hartford, United States, in the North America region.
How does Harvard Pilgrim Health Care make money?
One revenue line is on record: health Insurance Premiums.
Who are Harvard Pilgrim Health Care's main competitors?
Broad incumbents on record are Humana, UnitedHealthcare, Aetna (CVS Health) and Cigna Group. Regional players are Health New England, ConnectiCare and Anthem Blue Cross Blue Shield. Direct peers are Tufts Health Plan and Blue Cross Blue Shield of Massachusetts. Kaiser Permanente is listed as an emerging player.
Does Harvard Pilgrim Health Care have an API?
Yes. Harvard Pilgrim provides a Patient Access API as part of CMS Interoperability and Patient Access final rule compliance. This API allows Medicare Advantage and New Hampshire Exchange members to connect their health data to third-party applications of their choice. The API enables members to access their health information including claims data, formulary data, and provider directory information. Additionally, the company publishes machine-readable files (MRFs) in JSON format containing provider negotiated rates, out-of-network allowed amounts, and plan data. These are published monthly for self-insured and fully insured accounts. Developer documentation is at www.harvardpilgrim.org/public/interoperability-website-resources.
What industry is Harvard Pilgrim Health Care in?
Harvard Pilgrim Health Care's product category is Health Insurance. Its primary akta.pro industry code is FSAIAEAB, Off-Exchange Individual Major Medical Plans, with a secondary code of FSAIAEAG, Medicare Supplement (Medigap). Its NAICS code is 524114 and its SIC code is 6324.