Point C

Name

Point C

Legal name

Benefit Plan Administrators of Eau Claire LLC

Website

https://pointchealth.com

Company type

Private

Founded year

2019

Operating status

Operating

Headcount range

101–250 employees

Ownership category

akta.pro rank

Product category

Third-Party Administration (Self-Funded Health Plans)

NAICS

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

SIC

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

akta.pro primary industry

Member Services & Contact Center Operations (TPA) (HLAEALAI)

akta.pro secondary industries

Flexible Benefits Administration (FSA/HSA/HRA) (HLAEALAK), Employer/Member Engagement Platforms for Provider-Sponsored Plans (HLACAEAM), Dental & Vision Third-Party Administration (TPA) (FSAIAHAL)

Keywords

• Self-funded health plans
• Third-party administration
• Pharmacy benefit management
• Medical cost containment
• Care management services

Headquarters

HQ city

Chicago

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. TPA Administrative Services: Point C generates revenue through administrative fees for claims processing, customer service, eligibility management, reporting, compliance coordination, and network access for self-funded health plans.
2. Medical Cost Containment: Revenue derived from payment integrity review, medical claim repricing, high-dollar claim review, and identification of billing issues that reduce unnecessary medical spend in self-funded plans.
3. Pharmacy Benefit Management (PBM): Revenue from specialty PBM solutions, PBM contract analysis, pharmacy vendor evaluation, drug spend optimization, and specialty pharmacy oversight including URAC-accredited services.
4. Care Management Services: Revenue from nurse-led care management, utilization management, specialty case management (oncology, behavioral health, dialysis, specialty pharmacy), and clinical guidance for high-cost members.
5. Consumer-Driven Products Administration: Revenue from administering FSA, HSA, HRA, COBRA, and Family Medical Leave programs with ongoing account administration, processing support, and compliance oversight.

Pricing tiers

Go-to-market motion4 records

Distribution channels4 records

Marketing channels8 records

Core offering

Point C is a national independent Third-Party Administrator (TPA) for self-funded employer health plans. The company administers claims, eligibility, compliance, network access, and care management for self-funded health plans, with integrated medical cost containment, pharmacy benefit management (PBM), care management, consumer-driven benefit accounts (FSA/HSA/HRA/COBRA), and compliance navigation delivered through proprietary member, employer, broker, and provider portals plus a mobile app.

Product overview

Point C is a national independent third-party administrator (TPA) offering a unified platform for self-funded health plan management. The core offering combines five integrated service modules: Medical Cost Containment (claims review, fraud detection, repricing), Pharmacy Solutions/PBM Services (URAC-accredited pharmacy benefit management), Care Management (nurse-led case management, utilization review, specialty conditions), Consumer-Driven Products (FSA, HSA, HRA, COBRA, leave administration), and Compliance Navigation (CAA, RxDC, ERISA support). These are delivered through a connected administrative model with dedicated member, employer, broker, and provider web portals and a mobile application (Point C Health Mobile), supporting over 100,000 employee lives across 650+ employer clients.

Differentiator

Problem solved

Functional benefit

Products and services

• Third-Party Administrator (TPA) Core Services Core TPA services for self-funded employer health plans covering claims administration, eligibility management, compliance coordination, account management, plan operations, and network access. Designed for benefits brokers and self-funded employers needing integrated plan administration.
• Medical Cost Containment Claims-focused cost management service integrating clinical claim review, fraud/waste/abuse detection, drug optimization, specialty claim review, payment integrity, high-dollar claim review, and repricing strategies to reduce unnecessary medical spend. For self-funded employers and brokers.
• Pharmacy Solutions / PBM Services URAC-accredited pharmacy benefit management offering PBM contract review, market-based savings analysis, rate negotiation, specialty drug oversight, drug spend optimization, rebate transparency, and pharmacy trend reporting. Includes multiple PBM partnership options (Carelon, CVS, Optum, ESI, Prime Therapeutics, CapitalRx, MedImpact). For self-funded employers.
• Care Management Clinical support service including general care management, URAC-accredited utilization management, and specialty case management for oncology, behavioral health, dialysis, specialty pharmacy, and complex chronic conditions. Backed by 30+ in-house licensed clinicians and a Johns Hopkins-trained Medical Director. For self-funded employer plan members.
• Consumer-Driven Products Administration Account-based benefit administration including FSA, HSA, HRA management, COBRA continuation coverage administration, and Family Medical Leave (FML) administration with ongoing account servicing, processing support, and compliance oversight. For self-funded employers.
• Compliance Navigation Regulatory compliance service covering federal requirements (Consolidated Appropriations Act, Transparency in Coverage, RxDC submissions, Gag Clause Attestation), state reporting obligations, ERISA guidance, audit-ready documentation, and fiduciary oversight support. For self-funded employers and brokers.
• Point C Health Mobile App Mobile application for iOS and Android giving self-funded health plan members access to plan information, claims, ID cards, coverage details, and benefits documentation on mobile devices.

Quantifiable outcome

• Point C Surpasses 100,000 Employee Lives Nationwide
• +7 more outcomes

Named customers4 records

Segments4 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration17 records

Feature5 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Coastal Administrative Services (CAS)coreStrategic or Co-development Partner · 5 May 2026Point C acquired Coastal Administrative Services (CAS), one of the Pacific Northwest's fastest-growing TPAs. The partnership combines Point C's seven regional offices with CAS's established Pacific Northwest presence, expanding Point C's West Coast footprint while providing CAS access to Point C's full suite of in-house product offerings.
• PPO Network Partners (Aetna, Anthem, Cigna, First Health, First Choice Health Network, HealthLink, PHCS, 25+ Regional Networks)coreTechnology or IntegrationPoint C provides access to national and regional PPO network partners including Aetna, Anthem, Cigna, First Health, First Choice Health Network, HealthLink, PHCS, and 25+ regional networks, giving members broad provider access across the United States.
• Jim ForemanminorOthersChairman of the Board, serving on HPOne and Centivo boards. Provides strategic guidance and governance oversight as an independent board member.
• Hilarie AitkenminorOthersCEO of Navia Benefit Solutions, serving as an independent board member providing healthcare industry expertise and strategic guidance.
• Rob ButlerminorOthersCEO of Hightop Health, serving as an independent board member with expertise in healthcare services and benefits administration.
• John SnyderminorOthersFormer Founder & CEO of Medical Excess, serving as an independent board member with deep expertise in medical excess and stop-loss coverage.
• David YoungminorOthersFormer President and CEO of Optum WCS and Coventry WCS, serving as an independent board member with extensive healthcare industry leadership experience.

Scale indicators13 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• UMR: UnitedHealth Group's TPA subsidiary and the largest third-party administrator in the US. Competes with Point C for self-funded employer business but at dramatically greater scale with carrier-integrated PBM (OptumRx) and provider networks.
• Meritain Health: CVS Health/Aetna-affiliated TPA offering self-funded plan administration, pharmacy, and care management. Direct competitor to Point C for self-funded employer groups with the advantage of CVS Caremark PBM integration.

Direct peers

• HealthEZ: Independent national TPA focused on self-funded employer health plans with integrated cost containment, PBM, and member advocacy services. Highly comparable to Point C in independent positioning, target market, and integrated service model.
• Imagine360: Independent TPA combining cost containment strategies with self-funded plan administration and reference-based pricing. Comparable to Point C as an independent alternative to carrier-owned TPAs targeting mid-market and enterprise self-funded employers.
• Allied Benefit Systems: Independent TPA administering self-funded health plans for employers nationwide with integrated PBM, care management, and consumer-directed benefit services. Closely matches Point C's independent TPA positioning and product breadth.
• Lucent Health: Independent TPA providing self-funded health plan administration with care management and cost containment capabilities. Recently scaled through PE backing and acquisition activity, closely paralleling Point C's growth thesis.
• Auxiant: Mid-sized independent TPA offering self-funded plan administration, PBM services, and cost containment for employer groups. Competes in a similar mid-market self-funded niche with comparable service breadth to Point C.
• Key Benefit Administrators: Independent TPA administering self-funded plans for mid-market and enterprise employers with integrated care management and consumer-driven benefit services. Direct functional comparable to Point C across the TPA product stack.
• Amwins Group Benefits: Specialty insurance distributor with a TPA and stop-loss practice serving self-funded employers. Comparable to Point C where it competes in the self-funded administration and stop-loss coordination space.
• Benefit Administrative Services (BAS): Independent TPA administering self-funded health, dental, and consumer-driven benefit plans. Comparable to Point C in independent TPA positioning, FSA/HRA/HSA administration, and broker channel focus.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/point-c

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Subsidiaries1 record

Funding overview

Funding rounds1 record

Investors1 record

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

M&A1 record

Investments

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

Frequently asked questions about Point C