VIVA HEALTH

What VIVA HEALTH does

VIVA HEALTH, Inc. is an Alabama-domiciled health maintenance organization (HMO) founded in 1994 and headquartered in Birmingham, operating as an affiliate of the UAB Health System. The company delivers healthcare coverage through two principal product lines: Viva Medicare, a portfolio of eight Medicare Advantage HMO plans (including Plus, Premier, Select, Extra Value, Classic, Extra Care, and the Infirmary Health Advantage co-branded plan), and commercial group health insurance for small (2-50 employees) and large (51+ employees) employers. Supporting product lines include Viva Rx, a pharmacy benefit management offering for employer groups, and a third-party administration arm operated through sister entity Viva Health Administration, L.L.C. Underlying infrastructure comprises claims processing, utilization management built on third-party clinical criteria (InterQual, NCCN, NCDs/LCDs), a provider portal at vivaproviders.com with some automated prior-authorization approvals, a member portal, a mobile app, and compliance-grade machine-readable pricing files.

The company generates revenue primarily through Medicare capitation payments for MA members (with member premiums on certain plans) and employer premium contributions plus member cost-sharing on commercial business, supplemented by PBM administrative fees and rebates from CVS Caremark (Medicare Part D) and Express Scripts (commercial). Distribution is omnichannel: phone-based sales, online self-service enrollment at vivahealth.com/medicare/enroll, the CMS Medicare Online Enrollment Center, four physical Viva Health Cafés (Birmingham, Hoover, Mobile, Montgomery), provider referral networks, and a regional field-sales force for employer groups. Viva Health serves 100,000+ members across 67 Alabama counties with access to 70+ hospitals, and has maintained Medicare Star Ratings participation continuously from 2016 through 2026.

Name

VIVA HEALTH

Legal name

Viva Health, Inc.

Website

https://vivahealth.com

Company type

Private

Founded year

1995

Operating status

Operating

Headcount range

501–1,000 employees

Short description

VIVA HEALTH is a Birmingham, Alabama-based HMO affiliated with UAB Health System, providing Medicare Advantage plans, commercial group health insurance, and pharmacy benefit management to 100,000+ members across 67 Alabama counties.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

HMO Medical Centers (621491)

SIC

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

akta.pro primary industry

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)

akta.pro secondary industries

MA HMO Plans (HLAEACAA), Medicaid Managed Care HMOs (HLAEAMAI), Group HMO Plans (FSAIAFAK), Mixed-Model HMOs (HLAEAMAE)

Keywords

• Medicare Advantage plans
• Health insurance
• HMO healthcare coverage
• Pharmacy benefit management
• Employer group plans

Headquarters

HQ city

Birmingham

HQ country

United States

HQ region

North America

Offices5 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicare Advantage Plans: Viva Medicare offers multiple HMO Medicare Advantage plans including Plus, Premier, Select, Extra Value, Classic, Extra Care, and Infirmary Health Advantage. Revenue comes from Medicare capitation payments based on enrolled member demographics and risk scores, plus member premiums where applicable.
2. Commercial Group Health Plans: Small group (2-50 employees) and large group (51+ employees) employer-sponsored health insurance plans. Revenue derived from employer premium contributions and member cost-sharing.
3. Pharmacy Benefit Management (Viva Rx): Viva Rx provides prescription drug program management for employer groups, helping control pharmacy spending. Revenue generated through administrative fees and pharmacy network rebates.

Pricing tiers

Go-to-market motion2 records

Distribution channels6 records

Marketing channels6 records

Core offering

VIVA HEALTH is a health maintenance organization (HMO) providing Medicare Advantage health insurance plans and commercial group health plans to Alabama residents and employers. The company offers eight distinct Medicare Advantage HMO plans plus employer-sponsored coverage for small (2-50 employees) and large (51+ employees) groups, supported by an integrated provider network spanning 67 Alabama counties and 70+ hospitals, pharmacy benefit management, and member self-service technology.

Product overview

Viva Health is a health maintenance organization (HMO) providing healthcare coverage through two primary product lines: Viva Medicare (Medicare Advantage plans) and Viva Health Group Plans (employer-sponsored commercial coverage). The Medicare portfolio includes eight distinct HMO plans (Plus, Premier, Select, Extra Value, Classic, Extra Care, and Infirmary Health Advantage) offering varying premium levels, benefit structures, and network configurations. The commercial portfolio serves both small employers (2-50 employees) and large employers (51+ employees) with customizable plan options. Supporting infrastructure includes provider and member web portals, mobile applications, integrated telehealth through Teladoc, pharmacy benefit management via CVS Caremark (Medicare) and Express Scripts (commercial), the Silver&Fit fitness program, Modivcare transportation services, and dedicated Viva Health Café retail locations for member engagement.

Differentiator

Problem solved

Functional benefit

Brands

• Viva Medicare: Medicare Advantage plans offered by Viva Health including Plus, Premier, Select, Extra Value, Classic, Extra Care, and Infirmary Health Advantage plans.
• Viva Rx

Products and services

• Viva Medicare Plus Medicare Advantage HMO plan with $20 Part B buy-down, offering $0 monthly premium, $0 PCP copays, dental allowance, vision coverage, and Part D drug coverage.
• Viva Medicare Plus ($2 Part B Buy-Down) Medicare Advantage HMO plan with $2 Part B buy-down, providing lower copays and enhanced benefits compared to the standard Plus plan.
• Viva Medicare Premier Medicare Advantage HMO plan with $99 monthly premium for 2026, offering comprehensive medical and drug coverage with enhanced provider networks.
• Viva Medicare Select Medicare Advantage HMO plan with $0 monthly premium and no prescription drug coverage, designed for members who have other drug coverage.
• Viva Medicare Extra Value Special Needs Plan (HMO SNP) for dual-eligible beneficiaries (Medicare and Medicaid), offering $0 premium, comprehensive benefits, and supplemental supports including grocery/OTC allowances and flex cards.
• Viva Medicare Classic Medicare Advantage HMO plan with $0 monthly premium offering broad coverage with dental, vision, hearing, and fitness benefits.
• Viva Medicare Extra Care Special Needs Plan (HMO SNP) for dual-eligible beneficiaries providing $0 premium coverage with enhanced benefits for chronically ill members including SSBCI supplemental benefits.
• Viva Medicare Infirmary Health Advantage Medicare Advantage HMO plan with $0 premium offering coverage through the Infirmary Health provider network in Baldwin, Mobile, and surrounding counties.
• Small Group Plans Health insurance plans for small businesses with 2-50 employees, offering affordable coverage with benefits such as urgent care, preventive services, and access to Teladoc telehealth.
• Large Group Plans Health insurance plans for large employers with 51+ employees, featuring low PCP copays, vision care, preventive services, worldwide emergency coverage, and Teladoc telehealth access.
• Viva Rx Specialized pharmacy benefit management program designed to control pharmacy costs and manage drug trends for employer groups, including specialty medication management.

Quantifiable outcome

• Over 100,000 members served across commercial and Medicare plans
• +3 more outcomes

Named customers9 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration9 records

Feature4 records

Partnerships

Nine partnerships are on record, tiered core and standard.

• UAB Health SystemcoreStrategic or Co-development PartnerViva Health is an affiliate of the University of Alabama at Birmingham Health System. This affiliation provides access to UAB, a world leader in tertiary and quaternary care, and enables Viva Health to leverage UAB's clinical expertise and reputation. The relationship provides mutual benefits: Viva Health supports UAB's mission while gaining access to top-tier hospital services for members.
• TeladoccoreTechnology or IntegrationTeladoc provides 24/7 telehealth services for Viva Health commercial members. Members can consult board-certified doctors via phone or video for $45 per visit. Teladoc does not replace primary care physicians but provides convenient access for minor health issues when PCPs are unavailable.
• CVS CaremarkcoreTechnology or IntegrationCVS Caremark administers Medicare Part D prescription drug benefits for Viva Medicare members. Also manages the Medicare Prescription Payment Plan (MPPP) for spreading out-of-pocket drug costs over monthly payments. Handles enrollment billing and payment processing for the MPPP program.
• Express ScriptscoreTechnology or IntegrationExpress Scripts is the pharmacy benefit manager for Viva Health commercial members. Provides mobile app for drug coverage checks, cost determination, pharmacy location, home delivery enrollment, and safety checks. Members access services through Express Scripts website or mobile app.
• American Specialty Health (Silver&Fit)standardTechnology or IntegrationAmerican Specialty Health provides the Silver&Fit Healthy Aging and Exercise Program for Viva Medicare members. Includes access to thousands of fitness centers nationwide and home fitness options for members who prefer exercising at home.
• ModivcarestandardTechnology or IntegrationModivcare provides non-emergency medical transportation services for Viva Medicare Extra Value plan members. Offers mobile app for booking rides to medical appointments. Helps ensure members can access healthcare services despite transportation barriers.
• Huntsville Hospital NetworkcoreTechnology or IntegrationProvider network partner within Viva Medicare, offering Huntsville-area hospital and physician services to Medicare members. Part of the provider system model where members select a PCP associated with this network.
• Infirmary HealthcoreTechnology or IntegrationProvider network partner offering the Infirmary Health Advantage plan option through Viva Medicare. Provides Mobile-area hospital and physician services. Infirmary Health members have access to the entire Viva Health network for urgent care and DME.
• RMC Health SystemstandardTechnology or IntegrationProvider network partner within Viva Health commercial network serving Anniston and surrounding east Alabama areas. Offers RMC Network tier options for employer group members.

Scale indicators4 records

Recent moves1 record

Expansion highlights3 records

Direct peers

• Blue Cross and Blue Shield of Alabama: Dominant Alabama-based health insurer offering commercial group plans and Medicare Advantage products. Direct competitor in the same Alabama market across both commercial and MA segments, with comparable scale and provider network depth.

Broad incumbents

• Humana: One of the largest U.S. Medicare Advantage insurers with significant Alabama MA presence. Competes with Viva Medicare for the same Medicare beneficiaries, with a broader national footprint and larger product portfolio including PPO options.
• UnitedHealthcare: Largest U.S. health insurer with broad Medicare Advantage, commercial group, and dual-eligible SNP offerings. Operates in Alabama across all of Viva Health's segments, with superior scale, marketing budgets, and product breadth.
• Aetna (CVS Health): National health insurer offering Medicare Advantage, commercial group, and integrated pharmacy benefits (linked to CVS Caremark, which is also Viva Health's Medicare PBM partner). Direct competitor across MA and commercial segments.
• Cigna: National health insurer with commercial group and Medicare Advantage offerings, including Evernorth PBM services. Competes for the same Alabama employer groups and increasingly for MA members via Cigna Healthcare.
• Centene: Major managed care company with strong Medicaid and dual-eligible SNP focus. Competes with Viva Medicare in the dual-eligible SNP segment in Alabama and across state Medicaid managed care markets.
• Elevance Health (Anthem Blue Cross Blue Shield): Major national Blues-affiliated insurer with significant Medicare Advantage and commercial group business. Competes for Alabama employer groups and Medicare beneficiaries, with broader geographic diversification and product set.

Emerging players

• Molina Healthcare: Managed care company focused on government-sponsored programs including Medicaid and dual-eligible SNP plans. Comparable to Viva Health in dual-eligible member focus and reliance on government capitation revenue.
• Alignment Healthcare: Tech-enabled Medicare Advantage insurer focused on senior care coordination and SNP products. Comparable to Viva Medicare in MA-only focus and dual-eligible member targeting, though operating in different geographies.
• Clover Health: Medicare Advantage insurer focused on primary care-driven care models for seniors. Comparable to Viva Health in MA focus and senior care orientation, though Clover is more technology-platform-centric.

Market position

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/VIVAHealth

Compliance7 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Subsidiaries1 record

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 VIVA HEALTH