Health Plans
Health Plans, Inc. is a national Third Party Administrator of self-funded health and benefit plans, serving employers, municipalities, and Taft-Hartley plans nationwide. Founded in 1981 and operating as a Harvard Pilgrim Health Care subsidiary since 2005, it delivers plan administration, population health management, and reference-based pricing.
- Company typePrivate
- Founded1981
- HeadquartersWestborough, United States
- Headcount501–1,000
- GTM typeB2B
- OfferingServices
What Health Plans does
Health Plans, Inc. (HPI) is a national Third Party Administrator (TPA) of self-funded health and benefit plans, headquartered in Westborough, Massachusetts, and a wholly-owned subsidiary of Harvard Pilgrim Health Care since 2005. Founded in 1981, HPI administers customized self-funded plans for employers of all sizes, municipalities, Taft-Hartley plans, and benefits brokers nationwide, leveraging Harvard Pilgrim's provider network alongside partnerships with UnitedHealthcare, Cigna, MedCost, PHCS, Multiplan, First Choice Health, and other regional networks. The company reports a 96% client retention rate and holds URAC accreditation (HUM010042) for health plan administration.
HPI's technology stack centers on proprietary administrative platforms — the eligibility and claims portal infrastructure migrated from WEBeci to MESA, and the AchieveHealth population health management program that applies predictive analytics for risk stratification and care-gap identification across employee populations. The product surface is structured as a platform-plus-modules architecture: a core self-funded administration capability plus specialized plan design modules (Consumer-Driven Health Plans using FSAs/HSAs/HRAs, Level-Funded Health Plans, Reference-Based Pricing, and Specialized Plan Designs) and stakeholder-specific portals (My Plan for members, Employer Portal, Broker Online Reporting, Provider Portal, and a Referral Portal used by Massachusetts PCPs for Boston Medical Center and BMC HealthNet patients).
HPI's revenue model combines administrative-services fees (managed services) charged to employers for claims processing, benefit administration, and enrollment management with recurring revenue from level-funded plan administration. Pricing is quote-based and varies by employer census, claims history, plan design, and network requirements, with no publicly disclosed fee schedule. Go-to-market is sales-led through direct employer outreach and benefits broker partnerships, supported by sales offices in Westborough, MA and Woburn, MA serving CT, NH, and ME, and a Portland, ME office. The company has executed five acquisitions — BPM (2006), MedWatch (2014), TrestleTree (2015), Employers Health Network (July 2022), and MedCost (July 2025) — alongside a 2015 PBM partnership with Southern Scripts, signaling an active inorganic expansion strategy that culminates in a June 2026 leadership transition with Tim O'Brien's appointment as President.
Health Plans firmographics
Firmographics- Name
- Health Plans
- Legal name
- Health Plans, Inc.
- Website
- https://healthplansinc.com
- Company type
- Private
- Founded year
- 1981
- Operating status
- Operating
- Headcount range
- 501–1,000 employees
- Short description
- Health Plans, Inc. is a national Third Party Administrator of self-funded health and benefit plans, serving employers, municipalities, and Taft-Hartley plans nationwide. Founded in 1981 and operating as a Harvard Pilgrim Health Care subsidiary since 2005, it delivers plan administration, population health management, and reference-based pricing.
- Ownership category
- akta.pro rank
Health Plans industry classification
Industry- Product category
- Third Party Administration (TPA) / Health Benefits Administration
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120)
- SIC
- Accident & Health Insurance (6321), Insurance Agents, Brokers & Service (6411)
- akta.pro primary industry
- Self-Funded Employer Plan TPA (ASO Administration) (HLAEALAA)
- akta.pro secondary industry
- Care Management & Population Health Program Administration (HLAEALAG)
Keywords
Where Health Plans is headquartered
LocationHeadquarters
- HQ city
- Westborough
- HQ country
- United States
- HQ region
- North America
Offices3 records
Markets served
Health Plans business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales
Revenue model
- TPA Administrative Services: Health Plans Inc. generates revenue as a Third Party Administrator by providing administrative services for self-funded health plans. Revenue comes from administrative fees charged to employers for claims processing, benefit administration, enrollment management, and other TPA services.
- Level-Funded Health Plans: The company offers level-funded plans providing predictable costs while limiting financial liability per member, generating revenue through the administration of these plans.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Other | Annual | Customized self-funded health plan solutions tailored to employer needs |
Go-to-market motion1 record
Distribution channels3 records
Marketing channels5 records
Health Plans product offering
Product offeringCore offering
Health Plans, Inc. (HPI) is a national Third Party Administrator (TPA) of self-funded health and benefit plans serving employers, municipalities, and Taft-Hartley plans. The company administers customized health plan designs, processes claims, manages enrollment, and delivers population health management through its AchieveHealth program, providing access to multiple national and regional provider networks.
Product overview
Health Plans, Inc. (HPI) is a national Third Party Administrator (TPA) of self-funded health and benefit plans. The company operates a platform-plus-modules architecture, offering its core HPI | Self-Funded Health Plans administration service complemented by specialized plan design modules (Consumer-Driven Health Plans, Level-Funded Health Plans, Reference-Based Pricing, Specialized Plan Designs), population health management through AchieveHealth, and multiple stakeholder portals (Member Portal/My Plan, Employer Portal, Broker Online Reporting, Provider Portal, Referral Portal). The company also provides access to national and regional provider networks. HPI serves employers, municipalities, and Taft-Hartley plans nationwide, functioning as a Harvard Pilgrim company since its 2005 acquisition.
Differentiator
Problem solved
Functional benefit
Brands
- AchieveHealth: Population health and risk management program providing 360-degree monitoring of populations to identify, prioritize and impact leading drivers of healthcare spend through lifestyle coaching, condition/case management, and utilization management.
Quantifiable outcome
- 96% client retention rate demonstrating high customer satisfaction
- +1 more outcomes
Companies that use Health Plans
Customer profileNamed customers1 record
Segments4 records
Ideal customer profiles3 records
Health Plans technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature3 records
Health Plans partnerships and signals
Strategic signalPartnerships
Seven partnerships are on record, tiered core, major and supporting.
- MedCostcoreHPI announced acquisition of MedCost in July 2025, expanding market reach and enhancing network capabilities in the Southeast. MedCost PPO network provides provider resources for HPI members.
- Employers Health Network (EHN)coreHPI acquired EHN in July 2022, having partnered since 2015 in offering FL and SC employers an alternative, best-in-class health benefit plan solution through greater healthcare cost control and transparency.
- Southern ScriptsmajorStrategic partnership with Pharmacy Benefit Manager Southern Scripts of Louisiana to offer fully integrated, customizable plan options for FL and SC employers.
- TrestleTreesupportingTrestleTree, an innovative lifestyle coaching company based in Arkansas, joined the Harvard Pilgrim family to provide proactive health risk management.
- MedWatchsupportingMedWatch, a health management company based in Florida, was welcomed into the Harvard Pilgrim family of companies, enabling HPI to offer employers additional risk management tools.
- Benefit Plan Management (BPM)supportingHPI acquired the assets of BPM, a Norwell, Massachusetts-based TPA, strengthening commitment to the self-insured community.
- Harvard Pilgrim Health CarecoreIn 2005, HPI was acquired by Harvard Pilgrim Health Care to merge the flexibility and affordability of a TPA with the power of Harvard Pilgrim's extensive provider network. HPI is now part of the Harvard Pilgrim family of companies and is a Harvard Pilgrim company.
Scale indicators3 records
Recent moves12 records
Expansion highlights5 records
Health Plans competitors and assessment
Company assessmentDirect peers
- EBMS (Employee Benefit Management Services): EBMS is a third-party administrator providing self-funded health plan administration, claims processing, and population health for employers nationwide. Directly comparable to HPI in TPA services, plan design flexibility, and broker-led GTM.
- Surency: Surency is a TPA administering self-funded health, FSA, HRA, and COBRA benefits for employers. Comparable to HPI's self-funded employer administration, consumer-driven plan design expertise, and broker channel distribution.
- CoreSource: CoreSource (part of Trustmark Companies) is a TPA providing administrative services for self-funded employer health plans, including claims, utilization management, and population health — directly overlapping HPI's core service portfolio.
- Imagine360: Imagine360 is a TPA specializing in reference-based pricing and self-funded health plans for mid-market and large employers. Directly comparable to HPI's reference-based pricing expertise and self-funded employer focus.
- Meritain Health: Meritain Health is Aetna's (CVS Health) TPA arm, administering self-funded health plans for employers nationwide. A direct competitor to HPI with similar self-funded employer focus, network breadth, and broker channel distribution.
- HealthScope Benefits: HealthScope Benefits is a national TPA administering self-funded health plans, level-funded plans, and reference-based pricing for employers. Closely matches HPI's self-funded plan design portfolio and broker distribution model.
- Allied Benefit Systems: Allied Benefit Systems is an independent TPA administering self-funded health, dental, and other benefit plans for employers, with strong broker relationships. Comparable to HPI in self-funded employer administration and broker-led distribution.
- UMR: UMR is UnitedHealthcare's third-party administrator and the largest TPA in the U.S., serving self-funded employer plans of all sizes. Directly comparable to HPI in core claims administration, network access, and self-funded employer segment.
- Lucent Health: Lucent Health is a TPA providing self-funded health plan administration, care management, and population health services to mid-market and large employers. Comparable to HPI in self-funded administration, care management, and broker channel.
Broad incumbents
- AmWINS Group Benefits: AmWINS Group Benefits operates as part of AmWINS, a large insurance wholesale/distribution group with TPA capabilities. A broader incumbent with overlapping self-funded employer administration and broker distribution; competes for similar accounts.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
Health Plans social profiles
Digital presenceHealth Plans compliance and trust
Trust signalCompliance1 record
Health Plans financial estimates
Financial estimateRevenue estimate
Valuation estimate
Health Plans leadership team
Management profileNumber of profiles
Profiles1 record
Health Plans subsidiaries and ownership
Company hierarchySubsidiaries1 record
Health Plans funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Health Plans M&A and investment
M&A and investmentM&A1 record
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Health Plans
What does Health Plans do?
Health Plans, Inc. (HPI) is a national Third Party Administrator (TPA) of self-funded health and benefit plans serving employers, municipalities, and Taft-Hartley plans. The company administers customized health plan designs, processes claims, manages enrollment, and delivers population health management through its AchieveHealth program, providing access to multiple national and regional provider networks.
Is Health Plans a public or private company?
Health Plans is a private company. It is classified as corporate owned and is currently operating.
When was Health Plans founded?
Health Plans was founded in 1981. It employs 501 to 1,000 people.
Where is Health Plans based?
Health Plans is headquartered in Westborough, United States, in the North America region.
How does Health Plans make money?
Two revenue lines are on record. TPA Administrative Services are the primary driver. The others are level-Funded Health Plans.
Who are Health Plans's main competitors?
Direct peers on record are EBMS (Employee Benefit Management Services), Surency, CoreSource, Imagine360, Meritain Health, HealthScope Benefits, Allied Benefit Systems, UMR and Lucent Health. AmWINS Group Benefits is listed as a broad incumbent.
Does Health Plans have an API?
No public API is recorded for Health Plans.
What industry is Health Plans in?
Health Plans's product category is Third Party Administration (TPA) / Health Benefits Administration. Its primary akta.pro industry code is HLAEALAA, Self-Funded Employer Plan TPA (ASO Administration), with a secondary code of HLAEALAG, Care Management & Population Health Program Administration. Its NAICS code is 524292 and its SIC code is 6321.