Preferred Health Plan Of The Carolinas
Preferred Health Plan of the Carolinas is a privately held third-party administrator (TPA) based in Matthews, NC, that administers self-funded health benefit plans for employers and their employees across the Carolinas region.
- Company typePrivate
- Founded2008
- HeadquartersMatthews, United States
- Headcount1–10
- GTM typeB2B
- OfferingServices
What Preferred Health Plan Of The Carolinas does
Preferred Health Plan of the Carolinas (PHP) is a privately held third-party administrator (TPA) headquartered in Matthews, North Carolina, that administers self-funded health benefit plans on behalf of employers and their employees, primarily in the Carolinas region but with national provider network reach. The company has operated since 2008 and functions as a regional, owner-operated TPA serving the self-funded employer market, with services spanning claims administration, medical management, PPO network access, eligibility review, COBRA/HIPAA compliance, and stop-loss coordination.
PHP's core product is its TPA services platform, augmented by an add-on module suite that includes FSA and HRA administration, COBRA administration, pharmacy benefit management, telemedicine, direct primary care, diagnostic imaging, bundled surgical services, second opinions, surgery navigation, and DME/home infusion services. Underlying technology is largely third-party-integrated rather than proprietary: the VBA Gateway portal handles member/employer/provider self-service; the Medxoom mobile app provides member access; the Alegeus platform powers the FSA/HRA & ACP benefit card; and MedWatch delivers medical management review and case management. The company's flagship commercial offering, "The Power of Zero," bundles Direct Primary Care, Telemedicine, MRI/PET/CT imaging, bundled surgery, and second opinions into zero-cost-access benefits for plan members, differentiated by partner-provided pricing rather than internally built technology.
PHP makes money through recurring subscription/PEPM-style administration fees paid by employer plan sponsors for TPA services, FSA/HRA/COBRA administration, and ancillary modules. Go-to-market is sales-led: direct employer outreach via a toll-free sales line (866.636.0239) and website inquiry forms, supported by a digital presence on Facebook, LinkedIn, and an email newsletter. Pricing is opaque (quote-based, not publicly disclosed), and no customer logos or revenue figures are publicly available. The firm's 1-10 employee headcount, 15+ year operating history, and absence of any disclosed funding rounds, institutional investors, or M&A activity indicate a stable, privately controlled regional operator rather than a venture-backed growth entity.
Preferred Health Plan Of The Carolinas firmographics
Firmographics- Name
- Preferred Health Plan Of The Carolinas
- Legal name
- Preferred Health Plan of the Carolinas
- Website
- https://phpcarolinas.com
- Company type
- Private
- Founded year
- 2008
- Operating status
- Operating
- Headcount range
- 1–10 employees
- Short description
- Preferred Health Plan of the Carolinas is a privately held third-party administrator (TPA) based in Matthews, NC, that administers self-funded health benefit plans for employers and their employees across the Carolinas region.
- Ownership category
- akta.pro rank
Preferred Health Plan Of The Carolinas industry classification
Industry- Product category
- Health Plan Administration Services (Third-Party Administration)
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)
- akta.pro primary industry
- Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing) (FSAIAGAI)
Keywords
Where Preferred Health Plan Of The Carolinas is headquartered
LocationHeadquarters
- HQ city
- Matthews
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Preferred Health Plan Of The Carolinas business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- TPA Administration Services: Third-party administration fees for managing self-funded health plans including claims administration, medical management, PPO network access, eligibility review, coordination of benefits, claim audits, HIPAA administration, COBRA administration, and stop-loss coordination.
- HRA Administration: Health Reimbursement Arrangement administration with employer-funded accounts for employee medical expense reimbursement.
- FSA Administration: Flexible Spending Account administration allowing pre-tax health care expense management.
- COBRA Administration: Federal COBRA compliance administration services for continuation of health coverage to former employees.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Usage-based | Pay-as-you-go | Teladoc telemedicine consultations at $38 per consult |
| Subscription | Monthly | Direct Primary Care membership approximately $80 per month |
Go-to-market motion2 records
Distribution channels3 records
Marketing channels5 records
Preferred Health Plan Of The Carolinas product offering
Product offeringCore offering
Preferred Health Plan of the Carolinas (PHP) is a third-party administrator (TPA) that enables employers to sponsor their own self-funded health benefit plans. PHP provides comprehensive administration services including claims administration, medical management, PPO network access, eligibility and COBRA administration, FSA/HRA benefit management, and pharmacy benefits, delivered through an integrated technology platform (VBA Gateway portal, Medxoom mobile app, Alegeus benefit card).
Product overview
Preferred Health Plan of the Carolinas is a third-party administrator (TPA) for self-funded health plans offering a comprehensive portfolio of health care administration services. The core platform consists of TPA Services providing claims administration, medical management, PPO network access, and compliance services. This core is augmented by integrated add-on modules including Pharmacy (via Prime Therapeutics, Script Care, and Drexi), Telemedicine (via Teladoc), Direct Primary Care, Diagnostic Imaging (via KIS Imaging), Bundled Surgical Services (via Rubicon Health Group), Second Opinions (via Pinnacle Care), and Goldfinch Health for surgery navigation. Additional administrative tools include FSA, HRA, and COBRA Administration. Member access is provided through VBA Gateway online portal and Medxoom mobile app, while employers can access benefit management through Alegeus-powered FSA/HRA benefit cards.
Differentiator
Problem solved
Functional benefit
Products and services
- TPA Services Third-party administration services enabling companies to sponsor their own self-funded health plans, including claims administration, network access, eligibility review, and comprehensive plan management reporting.
- Traditional Self-Funding Self-funded health plan option allowing employers to take control of their health coverage with customizable benefits administration.
- FSA Administration Flexible Spending Account allowing employees to pay for eligible health care expenses with pre-tax income, including copays, deductibles, prescription drugs, and certain over-the-counter products.
- HRA Administration Health Reimbursement Account funded solely by the employer to reimburse employees for eligible medical expenses on a non-taxable basis, with options for unused fund roll-over to subsequent plan years.
- COBRA Administration Complete COBRA administration system handling all federal requirements including timely notification, premium payment tracking, termination notices, and compliance reporting.
- Pharmacy Benefits Management Pharmacy benefit management through Prime Therapeutics, Script Care, and Drexi, providing prescription pricing transparency and cost-efficient pharmacy solutions.
- PPO Network Access Access to PPO networks including Medcost, Zelis, First Health Cofinity, and Health Link, providing nationwide networks of physicians, specialists, hospitals, and ancillary providers.
- Medical Management MedWatch Medical Management services including medical necessity determinations, utilization review, and case management to promote evidence-based medicine and cost-effective care delivery.
- Telemedicine (Teladoc) Teladoc telehealth services providing 24/7/365 access to board-certified physicians with average 22-minute response time and $38 per consult.
- Direct Primary Care Direct Primary Care model providing unlimited primary care services at no cost with flat monthly membership fees, covering chronic condition management, urgent care, wellness services, and procedures.
- Bundled Surgical Services Rubicon Health Group bundled surgical services offering significant discounts for common outpatient surgeries including surgeon, facility, anesthesiologist, and pathologist fees.
- Second Opinion Services Pinnacle Care second opinion services providing access to over 50,000 top medical experts to confirm or refute diagnoses and treatment plans.
- Diagnostic Imaging KIS Imaging diagnostic imaging services offering up to 50% savings on MRI, CT, and PET scans with national concierge scheduling.
- Goldfinch Health Surgery Navigation Surgery navigation and recovery services providing personal nurse navigators to help with surgical planning, pain management, and recovery support.
- HOMELINK DME and Home Infusion DME supplies and home infusion services through a network of over 17,800 credentialed providers, offering significant cost savings compared to hospital-based care.
Quantifiable outcome
- Up to 50% savings on advanced radiology procedures like MRI, CT and PET Scans
- +7 more outcomes
Companies that use Preferred Health Plan Of The Carolinas
Customer profileSegments2 records
Ideal customer profiles2 records
Preferred Health Plan Of The Carolinas technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration12 records
Feature8 records
Preferred Health Plan Of The Carolinas partnerships and signals
Strategic signalPartnerships
17 partnerships are on record, tiered minor and core.
- The Spokes GroupminorCommunity partnership supporting The Spokes Group, a non-profit that provides bicycles and helmets to youngsters in depressed communities around Charlotte. PHP supports their efforts and encourages others to participate.
- MedWatch Medical ManagementcoreMedWatch provides medical management services including medical necessity determinations, utilization review services, and case management. Their physician-directed team of registered nurses evaluates medical necessity and promotes evidence-based medicine delivery.
- MedcostcorePPO network provider offering access to networks of physicians, specialists, hospitals, and ancillary providers for self-funded plan members.
- ZeliscorePPO network provider offering healthcare network access for cost-effective care delivery.
- First Health CofinitycorePPO network provider offering nationwide provider network access for self-funded plans.
- Health LinkcorePPO network provider offering additional network options for comprehensive provider coverage.
- Prime TherapeuticscorePharmacy solutions partner delivering savings, simplicity and support. Prime is a transparent pharmacy solutions partner with over 7,000 dedicated employees serving millions nationwide.
- Script CarecoreIndependent Pharmacy Benefits Manager founded in 1989, headquartered in Beaumont, TX. Known for outstanding customer service and innovative plan design providing genuine prescription savings.
- KIS Imaging (Pinnacle)coreDiagnostic imaging network providing up to 50% savings on MRI, CT and PET scans. National concierge service with multilingual staff for provider selection and appointment scheduling.
- Pinnacle CarecoreSecond opinion services provider with network of over 50,000 top medical experts. Helps patients get correct diagnoses and appropriate treatment, addressing misdiagnosis which affects 33% of cases.
- TeladoccoreTelehealth provider offering 24/7/365 access to quality care. Largest physician network in telehealth with 22-minute average response time and $38/consult cost, treating conditions like sore throat, UTIs, and respiratory infections.
- Goldfinch HealthcoreSurgery decision support providing personal nurse navigators to help employees make better surgical decisions. Claims surgical gameplans shorten recovery by 30 days on average and reduce opioid dependency.
- HOMELINKcoreDME supplies provider with over 17,800 credentialed providers and manufacturers. Also provides home infusions and nursing services at significant cost savings vs hospital settings.
- Rubicon Health GroupcoreBundled surgical services provider offering significant discounts for common outpatient surgeries with little or no out-of-pocket costs. Includes surgeon, facility, anesthesiologist, and pathologist in bundled pricing.
- AlegeuscoreFSA/HRA & ACP benefit card platform providing consolidated benefits tracking in one convenient location.
- MedxoomcoreMobile app platform providing all benefits in one place with mobile accessibility for members.
- VBA GatewaycoreTechnology platform providing online portal access for members, employers, and providers to manage accounts and benefits.
Scale indicators4 records
Recent moves6 records
Expansion highlights3 records
Preferred Health Plan Of The Carolinas competitors and assessment
Company assessmentBroad incumbents
- UMR: UnitedHealth Group's third-party administrator and the largest TPA in the U.S., serving self-funded employer health plans with claims administration, PPO network access, and integrated stop-loss. Directly comparable to PHP's core TPA offering but at vastly greater scale and backed by UnitedHealthcare's network infrastructure.
- CoreSource: Cigna/Evernorth's TPA subsidiary administering self-funded employer health, disability, and absence plans. Comparable to PHP in offering TPA services for self-funded plans, but with parent-company integration into broader Cigna healthcare ecosystem.
- Meritain Health: Aetna/CVS-owned TPA providing administration of self-funded health plans, pharmacy, and population health management. Offers the same suite of services PHP provides but as part of a national, vertically integrated benefits platform.
Direct peers
- Imagine360: Self-funded health plan administrator leveraging reference-based pricing and direct provider contracting to reduce employer health spend. Competes with PHP for self-funded employers seeking differentiated cost-containment strategies.
- HealthScope Benefits: Independent TPA providing customized third-party administration for self-funded employer health plans, including claims processing, medical management, and PPO network access. Highly comparable mid-size independent TPA competitor.
- Lucent Health: PE-backed TPA platform administering self-funded health plans for employers across the U.S. Offers comparable core TPA capabilities and represents a similar private-equity-style growth trajectory for self-funded administration.
- Trustmark Companies: Benefits provider offering third-party administration for self-funded plans alongside stop-loss insurance and ancillary benefits. Directly comparable to PHP's bundled TPA + ancillary services approach.
- Allied Benefit Systems: Independent TPA administering self-funded health benefit plans for employers, including claims, network access, and FSA/HRA/COBRA administration. Closely aligned with PHP's service model, scale, and target customer segment.
Regional players
- Crescent Health Solutions: Regional TPA operating in the Southeast U.S. providing third-party administration for self-funded employer plans. Geographic and service-line overlap with PHP's Carolinas-focused footprint, making it a direct regional competitor.
Emerging players
- Sana Benefits: Tech-enabled self-funded health plan administrator targeting small and mid-sized employers with a modern, member-centric platform. Comparable to PHP in serving self-funded employer needs, but with a newer technology-first approach that may pressure traditional TPAs.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat4 records
Key risks5 records
Key highlights6 records
Customer concentration
Preferred Health Plan Of The Carolinas social profiles
Digital presencePreferred Health Plan Of The Carolinas financial estimates
Financial estimateRevenue estimate
Valuation estimate
Preferred Health Plan Of The Carolinas leadership team
Management profileNumber of profiles
Preferred Health Plan Of The Carolinas funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Preferred Health Plan Of The Carolinas M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Preferred Health Plan Of The Carolinas
What does Preferred Health Plan Of The Carolinas do?
Preferred Health Plan of the Carolinas (PHP) is a third-party administrator (TPA) that enables employers to sponsor their own self-funded health benefit plans. PHP provides comprehensive administration services including claims administration, medical management, PPO network access, eligibility and COBRA administration, FSA/HRA benefit management, and pharmacy benefits, delivered through an integrated technology platform (VBA Gateway portal, Medxoom mobile app, Alegeus benefit card).
Is Preferred Health Plan Of The Carolinas a public or private company?
Preferred Health Plan Of The Carolinas is a private company. It is classified as unknown and is currently operating.
When was Preferred Health Plan Of The Carolinas founded?
Preferred Health Plan Of The Carolinas was founded in 2008. It employs 1 to 10 people.
Where is Preferred Health Plan Of The Carolinas based?
Preferred Health Plan Of The Carolinas is headquartered in Matthews, United States, in the North America region.
How does Preferred Health Plan Of The Carolinas make money?
Four revenue lines are on record. TPA Administration Services are the primary driver. The others are HRA Administration, FSA Administration and COBRA Administration.
Who are Preferred Health Plan Of The Carolinas's main competitors?
Broad incumbents on record are UMR, CoreSource and Meritain Health. Direct peers are Imagine360, HealthScope Benefits, Lucent Health, Trustmark Companies and Allied Benefit Systems. Crescent Health Solutions is listed as a regional player. Sana Benefits is listed as an emerging player.
Does Preferred Health Plan Of The Carolinas have an API?
No public API is recorded for Preferred Health Plan Of The Carolinas.
What industry is Preferred Health Plan Of The Carolinas in?
Preferred Health Plan Of The Carolinas's product category is Health Plan Administration Services (Third-Party Administration). Its primary akta.pro industry code is FSAIAGAI, Medicare Plan Administration & Third-Party Services (TPA/BPO, Enrollment, Billing). Its NAICS code is 524292 and its SIC code is 6324.