CDPHP

What CDPHP does

CDPHP (legal name Capital District Physicians' Health Plan, Inc.) is a New York State-chartered, not-for-profit health insurance corporation founded in 1984 and headquartered at 6 Wellness Way in Latham, New York. It operates through two wholly owned affiliates — CDPHP Universal Benefits, Inc. (health insurance issuer and FSA/HRA third-party administrator) and Capital District Physicians' Healthcare Network, Inc. (healthcare network services). CDPHP sells a full stack of health plan products including individual and family metal-tier plans (Platinum, Gold, Silver, Bronze), employer-sponsored group plans, Medicare Advantage HMO and PPO products with Part D prescription drug coverage, and government programs (Medicaid, Child Health Plus, Essential Plan). The company is licensed to operate in the Capital District region of New York (Albany, Schenectady, Rensselaer, Saratoga counties) and serves individual members, employer groups, Medicare beneficiaries, and government program enrollees, with healthcare providers and insurance brokers as secondary segments.

The underlying technology platform consists of a member-facing web portal and the My CDPHP mobile app, both supporting account access, claims viewing, PCP selection, spending tracking, and HSA/HRA/FSA balance management; Find-A-Doc provider search; a Price Check cost-estimation tool; Doctor On Demand telemedicine (vendor-delivered, available 24/7 at $0 for most Medicare members); ConnectRx mail-order pharmacy and prescription discount program administered with Capital Rx; Medication Therapy Management through Outcomes; prepaid Benefits Mastercard fulfillment via NationsBenefits; and HIXNY health information exchange integration. Security is enforced through MFA across email, text, voice, and TOTP channels. CDPHP holds NCQA accreditation with high quality honors and earned a 4.5/5 CMS Medicare star rating for 2025, and was ranked #1 in Member Satisfaction among Commercial Health Plans in New York by JD Power in 2026.

Revenue is generated primarily through recurring health insurance premiums from individuals, employer groups, Medicare beneficiaries, and the federal government, supplemented by per-seat telemedicine pricing, pharmacy revenue, and third-party administration fees for FSA/HRA programs. Distribution is multi-channel: direct-to-consumer online/phone/mail/in-person enrollment (including Medicare Advantage enrollment through cdphpmedicare1.destinationrx.com and Medicare.gov), a dedicated Medicare sales department, employer-facing field sales, and a broker channel for commercial group plans. Marketing combines content marketing (The Daily Dose blog), organic social, community events (notably the annual Workforce Team Challenge that drew 8,000+ participants and raised $50,000 for local non-profits in 2026), and free Medicare educational seminars. CDPHP is led by CEO John D. Bennett, CFO Frank Ulibarri, Chief Medical Officer Elizabeth Warner, and Chief Sales and Marketing Officer Nicholas Kraft. Revenue figures are not publicly disclosed.

Name

CDPHP

Legal name

Capital District Physicians' Health Plan, Inc.

Website

https://cdphp.com

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

501–1,000 employees

Short description

CDPHP is a New York State-chartered not-for-profit health plan founded in 1984, serving individuals, employer groups, Medicare beneficiaries, and government program enrollees in the Capital District region (Albany, Schenectady, Rensselaer, Saratoga counties) with Medicare Advantage, commercial, Medicaid, and Child Health Plus products.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

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

SIC

Accident & Health Insurance (6321)

akta.pro primary industry

Medicare Part D Prescription Drug Plans (PDP) (FSAIAGAC)

Keywords

• Health insurance plans
• Medicare Advantage coverage
• Employer group benefits
• Prescription drug coverage
• Wellness programs

Headquarters

HQ city

Albany

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

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

Revenue model

1. Health Insurance Premiums: CDPHP generates revenue primarily through health insurance premiums paid by members (individuals and employer groups). Premium rate changes are filed annually with NY State Department of Financial Services for community-rated Small Group and Individual plans.
2. Medicare Advantage Plans: CDPHP offers Medicare Advantage HMO and PPO plans with Part D prescription drug coverage, generating premium revenue from Medicare beneficiaries and the federal government.
3. Government Program Plans: CDPHP administers Medicaid, Child Health Plus, and Essential Plan programs, receiving government funding to provide health coverage for eligible populations.
4. Third-Party Administration: CDPHP provides third-party administration services for employer health Flexible Spending Accounts (FSA) and Health Reimbursement Arrangements (HRA).

Pricing tiers

Go-to-market motion3 records

Distribution channels7 records

Marketing channels8 records

Core offering

CDPHP is a not-for-profit health insurance company that issues and administers medical, prescription drug, dental, vision, hearing, and wellness coverage for individuals, families, employers, and Medicare, Medicaid, Child Health Plus, and Essential Plan enrollees in New York's Capital District. It also provides third-party administration of FSA/HRA accounts, mail order pharmacy services through ConnectRx, telemedicine via Doctor On Demand, fitness programs, and member digital tools.

Differentiator

Problem solved

Functional benefit

Brands

• CDPHP Medicare Advantage: Medicare Advantage health plans offered by CDPHP including HMO options for Medicare beneficiaries.
• CDPHP Health Hub
• CDPHP Cycle!
• ConnectRx
• Fitness Connect

Products and services

• Individual and Family Health Plans (Platinum, Gold, Silver, Bronze)
• Employer Group Health Plans
• Medicare Advantage HMO Plans
• Medicare Advantage PPO Plans
• Medicaid Managed Care
• Child Health Plus
• Essential Plan
• Third-Party Administration of FSA and HRA
• Doctor On Demand Telemedicine
• ConnectRx Mail Order Pharmacy
• CDPHP Health Hub Wellness Rewards
• CDPHP Cycle! Fitness Program

Quantifiable outcome

• 8,000+ participants engaged through Workforce Team Challenge community event
• +4 more outcomes

Named customers5 records

Segments6 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration14 records

Feature8 records

Partnerships

Seven partnerships are on record, tiered core.

• Community Care PhysicianscoreStrategic or Co-development Partner · 1 April 2026Strategic collaboration announced between Community Care Physicians, Albany Med Health System, and CDPHP in April 2026. The partnership aims to enhance patient access and outcomes through coordinated care initiatives.
• Albany Med Health SystemcoreStrategic or Co-development Partner · 1 April 2026Strategic collaboration announced between Community Care Physicians, Albany Med Health System, and CDPHP in April 2026. The partnership aims to enhance patient access and outcomes through coordinated care initiatives.
• Capital RxcoreTechnology or IntegrationCDPHP has partnered with Capital Rx to administer pharmacy services including mail order prescription delivery and the Medication Therapy Management Program for Medicare Advantage members.
• Outcomes (Pharmacy)coreTechnology or IntegrationCDPHP has partnered with Outcomes to administer the Medication Therapy Management Program (MTM) which helps Medicare members optimize prescription drug therapy and outcomes.
• NationsBenefitscoreTechnology or IntegrationCDPHP partnered with NationsBenefits to provide the prepaid Benefits Mastercard for Medicare Advantage members, loading yearly dental and eyewear spending amounts along with quarterly OTC spending amounts.
• Preferred Retail Pharmacies (ConnectRx, Market 32/Price Chopper, Walmart, Hannaford, ShopRite, Walgreens, Kinney Drugs, Stop & Shop, Giant Foods, Food Lion)coreChannel Partner/ Reseller/ DistributorNetwork of preferred retail pharmacies offering prescription drug coverage with Tier 1 generic drugs available at $0 copay. Preferred pharmacies provide deeper discounts compared to standard pharmacies.
• Doctor On DemandcoreTechnology or IntegrationCDPHP offers Doctor On Demand telemedicine service allowing members to connect with doctors via live video visits 365 days a year, 24/7. Most Medicare members pay $0 for this service.

Scale indicators7 records

Recent moves7 records

Expansion highlights5 records

Broad incumbents

• Humana: National Medicare Advantage leader; expanding commercial and dual-eligible presence in NY and competing directly with CDPHP's MA-focused product line for 65+ beneficiaries in the Capital District.
• UnitedHealthcare: Largest US health insurer with national Medicare Advantage, commercial, and Medicaid scale; competes for Capital District employer group and MA business with vastly superior capital and provider contracting leverage.
• Aetna (CVS Health): National carrier with significant NY commercial and Medicare Advantage presence; competes for Capital District employer group accounts and MA enrollment, with CVS retail integration providing pharmacy and clinical advantages CDPHP must match via its ConnectRx partnership.
• Empire BlueCross BlueShield (Anthem): Major NY commercial and Medicare Advantage carrier backed by Anthem's national scale; competes directly for employer group business and MA enrollment in the Capital District with much larger capital and network resources.

Direct peers

• Independent Health: Buffalo-based not-for-profit health plan offering commercial, Medicare Advantage, and Medicaid coverage in Western New York; comparable structure and scale to CDPHP with strong quality ratings and a similar provider-affiliated operating model.
• MVP Health Care: Not-for-profit regional health plan serving Upstate New York with commercial, Medicare Advantage, and Medicaid products; similar size, structure, and provider-sponsored model, making it CDPHP's most direct competitor for Capital District-adjacent markets.

Regional players

• Healthfirst: NY-based not-for-profit health plan with strong Medicare Advantage and Medicaid focus; primarily downstate but expanding upstate, competing for government-program members with similar multi-product strategy.
• Fidelis Care: New York-focused health plan (Centene-owned) with major Medicare Advantage and Medicaid presence statewide; competes directly with CDPHP for dual-eligible and government-program members in the Capital District.
• Excellus BlueCross BlueShield: Not-for-profit Blue Cross Blue Shield licensee serving Upstate New York with commercial, Medicare, and Medicaid products; regional competitor with broader Upstate reach than CDPHP but overlapping Capital District footprint.
• EmblemHealth: Not-for-profit NY-based health insurer offering commercial, Medicare, and Medicaid plans primarily in downstate NY with limited upstate overlap; structurally similar not-for-profit carrier with comparable product breadth.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/cdphp
• YouTubeyoutube.com/user/CDPHPvideo
• Facebookfacebook.com/CDPHP
• LinkedInlinkedin.com/company/cdphp
• Instagraminstagram.com/cdphp

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Subsidiaries2 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 CDPHP