edHEALTH

What edHEALTH does

edHEALTH (Educators Health, LLC) is a member-owned, self-insured stop-loss captive insurance consortium serving U.S. educational institutions. Founded in 2012 and operational since July 2013, the organization operates as a program under edRISK, a sponsored captive domiciled in Vermont — a leading global captive insurance domicile. Member colleges, universities, charter schools, and independent schools pool risk through the Educators Health Insurance Exchange captive, selecting self-insured retention levels tailored to their risk tolerance and gaining access to a network of regional and national third-party administrators.

The core technology stack consists of three proprietary components: (1) the stop-loss captive structure enabling pooled risk financing and member selection of retention levels; (2) a claims data warehouse providing enhanced reporting, cost-driver analysis, and population health management insights; and (3) a pharmacy carve-out program that directly contracts with pharmacy benefits managers — delivering approximately $119M in member savings since 2017. Member schools also access ancillary programs including dental insurance (through partner carriers), diabetes management, an annual wellness walking challenge, and employee engagement communications. As of September 2025, edHEALTH has 29 member-owner institutions with annual funding exceeding $350 million and capital reserves above $20 million.

edHEALTH generates revenue through member premium contributions tied to plan design, claims experience, census data, and selected self-insured retention level; one-time capital contributions (required by Vermont regulation, retained as a member asset); and stop-loss premiums layered on top of member retention. Member schools avoid broker commissions and administrator profit margins, and share in captive surplus — $8.7M has been returned as dividends to date. Distribution is primarily direct enterprise sales to HR and finance leadership at prospective schools, supplemented by broker/advisor referral channels. In May 2023, edHEALTH became the first cell of the broader edRISK sponsored captive, which subsequently launched edLIABILITY and edPROPERTY programs in June 2024, extending the captive model into adjacent insurance lines.

Name

edHEALTH

Legal name

Educators Health, LLC

Website

https://educatorshealth.org

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

1–10 employees

Short description

edHEALTH is a member-owned, Vermont-domiciled stop-loss captive insurance consortium that helps U.S. educational institutions control employee healthcare costs through pooled self-insurance, pharmacy carve-out, and claims data analytics across 29 member schools.

Ownership category

akta.pro rank

Product category

Self-Insured Healthcare Captive Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Stop-Loss & Reinsurance Administration (Captive/Level-Funded Support) (HLAEALAB)

akta.pro secondary industry

Captive Insurance Advisory & Management (FSAEADAF)

Keywords

• Self-insured healthcare captive
• Medical stop-loss insurance
• Educational institution benefits
• Group health insurance consortium
• Pharmacy benefit management

Headquarters

HQ city

Northbridge

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, Supply Chain

Revenue model

1. Self-Insured Healthcare Premium Contributions: Member schools pay into the captive based on their plan design, claims experience, census data, and selected self-insured retention level. Annual funding exceeds $350 million.
2. Stop-Loss Insurance: Purchased excess protection from stop-loss insurers for claims exceeding member retention levels.
3. Administrative Fees: Low negotiated third-party administrator fees negotiated through group purchasing power.
4. Capital Contributions: New member schools make a capital contribution (required by Vermont), which remains an asset to the institution.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels5 records

Core offering

edHEALTH is a medical stop-loss captive insurance program and healthcare coalition for educational institutions in the United States. Member-owner schools participate in self-insured healthcare programs with group purchasing power for stop-loss coverage, pharmacy benefit management, third-party administration, and data-driven decision-making. The captive provides transparent pricing, customizable plan designs, and returns 100% of profits to member institutions through dividends.

Product overview

edHEALTH is a comprehensive healthcare solution platform for educational institutions, built around its core edHEALTH medical stop-loss captive and healthcare coalition. The platform operates as part of the edRISK sponsored captive, which also includes edLIABILITY and edPROPERTY cell programs launched in June 2024. Member schools access self-insured healthcare programs with customizable plan designs, third-party administrator options, and pharmacy benefit management. Additional offerings include dental insurance, diabetes management, wellness programs, and employee engagement tools, all designed to help educational institutions control healthcare costs while maintaining quality benefits.

Differentiator

Problem solved

Functional benefit

Brands

• edRISK: Sponsored captive that includes edHEALTH, edLIABILITY, and edPROPERTY programs for educational institutions.
• Educators Health Insurance Exchange

Products and services

• edHEALTH Self-Insured Healthcare Program A medical stop-loss captive insurance program providing self-insured healthcare solutions for educational institutions through group purchasing power, ownership structure, and data-driven programs. Members pay actual claims, stop-loss premiums, and group-negotiated administrative fees with no broker commissions or administrator profits included.
• edLIABILITY Liability insurance program offered through the edRISK sponsored captive, helping educational institutions control liability insurance costs.
• edPROPERTY Property insurance program offered through the edRISK sponsored captive, helping educational institutions control property insurance costs.
• Pharmacy Carve-Out Program Direct contracting program with pharmacy benefits managers for optimal choice and cost control on prescription drug benefits for member institutions. Has saved member institutions approximately $119 million since 2017.
• Dental Insurance Program Dental insurance program offered through a partner insurer providing robust plan designs with enhanced preventive benefits and provider choice for faculty and staff of member schools.
• Diabetes Management Program Program offering services to help employees with diabetes better manage their care, including wellness, lifestyle, nutrition, preventive health, and medication adherence support.
• Wellness at Work Annual four-week walking challenge program where member schools compete for trophies, with weekly prizes for step achievers.

Quantifiable outcome

• $257 million in total savings since inception
• +3 more outcomes

Named customers9 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

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 and minor.

• Spring Consulting GroupcoreImplementation/ SI/ Consulting PartnerActuarial and consulting partner providing financial projections, pricing analyses, reserve certifications, and reporting analytics. Works with member schools and brokers to develop rates and explain financial projections.
• Third Party Administrators (TPAs)coreChannel Partner/ Reseller/ DistributorRegional and national healthcare TPAs providing claims processing, provider network negotiation, and customer service. Schools select their own TPA from available options.
• Pharmacy Benefits ManagerscoreTechnology or IntegrationDirect contracting for pharmacy benefit management as part of the pharmacy carve-out program that has saved member institutions approximately $119M since 2017.
• edRISKcoreStrategic or Co-development PartnerParent sponsored captive domiciled in Vermont representing three distinct captive insurance programs: edHEALTH, edLIABILITY, and edPROPERTY. edRISK returns 100% of profits to member-owner schools.
• MAXIS GBNminorStrategic or Co-development PartnerDr. Leena Johns, Head of Health & Wellness at MAXIS GBN, provides thought leadership on wellness programs and healthcare data analytics through edHEALTH's Virtual Thought Leadership Series.
• New England Employee Benefits Council (NEEBC)minorChannel Partner/ Reseller/ DistributoredHEALTH participates in NEEBC programs to educate higher education institutions about captive arrangements and risk management solutions for healthcare cost control.
• Association for Collaborative Leadership (ACL)minorChannel Partner/ Reseller/ DistributoredHEALTH participates in ACL annual conferences to share strategies for member institutions navigating healthcare challenges.

Scale indicators9 records

Recent moves11 records

Expansion highlights5 records

Direct peers

• Schools Insurance Authority (SIA): A pooled insurance program for California school districts providing property/liability coverage through a Joint Powers Authority; comparable to edHEALTH as a member-owned education-focused risk pool, though edHEALTH is stop-loss/medical focused.
• United Educators (UE): A member-owned insurance company providing liability, property, and other coverages exclusively to educational institutions. Comparable to edHEALTH's edRISK umbrella for its education-only captive insurance model and member-governance structure.
• PEBTF (Public Education Employee Benefit Trust): A self-funded employee benefit trust for Pennsylvania public school employees offering health insurance pools. Comparable to edHEALTH's pooled self-insurance model for educational employer groups, though serving public K-12 vs higher ed.
• HealthPool of Kansas: A pooled health insurance program for Kansas public schools and government entities. Comparable self-insurance pool structure for educational employers, similar captive-like risk-sharing approach to edHEALTH.

Broad incumbents

• Captive Resources (Great American Insurance): One of the largest U.S. captive management firms offering group captive programs across multiple industries. Comparable to edHEALTH's captive infrastructure model but serves broader industries with larger scale.
• Marsh McLennan (Education Practice): Global insurance brokerage with a dedicated higher education practice advising colleges and universities on benefits and risk. Competes indirectly with edHEALTH via traditional broker-led placements.

Regional players

• Higher Education Institutions Trust (HEIT): Regional insurance pool serving higher education institutions with self-insured workers' comp and liability programs. Comparable education-only captive model but regional scope vs edHEALTH's national reach.
• Allied Benefit Systems: Third-party administrator providing self-funded health plans to mid-sized employers including educational institutions. Comparable TPA role within edHEALTH's network, particularly in Midwest markets.

Others

• Self-Insurance Institute of America (SIIA): Industry trade association promoting self-insurance/alternative risk transfer. Comparable ecosystem context for edHEALTH's captive model and a useful industry benchmark source.
• Vermont Captive Insurance Association: Industry association representing Vermont-domiciled captive insurers. edHEALTH's CEO chaired this body; useful as a regulatory ecosystem peer given Vermont's dominance as captive domicile.

Market position

Strengths3 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/educators-health
• Xx.com/educatorshealth

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 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 edHEALTH