Meritain Health Servicing

What Meritain Health Servicing does

Meritain Health is a national third-party administrator (TPA) for self-funded employer health benefit plans, founded in 1983 and operating today as a wholly-owned subsidiary of CVS Health (acquired through the 2018 CVS-Aetna transaction). It administers claims, benefits, and member services for more than 2,400 plan sponsors covering over 2 million members, processing 40+ million claims annually with 99%+ financial and procedural accuracy and a 95.6% turnaround within 10 business days. Its core technology stack combines a self-funded benefits administration platform with integrated pharmacy benefit management (Meritain Health Pharmacy Solutions / MPS and the CARE Program), payment integrity systems validated by an independent actuarial firm, and the next-generation Meritain Go member platform that layers digital tools, predictive analytics, and machine learning for member identification and outreach.

The platform is augmented by a curated point-solutions portfolio (Meritain Health OnPoint Solutions) that bundles partner offerings across telehealth (Teladoc), chronic care (Livongo), musculoskeletal (Hinge Health), reproductive and family health (Maven Clinic), virtual second opinions (2nd.MD), early cancer detection (GRAIL Galleri), skin cancer screening (SkinIO), and cost transparency (Healthcare Bluebook). Meritain differentiates on exclusive TPA access to the Aetna Choice POS II network — 1.6 million providers, 776,000+ doctors, 6,100+ hospitals, and 350,000+ behavioral health providers — which is unavailable to other standalone TPAs.

Meritain generates revenue primarily through TPA and administrative fees charged to self-funded employers, billed on a subscription/recurring basis with custom pricing tied to employee count, plan design, and selected services including claims administration, network access, pharmacy solutions, and wellness programs. Go-to-market combines direct enterprise field sales to self-funded employers with a broker-and-consultant channel, supplemented by distribution leverage from parent CVS Health and Aetna. Customer concentration is diversified across 2,400 plan sponsors, with a 93% average client retention rate and an NPS of 57 underscoring the relationship-driven, sticky nature of the book.

Name

Meritain Health Servicing

Legal name

Meritain Health

Website

https://meritain.com

Company type

Private

Founded year

1983

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Meritain Health is a national third-party administrator for self-funded employer health plans, administering claims, pharmacy, and member services for 2,400+ plan sponsors covering 2+ million members. It operates as a subsidiary of CVS Health, leveraging exclusive access to the Aetna Choice POS II network and a curated point-solutions portfolio.

Ownership category

akta.pro rank

Product category

Third Party Health Benefits Administration

NAICS

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

SIC

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

akta.pro primary industry

Self-Funded Employer Plan TPA (ASO Administration) (HLAEALAA)

akta.pro secondary industries

Flexible Benefits Administration (FSA/HSA/HRA) (HLAEALAK), Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ), Ancillary Benefits TPA (Dental/Vision/Life/Accident/Critical Illness) (HLAEALAN), Dental & Vision Third-Party Administration (TPA) (FSAIAHAL)

Keywords

• Third party administration
• Self-funded health benefits
• Pharmacy benefit management
• Health benefits administration
• Claims processing services

Headquarters

HQ city

Buffalo

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. Third Party Administrator Fees: TPA fees charged to self-funded employers for administering health benefit plans including claims processing, benefits administration, network access, and member services

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels8 records

Core offering

Meritain Health is a national third party administrator (TPA) that administers self-funded health benefit plans for employers. The company provides claims processing, benefits administration, network access through the Aetna Choice POS II network, pharmacy benefit management via its in-house Meritain Health Pharmacy Solutions (MPS) division, and member support services including the Meritain Go digital platform. It serves more than 2,400 plan sponsors and supports over 2 million members nationwide.

Product overview

Meritain Health is a national third party administrator (TPA) offering a platform-plus-modules architecture for self-funded employer health benefits. The core Meritain Health TPA provides claims administration, while interconnected modules include Pharmacy Solutions (MPS) with the CARE Program, Network Solutions (Aetna networks), Payment Integrity Services, and OnPoint Solutions for curated point solutions. Additional offerings encompass the Meritain Go digital member platform, Meritain Health Ready Data analytics, corporate wellness programs, and various funding approaches (traditional self-funding, captives, alternative health plans). The company operates as a subsidiary of Aetna and CVS Health, leveraging these parent company relationships for network access and pharmacy benefits while maintaining flexible, client-focused administration.

Differentiator

Problem solved

Functional benefit

Products and services

• Meritain Health TPA (Third Party Administration) Core self-funded health benefits administration service offering claims processing, benefits management, and member support for employer-sponsored health plans, for employers of all sizes seeking self-funded or level-funded alternatives to fixed-premium insurance.
• Meritain Health Pharmacy Solutions (MPS) In-house pharmacy benefits management including specialty drug management, patient advocacy, and formulary management offered through the CVS Health pharmacy network, for self-funded employer health plans.
• Network Solutions Provider network access including the Aetna Choice POS II national network with 1.6 million providers, 776,000+ doctors, 6,100+ hospitals, and 350,000+ behavioral health providers, for self-funded plan sponsors.
• Payment Integrity Services Multi-layered audit process for claims lifecycle savings identification, fraud/waste/abuse prevention, and independent actuarial-validated outcomes for self-funded employer health plans.
• Meritain Health OnPoint Solutions Curated point solutions portfolio combining various third-party health and wellness offerings under one unified experience for simplified benefits administration, for self-funded employer plans.
• Meritain Go Next-generation mobile-friendly digital member platform with personalized dashboard, benefits visibility, and streamlined care journey navigation, for members of self-funded employer health plans.
• Meritain Health Ready Data Analytics platform providing employers with streamlined data tools for plan performance optimization and informed decision-making on self-funded health benefits.
• Corporate Wellness Programs Population health management including wellness programs, EAP, musculoskeletal solutions, digital/telehealth options, and condition-specific programs for employer-sponsored health plans.
• Self-Funding Plans Flexible funding approaches including traditional self-funding, captive arrangements, navigation/advocacy solutions, and alternative health plans, for employers seeking alternatives to fixed-premium insurance.
• COBRA Administration COBRA continuation coverage administration for employers transitioning employees between health plans.
• Dental and Vision Plans Dental-only and vision-only plan options offered as supplemental health benefits for employer-sponsored plans.
• Aetna Vision Preferred Streamlined vision benefits administration through the Aetna Vision Preferred network powered by EyeMed, providing access to 235,000+ providers for self-funded employer plan sponsors.
• GRAIL Galleri Cancer Screening Galleri multi-cancer early detection test from GRAIL offered for early cancer screening as a point solution for self-funded employers.
• SimplePay Health Plan Alternative health plan offered in partnership with SimplePay Health and Aetna, designed to reduce annual spend and shift away from deductible-based designs, for self-funded employers.
• Teladoc Primary360 Teladoc Primary360 virtual primary care service providing members with convenient and flexible telehealth access for primary care needs.
• 2nd.MD Virtual Second Opinion Virtual second opinion service connecting members with expert medical specialists for complex health conditions.
• The Phia Group Fiduciary Support Fiduciary support services helping plan sponsors manage claim appeals and reduce financial risk exposure under self-funded health plans.

Quantifiable outcome

• Saves average of $14,000 per case through CARE Program specialty drug advocacy
• +5 more outcomes

Named customers3 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

Integration10 records

AI capability5 records

Feature5 records

Partnerships

17 partnerships are on record, tiered core, flagship and minor.

• CVS HealthcoreOthers · 1 January 2018Parent company relationship. CVS Health acquired Aetna in 2018, making Meritain Health part of the CVS Health family of companies. CVS Health is ranked sixth on the Fortune 500 and provides pharmacy network access, scale, and additional health care services integration.
• AetnacoreOthers · 1 January 2011Parent company relationship. Meritain Health joined Aetna in 2011 and now operates as a subsidiary of both Aetna and CVS Health, leveraging Aetna's provider networks and health care expertise.
• Aetna Choice POS II NetworkcoreTechnology or IntegrationMeritain Health is the only TPA able to offer access to the Aetna Choice POS II network, a national network with carrier-level discounts providing access to 1.6 million health care providers, 776,000+ doctors, 6,100+ hospitals, and 350,000+ behavioral health providers.
• EyeMedcoreTechnology or IntegrationAetna Vision Preferred network is powered by EyeMed, providing access to one of the nation's largest vision provider networks with 235,000+ providers including independent providers, popular retail locations, and online options.
• CVS Health Pharmacy NetworkcoreTechnology or IntegrationMeritain Health Pharmacy Solutions (MPS) offers market-leading pricing through its relationship with CVS Health, providing access to one of the country's largest pharmacy networks.
• Teladoc HealthflagshipTechnology or IntegrationMeritain Health offers Teladoc Primary360 virtual primary care services, providing members with convenient and flexible telehealth access for primary care needs.
• LivongocoreTechnology or IntegrationMeritain Health offers Livongo Whole Person Plus for chronic condition care, supporting members with diabetes and other chronic conditions through connected devices and coaching.
• Hinge HealthcoreTechnology or IntegrationMusculoskeletal (MSK) solution helping people move past pain through digital exercise therapy and coaching programs.
• Maven CliniccoreTechnology or IntegrationDigital reproductive and family health platform providing support for family building, pregnancy, parenting, and menopause.
• 2nd.MDcoreTechnology or IntegrationVirtual second opinion service connecting members with expert medical specialists for complex health conditions.
• GRAILflagshipTechnology or IntegrationGalleri multi-cancer early detection test from GRAIL offered for early cancer screening, addressing one of the most complex and costly health challenges facing employers.
• SkinIOcoreTechnology or IntegrationSkin cancer detection solution for early skin cancer detection through dermoscopic imaging and AI analysis.
• Healthcare BluebookcoreTechnology or IntegrationTransparency tool helping consumers make informed choices about health care while providing cost savings through quality-based provider recommendations.
• MinuteCliniccoreTechnology or IntegrationCVS MinuteClinic walk-in locations open seven days a week providing accessible, affordable care for minor illnesses and preventive services.
• CVS HealthHUBcoreTechnology or IntegrationCVS HealthHUB locations offering expanded health services including wellness programs, health screenings, and immunizations.
• The Phia GroupminorImplementation/ SI/ Consulting PartnerFiduciary support services helping plan sponsors manage claim appeals and reduce financial risk exposure.
• SimplePay HealthflagshipTechnology or IntegrationAlternative health plan offered in partnership with Aetna, powered by Meritain Health. A new kind of health plan designed to reduce annual spend and shift away from deductible-based designs.

Scale indicators13 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Benefitfocus: Benefitfocus provides a benefits administration platform used by carriers and employers for enrollment, billing, and benefits management — a direct technology peer to Meritain's TPA and Meritain Go platforms.
• Personify Health (formerly Virgin Pulse): Personify Health combines well-being, navigation, and benefits administration for employers — directly comparable to Meritain's wellness, advocacy, and self-funded plan administration offerings.
• HealthEquity: HealthEquity is a leading benefits administrator focused on HSAs, HRAs, FSAs, COBRA, and commuter benefits — directly overlapping with Meritain's flexible-benefits and self-funded administration capabilities for employers.
• MedBen: MedBen is a third-party administrator focused on self-funded employer health plans with medical management, pharmacy, and compliance services — a direct mid-market TPA peer to Meritain.
• Auxiant: Auxiant is a regional TPA administering self-funded health, dental, vision, and COBRA benefits — a direct competitor in the self-funded employer administration space, especially for mid-market plans.

Broad incumbents

• Elevance Health (Anthem): Elevance Health operates Anthem Blue Cross plans alongside Carelon services for health benefits administration, analytics, and care delivery — competing with Meritain in the self-funded and fully insured employer market.
• Optum (UnitedHealth Group): Optum is the largest U.S. health services and benefits platform, bundling claims administration, PBM, analytics, and care delivery — directly competing with Meritain for large self-funded employer accounts.
• ADP TotalSource: ADP's PEO and benefits administration business serves SMB and mid-market employers with bundled HR, payroll, and benefits — competing with Meritain for self-funded employer relationships, particularly through broker channels.
• Evernorth Health Services (Cigna): Evernorth is Cigna's health services platform combining PBM (Express Scripts), care delivery, and benefits administration — a vertically integrated incumbent comparable to the Aetna/CVS Health stack that backs Meritain.

Emerging players

• Paychex: Paychex provides HR, payroll, and benefits administration to SMB employers. Its benefits administration and PEO (Paychex Flex) increasingly overlap with Meritain's mid-market self-funded administration footprint.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat7 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/@meritain_health
• LinkedInlinkedin.com/company/meritain-health
• Instagraminstagram.com/meritainhealth
• Xx.com/meritainlaura
• Facebookfacebook.com/110799289005234

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries2 records

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 Meritain Health Servicing