Health Plans

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.

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

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

• Third party administration
• Self-funded health plans
• Health benefit administration
• Population health management
• Claims processing services

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, Infrastructure, Marketing or Sales

Revenue model

1. 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.
2. 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

Go-to-market motion1 record

Distribution channels3 records

Marketing channels5 records

Core 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

Named customers1 record

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Seven partnerships are on record, tiered core, major and supporting.

• MedCostcoreStrategic or Co-development Partner · 1 July 2025HPI 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)coreStrategic or Co-development Partner · 1 July 2022HPI 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 or Co-development Partner · 1 January 2015Strategic partnership with Pharmacy Benefit Manager Southern Scripts of Louisiana to offer fully integrated, customizable plan options for FL and SC employers.
• TrestleTreesupportingStrategic or Co-development Partner · 1 January 2015TrestleTree, an innovative lifestyle coaching company based in Arkansas, joined the Harvard Pilgrim family to provide proactive health risk management.
• MedWatchsupportingStrategic or Co-development Partner · 1 January 2014MedWatch, 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)supportingStrategic or Co-development Partner · 1 January 2006HPI acquired the assets of BPM, a Norwell, Massachusetts-based TPA, strengthening commitment to the self-insured community.
• Harvard Pilgrim Health CarecoreStrategic or Co-development Partner · 1 January 2005In 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

Direct 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

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

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Subsidiaries1 record

Funding overview

Funding rounds

Investors

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 Health Plans