HPI

What HPI does

HPI (Health Plans, Inc.), founded in 1981 and headquartered in Westborough, Massachusetts, is a national third-party administrator (TPA) of self-funded health benefit plans. It serves employers of all sizes, municipalities, and Taft-Hartley plans across the United States, providing claims processing, benefits administration, enrollment, and eligibility management as its core services. The company's product portfolio spans self-funded health plan administration, health plan designs (including Consumer-Driven Health Plans, level-funded plans, reference-based pricing, and specialized plan designs), benefit administration, population health management, and wellness programs such as AchieveHealth (health coaching, chronic condition management). On the technology side, HPI operates multi-stakeholder portals for members (My Plan), employers, brokers (Online Reporting), and providers (Patient Benefits / Referral Portal); it is currently migrating brokers and employer groups from the legacy WEBeci platform (three-character group codes) to the new MESA platform (five-character group codes) for enrollment and claims management. Care management is supported by the MedWatch platform, which consolidates lab, pharmaceutical, claims, activity, and outcomes data into clinician-accessible patient records developed over 25 years. Underlying healthcare navigation is delivered through strategic partnerships including Mayo Clinic (Complex Care Program), HealthJoy, Welvie, Orlando Health, and Baylor Scott & White Quality Alliance.

HPI is a wholly-owned subsidiary of Point32Health, a not-for-profit health and well-being organization formed in 2020 from the merger of Harvard Pilgrim Health Care and Tufts Health Plan, which collectively serve nearly 2 million members. HPI operates with a sales-led go-to-market model relying heavily on insurance brokers and benefit consultants, supported by dedicated regional sales offices (Boston/Woburn, MA; Portland, ME), national sales executives, and a national client management team. Recent inorganic expansion includes the acquisition of Employers Health Network (EHN) in Irving, Texas (July 2022) and MedCost in the Southeast (announced July 2025). The company reports a 96% client retention rate, is URAC-accredited for Health Utilization Management (originally 2021, re-accredited August 2024), and is a Diamond Member of the Self-Insurance Institute of America. Revenue is generated through recurring third-party administration fees on a per-employee-per-month basis under multi-year contracts with employer clients and broker-sold groups; pricing is customized and not publicly disclosed.

Name

HPI

Legal name

Health Plans, Inc.

Website

https://hpitpa.com

Company type

Private

Founded year

1981

Operating status

Operating

Headcount range

251–500 employees

Short description

HPI is a national third-party administrator (TPA), founded in 1981 and subsidiary of Point32Health, providing self-funded health plan administration, claims processing, enrollment, benefit design, and population health management to employers, municipalities, and Taft-Hartley plans across the United States via a broker-led distribution channel.

Ownership category

akta.pro rank

Product category

Third-Party Health Plan Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120)

SIC

Insurance Agents, Brokers & Service (6411), Accident & Health Insurance (6321)

akta.pro primary industry

High-Deductible Health Plans (HDHP) with HSA-Eligible Coverage (FSAIAFAM)

akta.pro secondary industry

Provider Directory & Network Identity (HPD, NPI, credential linking) (HLACABAF)

Keywords

• Self-funded health plans
• Third-party administration
• Benefits administration
• Population health management
• Claims processing

Headquarters

HQ city

Westborough

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Third-Party Administration Fees: HPI generates revenue by providing third-party administration services to self-funded employers. As a TPA, HPI charges administrative fees for processing claims, managing benefits, enrollment, eligibility verification, and providing customer service to members and employers. The company also earns revenue from care management services, population health management programs, and network access fees.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels7 records

Core offering

HPI is a national third-party administrator that delivers self-funded health plan administration to employers, municipalities, and Taft-Hartley plans. Its core service covers claims processing, eligibility management, enrollment, and customer service, supported by customizable health plan designs such as Consumer-Driven Health Plans, Level-Funded Health Plans, Reference-Based Pricing, Specialized Plan Designs, and Network Relationships, along with integrated population health management including the AchieveHealth wellness programs.

Product overview

HPI operates as a national third-party administrator (TPA) offering a unified self-funded health benefits platform. The core offering centers on Self-Funded Health Plan Administration with integrated Health Plan Designs (including CDHP, Level-Funded, and Reference-Based Pricing options), Benefit Administration, and Population Health Management. The product portfolio includes member-facing portals (My Plan), employer and broker administration portals (MESA/WEBeci for enrollment and claims, Online Reporting), wellness programs (AchieveHealth for health coaching and chronic condition management), and Network Relationships providing access to national provider networks. HPI also acquired Employers Health Network (EHN) and MedCost to expand network capabilities.

Differentiator

Problem solved

Functional benefit

Products and services

• Self-Funded Health Plan Administration Comprehensive third-party administrator (TPA) services for self-funded employer health benefit plans, including claims processing, eligibility management, enrollment, customer service, and customizable plan designs, targeted at employers, municipalities, and Taft-Hartley plans nationwide.
• Health Plan Designs (CDHP, Level-Funded, Reference-Based Pricing, Specialized Designs, Network Relationships) A portfolio of innovative health plan design solutions for self-funded employers, including Consumer-Driven Health Plans, Level-Funded plans, Reference-Based Pricing, Specialized Plan Designs, and Network Relationships that allow employers to control healthcare spend and tailor plan structures to workforce needs.
• Benefit Administration Administrative services for managing employer health benefits, including claims administration, enrollment processing, eligibility management, and compliance management for self-funded plan sponsors.
• Population Health Management (AchieveHealth) Integrated care management and population health services combining the AchieveHealth wellness programs (personalized health coaching, weight management, tobacco cessation, stress reduction, fitness, and chronic condition management) with case, disease, and utilization management to help employers improve health outcomes and control healthcare costs.
• MESA Broker Enrollment and Claims Portal Third-party enrollment and claims portal for brokers with five-character group codes, providing online access for entering enrollments, terminations, and viewing claims on behalf of clients; replaces the legacy WEBeci portal with core system enhancements and new user credentials.

Quantifiable outcome

• 96% client retention rate
• +2 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature6 records

Partnerships

15 partnerships are on record, tiered core and minor.

• MedCostcoreStrategic or Co-development Partner · 23 July 2025HPI announced the acquisition of MedCost in July 2025, expanding market reach and enhancing network capabilities in the Southeast. MedCost was a competitor TPA that HPI acquired to accelerate its national expansion strategy.
• HealthJoyminorStrategic or Co-development Partner · 2 October 2022HPI announced a partnership with HealthJoy, a healthcare navigation platform company, in October 2022. The partnership provides HPI clients with access to HealthJoy's healthcare navigation technology.
• Employers Health Network (EHN)coreStrategic or Co-development Partner · 1 July 2022HPI acquired Employers Health Network (EHN) of Irving, Texas on July 1, 2022. The acquisition strengthened HPI's position in providing cost-effective healthcare solutions for self-funded employers and expanded its network options and ability to serve the national market with high-performance healthcare providers. EHN develops partnerships with large integrated delivery systems focused on direct-to-employer strategies.
• TrestleTree, Inc.minorStrategic or Co-development Partner · 9 January 2015Harvard Pilgrim Health Care, through its subsidiary HPI, acquired TrestleTree in January 2015. TrestleTree is a nationwide provider of lifestyle change management services to large employers, offering health behavior change coaching accredited by URAC for disease management, including health risk assessment, smoking cessation, weight management, and stress management programs.
• MedWatchcoreStrategic or Co-development Partner · 3 February 2014Harvard Pilgrim Health Care acquired MedWatch in February 2014. MedWatch is a care management firm offering case, disease, and utilization management programs (all URAC accredited) covering over 94,000 members nationwide. It has developed comprehensive care management software and provides cost containment services ranging from wellness and early detection programs to case management of complex and chronic conditions.
• Mayo CliniccoreStrategic or Co-development PartnerHPI partners with Mayo Clinic to provide clients with access to Mayo's Complex Care Program, offering Centers of Excellence for individuals with complex, rare, or undiagnosed medical conditions. Mayo providers are not incentivized to perform unnecessary surgeries, helping get to the right diagnosis initially. The partnership provides a holistic wellbeing solution and total care management.
• WelvieminorStrategic or Co-development PartnerHPI partners with Welvie to provide a more powerful and effective way for members to make healthcare decisions, specifically around surgery. Welvie helps members navigate surgical options and make informed decisions.
• Orlando Health SystemminorStrategic or Co-development PartnerHPI partners with Orlando Health System through EHN to provide employer-direct healthcare relationships, helping prevent unnecessary care, reduce plan spend, provide access to best-in-class providers, and advocate for members.
• Baylor Scott & White Quality AllianceminorStrategic or Co-development PartnerHPI partners with Baylor Scott & White Quality Alliance (BSWQA) through EHN to deliver the Total Cost of Care solution, helping employers reduce healthcare costs through direct-to-employer relationships with integrated delivery systems.
• MedWatch/Pathways ConciergeminorStrategic or Co-development PartnerHPI partners with MedWatch/Pathways Concierge to provide healthcare navigation services that help members navigate the healthcare system, offering efficient processes and quality health cost containment solutions.
• Point32Health (Parent Company)coreOthersHPI is a subsidiary of Point32Health, the parent company of Harvard Pilgrim Health Care and Tufts Health Plan. Point32Health is a not-for-profit health and wellbeing organization serving nearly 2 million members. HPI operates as the company's third-party administrator division.
• Sun LifeminorGTM or Marketing PartnerSun Life participates in HPI's annual Innovations Self-Funding Conference as a panelist on topics including high-cost claims, gene therapies, and clinical services. Sun Life provides stop loss and reinsurance-related products to HPI clients.
• The Phia GroupminorGTM or Marketing PartnerThe Phia Group, led by CEO Adam Russo, participates in HPI's Innovations Self-Funding Conference, providing thought leadership on self-funding regulations, best practices, and opportunities.
• EyeMedminorStrategic or Co-development PartnerHPI offers members EyeMed-affiliated vision provider discounts through its member discounts and savings program, providing 35% off frames and 20% off frames or lens options at participating providers including LensCrafters, Target Optical, and independent eye doctors.
• Amplifon Hearing Health CareminorStrategic or Co-development PartnerHPI partners with Amplifon Hearing Health Care to provide members with significant savings on hearing aids and services. The partnership includes virtual hearing screening, state-of-the-art technology, a 60-day risk-free trial, and a 3-year warranty.

Scale indicators6 records

Recent moves7 records

Expansion highlights6 records

Broad incumbents

• UnitedHealth Group (Optum): UnitedHealth Group, through its Optum Health and UnitedHealthcare divisions, operates large-scale health benefits administration, TPA services, and care management alongside its core insurance business. As a broad incumbent, it competes with HPI in self-funded employer administration while also serving as a benchmark for what scaled, vertically integrated administration looks like.
• Allstate Benefits: Allstate Benefits is the group benefits division of Allstate offering life, disability, and supplemental health products to employers, including voluntary and self-funded solutions. HPI's incoming Chief Growth Officer previously served as area vice president at Allstate Benefits, and the two overlap in serving mid-sized employer benefit programs.

Direct peers

• U.S. Administrative Services: U.S. Administrative Services (USAS) is a TPA focused on self-funded health plan administration for small and mid-sized employers. It offers a similar product set to HPI and competes in the same broker-distributed self-funded employer market.
• HealthScope Benefits: HealthScope Benefits is a national TPA focused on self-funded health plan administration for small to mid-sized employers. It offers a comparable product set (claims, enrollment, stop-loss support, reference-based pricing options) and competes for the same broker-driven employer segment that HPI targets.
• ACS Benefit Services: ACS Benefit Services is a TPA providing self-funded health plan administration, COBRA, and benefit management services. An HPI regional sales executive previously served as sales director at ACS Benefit Services, and the two companies compete in similar employer and broker channels.
• Lucent Health: Lucent Health is a TPA and health plan administrator offering self-funded plan administration, care management, and network solutions. Multiple HPI executives previously held senior roles at Lucent Health/Cypress Benefit Administrators, and the two compete in the same mid-market self-funded employer channel.
• Consociate Health: Consociate Health is a TPA focused on self-funded employer health plans, particularly for Taft-Hartley, public sector, and mid-market employer clients. HPI's COO Paul Wann previously served as COO at Consociate, and the two compete in similar self-funded employer segments.
• Meritain Health: Meritain Health is one of the largest national third-party administrators of self-funded health plans, serving employers of all sizes with claims processing, population health, and network solutions. It competes directly with HPI for self-funded employer accounts and broker partnerships across the U.S.
• Cypress Benefit Administrators: Cypress Benefit Administrators is a TPA specializing in self-funded health, dental, vision, and disability plan administration for mid-market employers. It is a direct competitor to HPI, and several HPI client management leaders previously held roles at Cypress.
• Vitori Health: Vitori Health is a TPA and health plan administrator specializing in self-funded employer health benefits. Incoming HPI President Tim O'Brien previously served as CEO of Vitori Health, and the company competes with HPI for self-funded employer accounts.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/HealthPlansInc
• LinkedInlinkedin.com/company/health-plans-inc.
• Xx.com/HealthPlansInc

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles20 records

Subsidiaries2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A2 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about HPI