Public Employees Health Program

What Public Employees Health Program does

Public Employees Health Program (PEHP) is a state-affiliated health benefit administrator serving Utah public employees since 1977, headquartered in Salt Lake City with a regional office in St. George. Operating under the umbrella of Utah Retirement Systems (URS), PEHP administers a self-funded, comprehensive benefits portfolio including medical plans across six network options (Advantage, Advantage Exclusive, Summit, Summit Exclusive, Preferred, and Capital), pharmacy benefit management, dental, vision, term life and accident, long-term disability, and flexible spending and HSA accounts. The organization serves Utah state agencies, school districts, and local government employers, enrolling public employees and their dependents through group health plans with additional Medicare Supplement offerings for eligible retirees.

The technology infrastructure centers on a web-based member portal with provider lookup, cost-comparison tools, and mobile app access, supported by SMS-based multi-factor authentication and Electronic Data Interchange (EDI) claims processing through the Utah Health Information Network (UHIN) clearinghouse. PEHP integrates operationally with Express Scripts for pharmacy benefit management, Accredo for specialty pharmaceuticals, HealthEquity for HSA administration, Alegeus for FSA services, and Multiplan for out-of-state provider coverage. The organization does not maintain a public API and has no documented AI/ML capabilities.

The business model is self-funded premium collection from public employers, with administrative services bundled into the premium structure. Revenue is generated through recurring premium subscriptions from employer clients and managed-services fees for claims processing, utilization review, network management, and compliance reporting. PEHP returns excess premiums to stakeholders — approximately $200 million over the past decade through premium holidays, reserve returns, and rebates — reflecting a mutual or quasi-public trust structure rather than a profit-maximizing carrier. Pricing is quote-based by employer group, with publicly available Medicare Supplement rate sheets and a tiered pharmacy copay structure.

Name

Public Employees Health Program

Legal name

Public Employees Health Program

Website

https://pehp.org

Company type

Private

Founded year

1977

Operating status

Operating

Headcount range

101–250 employees

Short description

Public Employees Health Program (PEHP) is a state-affiliated, self-funded health benefit administrator under Utah Retirement Systems, providing medical, pharmacy, dental, life, and disability benefits to Utah public employees and their dependents since 1977.

Ownership category

akta.pro rank

Product category

Health Benefits Administration

NAICS

Health and Welfare Funds (525120), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Other Insurance Funds (525190)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321), Life Insurance (6311)

akta.pro primary industry

Self-Funded (ERISA) Employer Plans (HLAEAAAC)

akta.pro secondary industries

Group Disability Income Insurance (Employer-Sponsored) (FSAIAIAB), Group Life Waiver of Premium & Accelerated Benefit Riders (FSAIADAI)

Keywords

• Health benefits administration
• Self-funded health plans
• Group medical insurance
• Pharmacy benefit management
• Public sector benefits

Headquarters

HQ city

Salt Lake City

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Health Insurance Premiums: PEHP collects premiums from public employers to fund self-insured health benefit plans. Employers pay based on employee enrollment and selected plan options. PEHP administers these funds to pay claims and cover administrative costs.
2. Administrative Services: PEHP provides administrative services including claims processing, utilization review, network management, and compliance reporting to employer clients. These services are bundled into the premium structure.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

Public Employees Health Program (PEHP) administers self-funded health benefit plans for Utah public sector employers and their employees, offering medical, dental, vision, pharmacy, life, disability, FSA, and Medicare Supplement coverage through multiple provider networks (Advantage, Summit, Preferred, Capital). The organization collects premiums from public employers, processes claims, manages provider networks, and returns excess funds to clients via premium holidays, reserve returns, and rebates.

Product overview

Public Employees Health Program (PEHP) is a state-sponsored health benefits administrator serving Utah public employees, offering a comprehensive suite of health and benefits products under a unified platform. The portfolio includes Medical Plans with six distinct network options (Advantage, Advantage Exclusive, Summit, Summit Exclusive, Preferred, and Capital networks), Pharmacy Benefit Management through Express Scripts including specialty pharmacy and a Pharmacy Tourism Program for international prescription savings, Dental Plans, Term Life & Accident, Long-Term Disability, Flexible Spending (PEHP FLEX$), and Medicare Supplement plans for retirees. Additional wellness and cost-saving products include the Utah Insulin Savings Program, PEHP E-Care telehealth, AgeWell rebates for seniors, Cost Comparison Tools, and various wellness programs. The offering operates as a one-stop-shop model with full integration with HealthEquity, Alegeus, and Express Scripts for streamlined benefits administration.

Differentiator

Problem solved

Functional benefit

Products and services

• Medical Plans
• Pharmacy Benefit Management
• Dental Plans
• Medicare Supplement Plans
• Term Life & Accident Insurance
• Long-Term Disability (LTD)
• PEHP FLEX$ (Flexible Spending Accounts)
• Pharmacy Tourism Program
• Specialty Pharmacy Program
• Utah Insulin Savings Program
• PEHP E-Care (Telehealth)

Quantifiable outcome

• Nearly $200 million returned to employers and members over 10 years through premium holidays, return of reserves, and rebates
• +3 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

Integration6 records

Feature5 records

Partnerships

Six partnerships are on record, tiered core and minor.

• Utah Health Information Network (UHIN)coreTechnology or IntegrationUHIN serves as PEHP's clearinghouse for electronic claims submission. Providers submit claims through UHIN to PEHP. UHIN is the statewide health information network facilitating electronic data interchange between healthcare entities.
• HealthEquitycoreTechnology or IntegrationPEHP is fully integrated with HealthEquity for HSA and health account administration, allowing seamless coordination between medical plan and health savings accounts.
• Express ScriptscoreTechnology or IntegrationExpress Scripts is PEHP's pharmacy benefit manager (PBM), providing prescription drug coverage, home delivery pharmacy, and drug pricing tools. PEHP structures contracts with Express Scripts to achieve lowest possible drug costs on an aggregate level.
• AccredocoreTechnology or IntegrationAccredo is PEHP's specialty pharmacy for high-cost specialty medications that require special handling. PEHP may require members to use Accredo for coverage of certain specialty drugs.
• NAVEXGLOBALminorOthersNAVEXGLOBAL provides PEHP's confidential fraud and abuse reporting hotline. Individuals can report concerns about fraud or inappropriate activities through the toll-free hotline or web portal.
• MultiplancoreTechnology or IntegrationMultiplan provides PEHP's out-of-state provider network. PEHP accepts contractual discounts through Multiplan for out-of-state providers as listed in the PEHP Provider Directory.

Scale indicators4 records

Recent moves6 records

Expansion highlights6 records

Emerging players

• EMI Health: Utah-based non-profit health plan and dental/medical carrier — directly comparable to PEHP as a regional Utah competitor serving employer groups and individuals, including public-sector and education clients.

Direct peers

• CalPERS Health Benefits Program: California state public-employer health benefits program that provides self-funded medical, dental, vision, and supplemental benefits to California public agency employees and retirees — directly comparable to PEHP as another large state-government health benefit administrator with similar group/employer-sponsor model.
• NYSHIP (New York State Health Insurance Program): New York State Health Insurance Program administers public-employer health coverage for state and local government employees through a self-funded model with multiple plan/network options — directly comparable to PEHP's structure and self-funded group benefits design.
• Oregon Public Employees Benefit Board (PEBB): Oregon PEBB administers self-funded health and dental benefits to Oregon state and public-sector employees — directly comparable to PEHP's public-employer group health administration mandate.
• Washington State Health Care Authority (PEBB Program): Washington's Public Employees Benefits Board (PEBB) administers self-funded health, dental, life, and LTD benefits to state and public-sector employees — closely aligned with PEHP's multi-line, self-funded, public-employer benefits administration model.
• Wisconsin State Employee Group Insurance Program (SEGIP): Wisconsin ETF/SEGIP administers health, pharmacy, life, and disability benefits to Wisconsin state and local government employees — directly comparable to PEHP's multi-line self-funded public-employer benefits model.
• Texas Employees Retirement System (ERS) Health Benefits: Texas ERS administers self-funded health, dental, vision, and prescription drug benefits to state employees and retirees — a near-direct structural analogue to PEHP in plan design, customer type, and self-funded administrator role.

Broad incumbents

• SelectHealth: Utah-based non-profit health plan that competes for the same employer-sponsored group business in Utah — same geography and customer segment as PEHP, but operates as a commercial carrier rather than a public-employer benefit administrator.
• Regence BlueCross BlueShield of Utah: Incumbent commercial health insurer in Utah competing for employer-sponsored group and individual market business — overlaps with PEHP in the same geography, product types (medical, dental, PBM), and customer base (large employer groups).

Regional players

• BeneSys, Inc. Third-party administrator specializing in health and welfare funds for multi-employer and Taft-Hartley trusts — closely comparable to PEHP's self-funded health and welfare fund administration focus, though serving labor/employer trusts rather than state government.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xx.com/PEHP2
• YouTubeyoutube.com/channel/UCCfNGFSc_KjNUx0lwZ-pdBw
• Facebookfacebook.com/PEHP1
• LinkedInlinkedin.com/company/pehp
• Instagraminstagram.com/pehphealthbenefits/?hl=en

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

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 Public Employees Health Program