CGS Health

What CGS Health does

CGS Health is a U.S. third-party administrator (TPA) that designs and administers self-funded group health benefit plans on behalf of small and midsize employers. Operating as a subsidiary of CGS Group alongside Litchfield Underwriters (stop-loss insurance) and CAPSLRx (pharmacy), the company offers an integrated platform spanning Qualified Plans (ACA-compliant major medical using the Cigna national PPO network), MEC-Enhanced and MEC-Traditional minimum essential coverage plans, and supporting services including pharmacy benefit management with access to 65,000+ pharmacies, medical stop-loss programs, 24/7 Teladoc telemedicine, and Rightway-powered member concierge navigation. The technology backbone is a purpose-built TPA platform handling plan design, eligibility verification, claims processing, and member self-service through the mycgshealth.com portal.

CGS Health's go-to-market is sales-led and broker-anchored: the company sells directly to employers and indirectly through a producer network that receives fixed per-employee-per-month distribution fees. Pricing is quote-based with monthly billing, and the value proposition rests on 15-25% average annual savings versus fully-insured plans, customized plan design, transparent billing, and turnkey implementation. Customers span SMB employers seeking alternatives to fully-insured coverage, insurance brokers selling group health plans, healthcare providers requiring eligibility and claims support, and union/Taft-Hartley funds.

In late 2025 CGS Health completed a significant growth inflection: it acquired Regional Care, Inc. assets (a Nebraska-based TPA) on December 1, 2025, and entered a strategic partnership with Carroll Street Capital, whose principals joined the board to fund organic growth and further M&A. The company maintains offices in Darien, Connecticut (headquarters), New York, NY, and Scottsbluff, Nebraska, and operates with 11-50 employees under the brand 'Superior Group Health Plans.'

Name

CGS Health

Legal name

CGS Health

Website

https://cgshealth.com

Company type

Private

Founded year

1974

Operating status

Operating

Headcount range

11–50 employees

Short description

CGS Health is a U.S. third-party administrator that designs and administers self-funded group health benefit plans for small and midsize employers, operating under CGS Group alongside stop-loss (Litchfield Underwriters) and PBM (CAPSLRx) units, distributing through brokers with claimed 15-25% savings versus fully-insured plans.

Ownership category

akta.pro rank

Product category

Third-Party Health Plan Administration

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

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

akta.pro primary industry

Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ)

akta.pro secondary industry

Care Management & Population Health Program Administration (HLAEALAG)

Keywords

• Self-funded health plans
• Third-party administration
• Group health benefits
• Medical stop-loss
• Pharmacy benefit management

Headquarters

HQ city

New York

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, Marketing or Sales, Infrastructure, Others

Revenue model

1. Third-Party Administration (TPA) Fees: CGS Health acts as a third-party administrator for self-funded employer health plans, earning fees for claims processing, plan administration, eligibility management, and related services.
2. Medical Stop-Loss Programs: CGS Health offers integrated medical stop-loss (reinsurance) programs to protect self-funded employers from catastrophic claims, generating revenue through reinsurance premiums.
3. Pharmacy Benefit Management (PBM): CGS Health provides access to pharmacy benefit managers for prescription coverage, passing pharmacy discounts back to clients either at point-of-sale or to their claims reserve account.
4. Producer Distribution Fees (PEPM): CGS Health pays producers (insurance brokers) a fixed per-employee-per-month (PEPM) distribution fee rather than a percentage of premium, generating revenue through the spread and administrative services.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

CGS Health is a third-party administrator (TPA) that designs, administers, and supports self-funded group health benefit plans for small and midsize employers, reporting 15-25% average annual savings versus fully-insured plans. Its integrated platform bundles plan design, eligibility/enrollment, claims processing, pharmacy benefit management, medical stop-loss, telemedicine via Teladoc, and member concierge navigation powered by Rightway, delivered to employers directly and through a producer/broker network.

Product overview

CGS Health is an independent third-party administrator delivering integrated, tech-enabled healthcare solutions for self-funded employers. The company offers a platform of self-funded group health plans centered on Qualified Plans (major medical ACA-compliant plans using Cigna PPO network), MEC-Enhanced plans, and MEC-Traditional plans. These core products are supported by integrated medical stop-loss programs, pharmacy benefit management with access to 65,000 pharmacies, telemedicine via Teladoc, member concierge services powered by Rightway, and a secure member portal (mycgshealth.com). The company recently expanded through the acquisition of Regional Care, Inc. and partners with brokers, providers, and employers to deliver flexible plan designs with reported 15% to 25% annual savings.

Differentiator

Problem solved

Functional benefit

Brands

• Litchfield Underwriters: Operating company under CGS Group focused on insurance and underwriting services
• CAPSLRx

Products and services

• Self-Funded Group Health Plans Customized self-funded health insurance plans for employers that pay employee claims directly rather than fixed premiums to insurance carriers, producing 15% to 25% average annual savings versus fully-insured plans.
• Qualified Plans (Major Medical) ACA-compliant major medical metallic plans (Bronze to Platinum) using Cigna's national PPO network of 860,000+ healthcare professionals and 6,200+ hospitals; available as PPO or EPO and HDHP/HSA options, with free 24x7 telemedicine by Teladoc.
• MEC-Enhanced Plans Enhanced minimum essential coverage combining preventative benefits with frequently utilized essential health benefits including PCP/SPC, diagnostics, advanced imaging, urgent care/ER access, free 24x7 Teladoc, and Tier 1-2 prescription coverage.
• MEC-Traditional Plans Traditional minimum essential coverage preventative benefits-only plans that help members avoid individual mandate penalties while counting toward carrier participation requirements, with free 24x7 Teladoc and an Rx discount card.
• Third-Party Administration Services Full-service third-party administration for self-funded health plans including claims processing, eligibility verification, enrollment, plan design, and customer support.
• Medical Stop-Loss Programs Integrated medical stop-loss insurance programs that protect self-funded employers from catastrophic claims, working with A-rated carriers to ensure predictable cash flow management.
• Pharmacy Benefit Management Access to nationally recognized pharmacy benefit managers providing prescription coverage through 65,000 pharmacies nationwide, with pharmacy discounts passed back to clients either at point-of-sale or to their claims reserve account.
• Telemedicine (Teladoc) Free 24/7 telemedicine service providing instant access to U.S. board-certified physicians for non-emergency medical issues including cold/flu, allergies, bronchitis, and prescriptions; embedded across all CGS Health plans (Major Medical, MEC, MEC-Enhanced) at no additional cost.
• Member Concierge Service Dedicated clinical navigator service powered by Rightway Healthcare that guides members through treatment options, prepares them for medical visits, provides billing support, and coordinates care across the healthcare continuum.
• Pre-Certification Services Prior authorization services for providers and members to obtain approval for services and prescriptions according to plan requirements.

Quantifiable outcome

• 15% to 25% average annual savings compared to fully-insured health plans
• +3 more outcomes

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature3 records

Partnerships

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

• Regional Care, Inc. (RCI)coreStrategic or Co-development Partner · 3 November 2025CGS Health announced a definitive agreement to acquire certain assets of Regional Care, Inc. (RCI), a third-party administrator owned by Regional West Health Services based in Scottsbluff, Nebraska. RCI brings over 30 years of regional expertise, local service relationships, and experienced personnel. Following the acquisition (closed December 1, 2025), RCI's Scottsbluff office serves as a key administrative hub for CGS Health in the Midwestern Mountain Region.
• Regional West Health ServicesmajorStrategic or Co-development Partner · 3 November 2025Parent company of Regional Care, Inc. (RCI). Ned Resch, President and CEO of Regional West Health Services, expressed confidence in CGS Health as an acquirer that recognizes RCI's potential and will ensure RCI continues to thrive and expand opportunities.
• Rightway HealthcarecoreTechnology or IntegrationCGS Health partners with Rightway Healthcare to power its Member Concierge service. Rightway provides a clinical navigator app and platform that gives CGS Health members dedicated healthcare navigators who guide them through treatment options, help schedule appointments, explain bills, and coordinate care across the healthcare continuum.
• TeladoccoreTechnology or IntegrationCGS Health partners with Teladoc to provide free 24/7 telemedicine access across all plan types (Major Medical, MEC, MEC-Enhanced). Teladoc provides instant access to U.S. board-certified physicians for non-emergency medical issues including cold/flu, allergies, bronchitis, and prescriptions. All CGS Health plans include Teladoc at no additional cost.
• CignacoreTechnology or IntegrationCGS Health partners with Cigna for the Cigna national PPO network, providing Major Medical plan members access to 860,000+ healthcare professionals and 6,200+ hospitals nationwide. Cigna network access is leased through Cigna Payer Solutions for CGS Health plan members.
• MultiPlan / PHCScoreTechnology or IntegrationCGS Health uses the MultiPlan/PHCS network for MEC and MEC-Enhanced plan members. PHCS network access is available for both Specific Services and Preventative Services Only tiers, providing a broad network of providers for minimum essential coverage plans.
• MedTrakRxsupportingTechnology or IntegrationCGS Health partners with MedTrakRx for specialty pharmacy services, providing prescription delivery right to members' doors and a best-in-class specialty pharmacy network for members requiring specialty medications.

Scale indicators5 records

Recent moves7 records

Expansion highlights6 records

Broad incumbents

• Brown & Brown: Brown & Brown is a publicly traded national insurance brokerage with growing employee benefits and TPA capabilities (including acquisitions such as TSS and RPS). Larger, more diversified incumbent that overlaps with CGS Health in the self-funded employer segment.
• USI Insurance Services: USI is one of the largest US insurance brokerage and consulting firms, with substantial employee benefits and self-funded plan administration practices. Competes with CGS Health across the mid-market employer segment, but operates as a much broader, multi-line incumbent.
• Lockton: Lockton is the world's largest independent insurance brokerage, with substantial employee benefits consulting and self-funded plan administration practices. Larger, broader incumbent competing for the same mid- and large-employer self-funded business as CGS Health.
• Hub International: Hub International is a large North American insurance brokerage that has aggressively consolidated TPAs (including the acquisition of Sequoia Benefit Services) to offer integrated self-funded administration. Broad incumbent competing for the same mid-market employer and broker relationships.

Emerging players

• Acrisure: Acrisure is a rapidly growing, PE-backed insurance brokerage and financial services roll-up that has built out significant employee benefits and TPA capabilities. Highly comparable to CGS Health in being a sponsor-backed consolidator pursuing organic growth and M&A in fragmented insurance services.

Direct peers

• Holmes Murphy & Associates: Holmes Murphy is an independent insurance brokerage and TPA serving mid- and large-employer groups, with self-funded plan administration, stop-loss, and benefits consulting practices. Direct peer in target segment, distribution approach, and product mix to CGS Health.
• Lucent Health: Lucent Health is a tech-enabled third-party administrator focused specifically on self-funded employer health plans, offering integrated medical, PBM, and stop-loss solutions. Highly comparable niche focus and product architecture to CGS Health's self-funded TPA model.
• HealthEZ: HealthEZ is an independent third-party administrator of self-funded health plans for employers, with integrated claims administration, PBM, and member engagement tools. Direct peer in self-funded TPA positioning, mid-market employer focus, and tech-enabled service delivery.
• OneDigital: OneDigital is one of the largest US insurance, financial services, and HR consulting firms focused on the mid- and large-employer market, with deep TPA and self-funded health plan administration capabilities. Highly comparable to CGS Health in target customer (mid-market employers), broker/producer-led distribution, and integrated medical/PBM/stop-loss stack.
• Alliant Insurance Services: Alliant is a specialty insurance brokerage and consulting firm with significant employee benefits and self-funded group health administration capabilities, including a TPA platform (through Alliant Health). Closely comparable in serving mid-market employers via broker channels with bundled benefits offerings.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/CGS_Health

Revenue estimate

Valuation estimate

Number of profiles

Profiles7 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 CGS Health