Imagine Health

What Imagine Health does

Imagine Health is a US-based healthcare benefits company that administers self-funded employer health plans as an alternative to traditional PPO coverage. Operating as a subsidiary of Imagine 360, LLC and headquartered in Wayne, Pennsylvania with operational support in Utah, the company serves self-funded employers across 18 US markets, primarily in manufacturing, hospitality, retail, home improvement, and other enterprise and mid-market segments. The stated customer base includes Western Extrusions, a large national home improvement retailer (23% savings), a hospitality company (16% savings), a large discount retailer (20% savings), and a Texas manufacturer, with documented savings of 15-30% versus traditional PPO plans.

The company's core product, the Imagine Health Plan, is built on three technology pillars: a proprietary provider quality scoring methodology that uses independent data to identify high-performing physicians, hospitals, and health systems in local markets; direct contracts with those selected providers at negotiated fair rates; and a built-in price protection mechanism based on reference-based pricing (RBP) anchored to Medicare rates. The technology stack includes the miBenefits member portal, a provider search tool, and a savings calculator. The contracted footprint spans 650+ facilities and 38,500+ providers across the 18 markets. Complementary service modules include care navigation, bill resolution and member advocacy, stop loss insurance, and a transparent pharmacy benefits management (PBM) solution; a bundled Philadelphia-market offering integrates medical, stop loss, PBM, and benefits administration into a single solution.

Imagine Health operates a hybrid go-to-market combining direct enterprise sales with a broker distribution channel. Direct sales account managers engage self-funded employers with savings analyses anchored to the 15-30% savings claim. The company also recruits licensed insurance brokers through a Certified Broker Program that provides additional training, resources, and tools, with any licensed broker able to sell the plan. Revenue is generated through two streams: managed-services fees for administering self-funded employer health plans (claims processing, member advocacy, plan administration) and transaction-based fees from reference-based pricing arrangements. Pricing is not publicly disclosed and varies by employer size, employee demographics, industry, and geographic location.

Name

Imagine Health

Legal name

Imagine Health, LLC

Website

https://imaginehealth.com

Company type

Private

Founded year

2006

Operating status

Operating

Headcount range

11–50 employees

Short description

Imagine Health is a US-based healthcare benefits company that administers self-funded employer health plans using reference-based pricing and direct contracts with quality providers, serving enterprise and mid-market employers across 18 markets through direct sales and a certified broker channel.

Ownership category

akta.pro rank

Product category

Self-Funded Employer Health Plans

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Self-Funded (ERISA) Employer Plans (HLAEAAAC)

Keywords

• Self-funded health plans
• Employer healthcare benefits
• Reference-based pricing
• Direct provider contracting
• Member advocacy services

Headquarters

HQ city

Midvale

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Self-Funded Employer Plan Administration: Imagine Health provides administrative services for self-funded employer health plans. The company earns fees for managing healthcare benefits, processing claims, and providing member advocacy services. Employers fund their own employee benefits plan but pay Imagine Health for plan administration and access to their provider network.
2. Reference-Based Pricing Management: Revenue generated through managing reference-based pricing arrangements where medical claims are paid based on a metric or reference point such as established Medicare payment data, providing fair pricing for quality care.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels8 records

Core offering

Imagine Health operates a self-funded employer health plan built on direct contracts with quality-rated providers, reference-based pricing, and built-in price protection. The company curates a network of high-performing physicians, hospitals, and urgent care centers across 18 U.S. markets, and layers on member advocacy, care navigation, bill resolution, and stop loss insurance services. Employers using Imagine Health typically achieve 15-30% savings versus traditional PPO plans.

Product overview

Imagine Health is a health benefits company offering a single core product: the Imagine Health Plan, a self-funded employer health plan that enables companies to control healthcare spend through direct contracts with quality providers, built-in price protection, and member advocacy services. The portfolio includes complementary service modules (Care Navigation, Bill Resolution, Stop Loss Insurance, Pharmacy Benefits Management), self-service digital tools (miBenefits Portal, Provider Search, Savings Calculator), and downloadable resources (Broker Guide, Employer Guide, Impact Report, White Papers). For the Philadelphia market, a bundled variant called 'The Imagine Health Plan' combines medical coverage, stop loss, pharmacy benefits, and benefits administration into a single integrated solution. The platform operates across 18 markets with a network of 650+ facilities and 38,500+ providers.

Differentiator

Problem solved

Functional benefit

Brands

• Imagine 360: Parent company and umbrella brand for Imagine Health and affiliated healthcare companies including Healthfirst by Imagine360, Partners Direct Health, ELAP Services, Employee Benefit Management Services, miCare, SpringTide Health, Preferred Medical Claim Solutions, Aldwyn Re Protected Cell LLC, and Upland Advocacy LLC.

Products and services

• Imagine Health Plan

Quantifiable outcome

• 15-30% savings on healthcare costs versus traditional PPO plans
• +5 more outcomes

Named customers5 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

25 partnerships are on record, tiered core.

• University of Calgary Faculty of MedicinecoreStrategic or Co-development PartnerImagine Health's Calgary Capitol Hill clinic (through parent company Datametrex subsidiary) established as a teaching facility. Dr. Michael Tam joined as walk-in physician bringing medical residents to the clinic. This partnership strengthens physician recruitment and retention strategy.
• Tenet HealthcoreTechnology or IntegrationSouth Florida market partner with 11 hospitals including 1 children's hospital, 20+ urgent care centers, and 2,350+ providers. Direct-contract pricing for Imagine Health members.
• Orlando HealthcoreTechnology or IntegrationOrlando market partner with 9 hospitals including 1 children's hospital, 15+ urgent care centers, and 1,200+ providers. Direct-contract pricing for Imagine Health members.
• Portneuf Medical CentercoreTechnology or IntegrationPocatello market partner with 120+ providers. Direct-contract pricing for Imagine Health members.
• Northwestern MedicinecoreTechnology or IntegrationChicago market partner. Part of network with 24 hospitals including 1 children's hospital, 80+ urgent care centers, and 8,650+ providers in Chicago market.
• AMITA HealthcoreTechnology or IntegrationChicago market partner. Part of network with 24 hospitals including 1 children's hospital, 80+ urgent care centers, and 8,650+ providers in Chicago market.
• Children's Hospital of ChicagocoreTechnology or IntegrationChicago market pediatric partner. Part of network with 24 hospitals including 1 children's hospital, 80+ urgent care centers, and 8,650+ providers in Chicago market.
• Community Health NetworkcoreTechnology or IntegrationIndianapolis market partner with 6 hospitals, 15+ urgent care centers, and 1,500+ providers. Direct-contract pricing for Imagine Health members.
• The University of Kansas Health System St. Francis CampuscoreTechnology or IntegrationTopeka market partner with 130+ providers. Direct-contract pricing for Imagine Health members.
• The Lovelace Health SystemcoreTechnology or IntegrationAlbuquerque market partner with 5 hospitals and 175+ providers. Direct-contract pricing for Imagine Health members.
• TriHealthcoreTechnology or IntegrationCincinnati market partner with 5 hospitals, 7 urgent care centers, and 1,450+ providers. Direct-contract pricing for Imagine Health members.
• Hillcrest HealthCare SystemcoreTechnology or IntegrationTulsa market partner with 8 hospitals and 250+ providers. Direct-contract pricing for Imagine Health members.
• Penn MedicinecoreTechnology or IntegrationPhiladelphia market partner with 7 hospitals, 25+ urgent care centers, and 5,500+ providers. Direct access to Penn Medicine including 7 hospitals and 2,100 physicians.
• Children's Hospital of PhiladelphiacoreTechnology or IntegrationPhiladelphia market pediatric partner with 7 hospitals, 25+ urgent care centers, and 5,500+ providers.
• Baylor Scott & WhitecoreTechnology or IntegrationDallas-Fort Worth market partner with 23 hospitals including 4 children's hospitals, 75+ urgent care centers, and 5,650+ providers. Also partner in Harker Heights and Tyler markets.
• Children's HealthcoreTechnology or IntegrationDallas-Fort Worth market pediatric partner with 23 hospitals including 4 children's hospitals, 75+ urgent care centers, and 5,650+ providers.
• Cook Children'scoreTechnology or IntegrationDallas-Fort Worth market pediatric partner with 23 hospitals including 4 children's hospitals, 75+ urgent care centers, and 5,650+ providers.
• Seton Medical Center Harker HeightscoreTechnology or IntegrationHarker Heights market partner with Baylor Scott & White, offering 30+ providers. Direct-contract pricing for Imagine Health members.
• UTHealth East TexascoreTechnology or IntegrationTyler market partner with 9 hospitals and 300+ providers. Direct-contract pricing for Imagine Health members.
• Baptist HealthcoreTechnology or IntegrationSan Antonio market partner with 8 hospitals, 20+ urgent care centers, and 1,850+ providers. Direct-contract pricing for Imagine Health members.
• The Hospitals of ProvidencecoreTechnology or IntegrationEl Paso market partner with 5 hospitals including a children's hospital, 8 urgent care centers, and 400+ providers. Direct-contract pricing for Imagine Health members.
• HCA Gulf CoastcoreTechnology or IntegrationHouston market partner with 30 hospitals including 4 children's hospitals, 45+ urgent care centers, and 5,750+ providers.
• Memorial HermanncoreTechnology or IntegrationHouston market partner with 30 hospitals including 4 children's hospitals, 45+ urgent care centers, and 5,750+ providers.
• Texas Children's HospitalcoreTechnology or IntegrationHouston market pediatric partner with 30 hospitals including 4 children's hospitals, 45+ urgent care centers, and 5,750+ providers.
• Valley Baptist HealthcoreTechnology or IntegrationRio Grande Valley market partner with 2 hospitals and 200+ providers. Direct-contract pricing for Imagine Health members.

Scale indicators5 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• ClaimDOC: Independent RBP and claim negotiation vendor used by self-funded employer health plans and TPAs. Competes with Imagine Health's RBP and built-in price protection on cost containment effectiveness.
• Surest (UnitedHealth Group): A value-based health plan (formerly Bind) that prices care transparently and is sold primarily to self-funded employers. Competes head-to-head with Imagine Health's curated, price-disciplined approach to employer benefits.
• Healthcare Highways: RBP-focused health plan and provider network for self-funded employers, with selective contracting and price protection features that closely mirror Imagine Health's model.
• Centivo: Health plan provider built around a curated network of quality providers for self-funded employers, with a similar value proposition of lower-cost, data-driven network design. Directly competes with Imagine Health for the same self-funded employer and broker channels.
• Sidecar Health: Reference-based pricing health plan that pays providers based on a pre-set price per service, sold to self-funded employers and individuals. Closely comparable to Imagine Health's RBP and price protection model.
• The Phia Group: TPA and plan-design firm focused on self-funded employer health plans, including RBP and cost containment strategies. Comparable to Imagine Health in serving self-funded employers through brokers and consultants.
• Vālenz Health: Integrated cost containment and RBP vendor for self-funded health plans, with provider network curation and member advocacy offerings overlapping Imagine Health's portfolio.

Broad incumbents

• Cigna Healthcare: Major health carrier and stop loss provider with deep self-funded employer relationships through Evernorth. Represents the incumbent option employers compare Imagine Health against.
• UMR (UnitedHealth Group): Largest third-party administrator of self-funded health plans in the US, owned by UnitedHealth. Competes with Imagine Health in the same self-funded employer segment but with vastly broader networks, scale, and product breadth.

Emerging players

• Allied National: Alternative health plan provider for self-funded employers with selective networks and cost-management features, competing in a similar niche to Imagine Health with overlapping broker distribution.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/watch?v=0qVrAKFTCjY
• Xx.com/doyouimagine
• Facebookfacebook.com/DoYouImagine
• LinkedInlinkedin.com/company/imagine-health-inc-

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Funding overview

Funding rounds2 records

Investors2 records

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 Imagine Health