AultCare

What AultCare does

AultCare is a private, provider-sponsored health insurance company headquartered in Canton, Ohio, founded in 1984 and affiliated with the Aultman Health Foundation / Aultman Hospital system. The company administers health coverage for more than 430,000 members and processes over $850 million in claims annually with a reported 99.8% accuracy rate. Its product portfolio spans fully insured and self-funded employer group plans (including a MEWA distributed through the Canton Regional Chamber of Commerce for small businesses with 2–50 employees), Medicare Advantage (PrimeTime Health Plan, rated 4.5 stars by CMS) and Medicare Supplement (PrimeTime Choices) for individuals, and workers' compensation managed care and third-party administration through its AultComp MCO and AultComp TPA subsidiaries.

The underlying technology stack combines a claims processing infrastructure with Population Health Management (PHM) offices where on-site nurses coordinate care between members, PCPs, and the health plan; disease, case, and utilization management modules; and digital channels including an online member portal and a mobile app on iOS and Google Play. The company integrates third-party platforms for pharmacy benefits management (OptumRx), dental (DenteMax), vision (VSP), HSA/FSA administration (HealthEquity), cost estimation (IBM Watson Health), analytics (Milliman MedInsight), and remote monitoring/telehealth (AllHealth Choice, AultmanNow). NCQA accreditation covers both Commercial HMO and Commercial PPO product lines.

AultCare generates revenue primarily through health insurance premiums on fully insured employer and Medicare Advantage books, per-employee-per-month administration fees on self-funded employer plans and workers' compensation, pharmacy benefit management economics via OptumRx, and ancillary product commissions. Distribution is multi-channel: direct employer sales supported by an in-house sales team and online quoting through AultAssist.com, a broker portal for independent agents, the Canton Chamber MEWA channel for SMBs, and direct-to-consumer Medicare sales. The company employs 500+ people and reports 92% member retention versus an industry benchmark of 75%.

Name

AultCare

Legal name

AultCare Insurance Company

Website

https://aultcare.com

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

251–500 employees

Short description

AultCare is a provider-sponsored, Ohio-based health insurance company and third-party administrator affiliated with Aultman Hospital, serving 430,000+ members across employer group plans, Medicare Advantage and Supplement products, and workers' compensation administration.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Health Care and Social Assistance (62)

SIC

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

akta.pro primary industry

International / Expatriate Group Health Plans (FSAIAFAJ)

akta.pro secondary industry

Medicare Dental & Vision (MA Embedded & Supplemental) (FSAIAHAJ)

Keywords

• Health insurance plans
• Medicare Advantage plans
• Third party administration
• Employer-sponsored coverage
• Managed care services

Headquarters

HQ city

Canton

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Others

Revenue model

1. Health Insurance Premiums: AultCare generates primary revenue through health insurance premiums from employer-sponsored plans (self-funded and insured), Medicare Advantage (PrimeTime Health Plan), and Medicare Supplement (PrimeTime Choices) plans.
2. Third-Party Administration Services: AultComp TPA provides third-party administrator services for self-funded employer plans with low administrative costs in Ohio.
3. Pharmacy Benefits Management: Integrated pharmacy benefit management through OptumRx partnership, covering medical and pharmacy data integration for cost savings.
4. Workers' Compensation Services: AultComp MCO manages workers' compensation healthcare in Ohio, providing managed care organization services. AultComp TPA also provides third-party administration for workers' comp.
5. Ancillary Products: Additional revenue from dental (DenteMax network), vision (VSP), accidental death and dismemberment, short-term disability, long-term disability, and pet insurance products.

Pricing tiers

Go-to-market motion3 records

Distribution channels6 records

Marketing channels9 records

Core offering

AultCare is a provider-sponsored health insurance company that designs, underwrites, and administers employer-sponsored health plans (self-funded, insured, small-cap, and stop-loss), MEWA arrangements for small employer groups, and Medicare Advantage (PrimeTime Health Plan) and Medicare Supplement (PrimeTime Choices) plans. It complements these insurance products with third-party administration and managed care organization services for workers' compensation (AultComp TPA and AultComp MCO), population health management, integrated pharmacy benefits through OptumRx, dental and vision networks, and 24/7 telehealth through AultmanNow.

Product overview

AultCare is a regional health insurance company providing a comprehensive portfolio of health insurance products and healthcare management services. The core offering consists of employer-sponsored health insurance plans (self-funded, insured, MEWA) and Medicare plans (PrimeTime Health Plan Medicare Advantage and PrimeTime Choices Medigap supplements). These are supported by integrated care coordination modules including Population Health Management, Disease Management, Case Management, Utilization Management, and Wellness Programs. Additional products include dental (via DenteMax), vision (via VSP), pharmacy benefits management (via OptumRx), telehealth (AultmanNow), and workers' compensation services (AultComp MCO and TPA). The company also offers FSA, HRA, and HSA accounts through HealthEquity. All offerings are backed by NCQA accreditation for both HMO and PPO products.

Differentiator

Problem solved

Functional benefit

Products and services

• AultCare Employer Health Insurance Plans Comprehensive health insurance plans for employer groups spanning self-funded, fully insured, small-cap, and reinsurance/stop-loss options, including integrated pharmacy benefits, population health management, and care coordination services. Sold to Ohio-based small, mid-market, and large employer groups through direct sales, brokers, and MEWA channels.
• PrimeTime Health Plan (Medicare Advantage) Medicare Advantage Plan (Part C) approved by Medicare, offering $0 plan premium with prescription drug coverage, hearing aid benefits, vision, dental, gym memberships, and 24/7/365 telehealth access. Rated 4.5 stars by CMS. Sold directly to Medicare-eligible individuals in Ohio.
• PrimeTime Choices (Medicare Supplement) Medicare Supplement (Medigap) plan allowing members to see any physician who accepts Medicare patients without network restrictions or specialist referral requirements. Offers standardized plan options A, F, High Deductible F, G, High Deductible G, M, and N. Sold throughout the state of Ohio.
• MEWA Healthcare Coverage Multiple Employer Welfare Arrangement healthcare coverage administered by AultCare in partnership with the Canton Regional Chamber of Commerce, designed for small-group employers with 2-50 employees. Includes 16 plan options combining traditional copay and consumer-driven HSA-compatible health plans.
• AultmanNow Telehealth 24/7/365 nonemergency telehealth service providing virtual visits through smartphone, iPad/tablet, or computer, connecting members with Aultman providers for urgent care needs. Available to AultCare plan members across all product lines.
• AultComp MCO (Workers Compensation Managed Care) Managed Care Organization managing Ohio workers' compensation healthcare needs with local connections and provider relationships. Rated as the No. 1 MCO in Ohio for workers' compensation.
• AultComp TPA (Third Party Administration) Third Party Administrator providing administrative services for self-funded employer plans and workers compensation, offering some of the lowest administrative costs of any TPA in Ohio with local customer service.

Quantifiable outcome

• 92% member retention rate vs industry 75%
• +6 more outcomes

Named customers2 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

Integration11 records

AI capability5 records

Feature5 records

Partnerships

17 partnerships are on record, tiered core and minor.

• Alliance of Community Health Plans (ACHP)coreStrategic or Co-development Partner · 22 August 2017AultCare is a member of ACHP, which represents the nation's top-performing nonprofit health plans to improve affordability and outcomes in the healthcare system. ACHP member companies are provider-aligned health organizations providing high-quality coverage and care.
• Aultman HospitalcoreStrategic or Co-development PartnerAultCare is provider-sponsored with close relationship to Aultman Hospital. Aultman provides emergency, trauma, and telehealth services (AultmanNow) to AultCare members. Founded 40 years ago as affiliated organizations.
• Canton Regional Chamber of CommercecoreStrategic or Co-development PartnerCanton Regional Chamber of Commerce partnered with AultCare to administer MEWA (Multiple Employer Welfare Arrangement) benefits. The partnership supports small businesses by offering healthcare coverage through MEWA.
• OptumRxcoreTechnology or IntegrationAultCare partners with OptumRx for pharmacy benefits management. Works alongside prescribing physicians to ensure appropriate, cost-effective medications. OptumRx provides integrated medical, pharmacy, and clinical data for improved cost savings.
• DenteMaxcoreChannel Partner/ Reseller/ DistributorDenteMax is one of the largest leasable dental PPO networks in the United States. AultCare offers dental coverage through the DenteMax network.
• VSP Vision CarecoreChannel Partner/ Reseller/ DistributorVSP Vision Care provides vision benefits to AultCare members. VSP is the first and only national not-for-profit vision benefits company.
• HealthEquityminorChannel Partner/ Reseller/ DistributorHealthEquity is the healthcare industry's No. 1 Health Savings Account (HSA) Administrator. AultCare offers HSA-compatible plans through this partnership.
• CVS MinuteCliniccoreChannel Partner/ Reseller/ DistributorAll CVS MinuteClinics nationwide are in-network for AultCare members, providing convenient urgent care access for non-emergency situations.
• CignaminorChannel Partner/ Reseller/ DistributorCigna National Network Access available to AultCare members outside the AultCare network service area, providing extended network access.
• EnrollX (formerly NWGS)minorChannel Partner/ Reseller/ DistributorEnrollX brings ease to ancillary products enrollment for AultCare employer groups.
• CCS MedicalminorChannel Partner/ Reseller/ DistributorCCS Medical is one of the country's leading providers of home delivery medical supplies, offering a complete line of quality products for people with diabetes.
• PrimeTime Health PlancoreStrategic or Co-development PartnerAultCare-branded Medicare Advantage plan offering $0 plan premium with prescription drug coverage, rated 4.5 stars by CMS. Part of the AultCare family of Medicare products.
• PrimeTime ChoicescoreStrategic or Co-development PartnerAultCare-branded Medicare Supplement (Medigap) plan allowing members to see any physician who accepts Medicare. Offered throughout the state of Ohio.
• Hall of Fame VillageminorGTM or Marketing PartnerPartnership announced May 8, 2024. AultCare serves as a sponsor for Hall of Fame Village sports and entertainment destination.
• Gentry Health ServicesminorChannel Partner/ Reseller/ DistributorGentry Health Services Specialty Pharmacy provides specialty medications for AultCare members. Located in Avon Lake, OH.
• AultComp MCOcoreStrategic or Co-development PartnerAultComp MCO (Managed Care Organization) manages workers' compensation healthcare in Ohio with local connections. Rated No. 1 MCO in Ohio.
• AultComp TPAcoreStrategic or Co-development PartnerAultComp TPA (Third Party Administrator) provides administrative services for self-funded employer plans with low administrative costs in Ohio.

Scale indicators14 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Independent Health: Independent Health is a Buffalo, New York-based community health plan offering commercial, Medicare, and self-funded employer products with strong retention metrics. It reflects AultCare's regional, community-oriented model outside Ohio with an analogous provider-aligned approach.
• Medical Mutual of Ohio: Medical Mutual is Ohio's largest Ohio-domiciled health insurer, offering commercial group, Medicare, and ancillary products statewide. It competes head-to-head with AultCare for the same Ohio employer and Medicare populations, making it a direct and well-scaled regional peer.
• CareSource: CareSource is a Dayton, Ohio-based nonprofit managed care plan serving Medicaid, Medicare Advantage, and marketplace customers. While product mix skews more government-program than AultCare's commercial-heavy book, it is a major Ohio-based health plan competing for the same Medicare and employer-sponsored channels.
• HealthPartners: HealthPartners is a Minnesota-based integrated health plan and care system offering commercial, Medicare, and Medicaid products with high member retention. Its integrated provider-payer model and regional employer focus closely parallel AultCare's provider-sponsored approach.
• SummaCare: SummaCare is the Northeast Ohio provider-sponsored health plan affiliated with Summa Health (Akron) and offers commercial group, Medicare Advantage, and individual plans in the same Ohio market as AultCare. It is the closest direct competitor given the parallel provider-sponsored model, regional Ohio footprint, and overlapping employer/Medicare customer base.
• Priority Health: Priority Health is a Michigan-based provider-sponsored health plan affiliated with Corewell Health (formerly Spectrum Health), offering commercial group, Medicare Advantage, and individual plans. Same provider-sponsored structure, similar integrated care coordination, and similar regional scale as AultCare.
• Geisinger Health Plan: Geisinger Health Plan is a Pennsylvania-based provider-sponsored health plan offering commercial, Medicare Advantage, and Medicaid products. It mirrors AultCare's provider-sponsored model, integrated care management, and self-funded employer focus, making it a strong same-model peer despite the different geography.
• Health Alliance Plan (HAP): HAP is a Michigan-based health plan affiliated with Henry Ford Health offering commercial, Medicare, and Medicaid products. It is a regional, provider-aligned health plan serving similar employer and Medicare segments as AultCare, making it a comparable regional peer.
• Paramount Health (ProMedica): Paramount is a ProMedica-affiliated health plan headquartered in Toledo, Ohio, offering employer group, Medicare Advantage, and individual plans through a provider-sponsored model. The structure, region, and product mix closely parallel AultCare's commercial + Medicare strategy.

Broad incumbents

• Anthem Blue Cross Blue Shield of Ohio: Anthem is a national Blues carrier with a large Ohio footprint offering commercial, Medicare, and ancillary products at scale. It competes with AultCare for the same employer and Medicare segments but operates across many states with broader portfolios.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/AultCare
• Facebookfacebook.com/AultCare.WhereYouMatter

Compliance1 record

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 AultCare