PERS Health Insurance Program

What PERS Health Insurance Program does

PERS Health Insurance Program (PHIP) is a group health insurance administration program exclusively for Oregon Public Employees Retirement System (PERS) retirees and their eligible spouses, domestic partners, and dependents. Established in 1959 and sponsored by Oregon PERS, the program serves approximately 52,000 health plan members with a small internal team of four staff who oversee operations; day-to-day administration, billing, and customer service were transitioned on January 1, 2026 to third-party administrator Zenith American Solutions at a walk-in location in Tualatin, OR.

PHIP aggregates multiple contracted health plan carriers and benefit options under a single enrollment umbrella. Members choose among Moda Health Medicare Supplement, Kaiser Permanente Senior Advantage, two Providence Medicare Advantage plans (HMO and HMO-POS, scheduled to end December 31, 2026), and UnitedHealthcare Group Medicare Advantage PPO for Medicare-eligible retirees, with Kaiser and UnitedHealthcare Core Value and Qualified HDHP plans available for non-Medicare members. Two dental carriers (Delta Dental of Oregon and Kaiser Permanente Dental), integrated prescription drug coverage including automatic Medicare Part D, optional Unum long-term care insurance, and a Snowbird travel switching benefit round out the offering.

Funding comes from participant premiums paid monthly via pension deduction or EFT, supplemented by the RHIA $60/month subsidy for Medicare-entitled retirees and the RHIPA subsidy for non-Medicare state retirees, both financed through PERS trust funds established by Oregon legislation. Membership is concentrated in Oregon with limited Washington coverage, restricted to U.S. residency, and locked to enrollment windows tied to qualifying life events, producing very high member retention.

Name

PERS Health Insurance Program

Legal name

PERS Health Insurance Program

Website

https://pershealth.com

Company type

Private

Founded year

1959

Operating status

Operating

Short description

PHIP is a state-administered group health insurance program exclusively for Oregon PERS retirees and their dependents, offering Medicare and non-Medicare medical plans through four contracted carriers, dental coverage, and integrated prescription drug benefits.

Ownership category

akta.pro rank

Product category

Retiree Health Insurance

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Insurance and Employee Benefit Funds (5251), Direct Health and Medical Insurance Carriers (524114)

SIC

Insurance Agents, Brokers & Service (6411), Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

Fully Insured Group Health Plans (Employer-Sponsored) (FSAIAFAA)

akta.pro secondary industry

Medicare Part D Prescription Drug Plans (PDP) (FSAIAGAC)

Keywords

• Retiree health insurance
• Medicare Advantage plans
• Medicare Supplement coverage
• Group dental benefits
• Public employee benefits

Headquarters

HQ city

Portland

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Marketing or Sales, Others

Revenue model

1. Health Insurance Premiums: PHIP collects monthly premiums from members for medical, prescription drug, and dental coverage. Premium rates are listed on a per member, per month basis and are adjusted annually (2026 rates effective January 1). Members can pay via pension deduction or Electronic Funds Transfer (EFT).
2. RHIA Premium Subsidy: $60 monthly contribution from the Retirement Health Insurance Account for Medicare-entitled retirees receiving PERS service or disability retirement allowance with 8+ years of qualifying service time. This subsidy reduces member premium costs.
3. RHIPA Premium Subsidy: Monthly contribution from Retiree Health Insurance Premium Account for non-Medicare retirees who retired from a state agency, based on years of state service (minimum 8 years required). Reduces member premium costs for eligible state retirees.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

PERS Health Insurance Program (PHIP) is a state-sponsored group health insurance program that administers retiree health coverage for Oregon PERS retirees, their spouses/domestic partners, and dependents. It contracts with multiple health plan carriers (Moda Health, Kaiser Permanente, Providence Health Assurance, UnitedHealthcare) and dental carriers (Delta Dental of Oregon, Kaiser Permanente) to deliver Medicare Supplement, Medicare Advantage, non-Medicare, HDHP, dental, prescription drug, and long-term care options. Members pay per-member, per-month premiums (often via pension deduction) and may receive RHIA ($60/month) or RHIPA premium subsidies funded through Oregon legislative trust funds.

Product overview

The PERS Health Insurance Program (PHIP) is a group health insurance program specifically designed for Oregon PERS retirees and their eligible family members. The offering comprises multiple contracted health plan carriers providing both Medicare and non-Medicare medical plans, two dental plan options, integrated prescription drug coverage (including automatic Medicare Part D enrollment), travel benefits with a unique Snowbird Option for extended travel, and optional long-term care insurance through Unum. The program is administered by Zenith American Solutions (as of January 2026) and partners with four health plan carriers: Moda Health (Medicare Supplement), Kaiser Permanente (Senior Advantage for Medicare, Core Value/HDHP for non-Medicare), Providence Health Assurance (Medicare Advantage HMO/HMO-POS plans), and UnitedHealthcare (Medicare Advantage PPO, Core Value, HDHP). Dental coverage is offered through Delta Dental of Oregon and Kaiser Permanente Dental. Premium subsidies (RHIA and RHIPA) are available for eligible Tier 1 and Tier 2 retirees.

Differentiator

Problem solved

Functional benefit

Products and services

• Moda Health Medicare Supplement Plan Traditional Medicare Supplement plan that pays secondary to Medicare with Part D pharmacy benefits included. Available nationwide with any Medicare provider, no referrals required, and minimal out-of-pocket expenses for Medicare-covered services. Targeted at PERS Medicare-eligible retirees.
• Kaiser Permanente Senior Advantage Plan Medicare Advantage plan providing coverage in Kaiser Permanente Northwest service areas (Oregon and Washington counties), with access to Kaiser physicians and hospitals. Targeted at PERS Medicare-eligible retirees residing in the Kaiser service area.
• Providence Medicare Align Group Plan + Rx (HMO) HMO Medicare Advantage plan with access to over 10,000 in-network providers, no deductible, low out-of-pocket maximum, worldwide urgent/emergent care, free gym membership, and vision hardware coverage. Targeted at PERS Medicare-eligible retirees in Providence service areas. Note: Providence Medicare Advantage plans will no longer be offered effective December 31, 2026.
• Providence Medicare Flex Group Plan + Rx (HMO-POS) HMO-POS Medicare Advantage plan offering Point of Service benefits allowing out-of-network provider access with no annual limit, referrals optional, and Part D prescription coverage. Targeted at PERS Medicare-eligible retirees seeking flexibility. Note: Providence Medicare Advantage plans will no longer be offered effective December 31, 2026.
• UnitedHealthcare Group Medicare Advantage (PPO) Plan Preferred Provider Organization (PPO) Medicare Advantage plan offering comprehensive hospital and medical coverage, prescription drug coverage, national provider network access, and flexibility to see any Medicare provider in or out-of-network. Targeted at PERS Medicare-eligible retirees, including those who travel or live outside Oregon seasonally.
• Kaiser Permanente Core Value Plan Non-Medicare health plan for eligible PERS retirees and dependents, providing comprehensive medical coverage in Kaiser Permanente service areas. Targeted at PERS non-Medicare retirees residing in the Kaiser service area.
• Kaiser Permanente Qualified HDHP HSA-qualified High-Deductible Health Plan for non-Medicare members, pairing traditional medical benefits with a Health Savings Account for tax-advantaged savings. Targeted at non-Medicare PERS retirees seeking HSA-qualified coverage.
• UnitedHealthcare Core Value Plan Non-Medicare Traditional plan with $1,000 deductible offering both in and out-of-network benefits, allowing members to see any provider with some services covered by member copay. Targeted at non-Medicare PERS retirees nationwide.
• UnitedHealthcare Qualified HDHP HSA-qualified High-Deductible Health Plan with $3,000 deductible offering in and out-of-network benefits, paired with a Health Savings Account for tax-advantaged medical savings. Targeted at non-Medicare PERS retirees seeking HSA-qualified nationwide coverage.
• Delta Dental Plan of Oregon Dental plan providing access to Premier and PPO Networks nationwide with over 154,000 participating dentists, no waiting periods for preventive care, and includes the Passport Dental program for worldwide coverage. Targeted at PERS retirees, spouses, and dependents needing nationwide dental access.
• Kaiser Permanente Dental Dental plan available to members residing in Kaiser Permanente dental service areas, with 20 dental offices in the Portland-Vancouver metro area, Longview, Salem, and Eugene, plus no-cost virtual dentistry options. Targeted at PERS retirees in the Kaiser service area.
• PHIP Medicare Part D Prescription Drug Plan Automatic Medicare Part D prescription drug coverage included in PHIP medical plan premiums for Medicare members, covering Medicare-approved prescription medications through various pharmacy networks. Targeted at PERS Medicare-eligible retirees.
• Unum Long-Term Care Insurance Optional long-term care insurance through Unum Life Insurance Company of America, covering care received at home or in facilities when assistance is needed with daily living activities. Available to all eligible PERS retirees, spouses, and dependents who apply.

Named customers3 records

Segments5 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature2 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• Zenith American SolutionscoreImplementation/ SI/ Consulting Partner · 1 January 2026As of January 1, 2026, Zenith American Solutions is PHIP's new third-party administrator. Provides billing, customer service, and walk-in assistance at their Tualatin, OR location.
• Moda HealthcoreStrategic or Co-development PartnerModa Health offers the PERS Moda Health Medicare Supplement plan - a traditional Medicare Supplement plan that pays secondary to Medicare with Part D pharmacy benefits. Available nationwide with any Medicare provider. Has offered Medicare Supplement plan to PERS members for nearly 30 years.
• Kaiser PermanentecoreStrategic or Co-development PartnerKaiser Permanente offers both Medicare and non-Medicare plans to PHIP members including Kaiser Permanente Senior Advantage (Medicare), Core Value Plan, and Qualified HDHP for non-Medicare members. Also provides dental plans in specific service areas with 20 dental offices.
• Providence Health AssurancecoreStrategic or Co-development PartnerProvidence offers Medicare Advantage plans including Providence Medicare Align Group Plan (HMO) and Providence Medicare Flex Group Plan (HMO-POS). Note: Providence will no longer offer PERS Providence Medicare Advantage plans effective December 31, 2026.
• UnitedHealthcarecoreStrategic or Co-development PartnerUnitedHealthcare offers Group Medicare Advantage (PPO) plan and non-Medicare plans (Core Value and HDHP) to PHIP members with national network access.
• Delta Dental of OregoncoreStrategic or Co-development PartnerDelta Dental provides dental coverage with access to Premier and PPO Networks nationwide. Includes Health through Oral Wellness program, Oral Health Total Health program for diabetics, and Passport Dental for international travel.
• Unum Life Insurance Company of AmericaminorStrategic or Co-development PartnerUnum is the PERS long-term care insurance carrier. All eligible PERS retirees, spouses and dependents may apply for long-term care insurance by contacting Unum at 1-800-227-4165.
• Oregon Public Employees Retirement System (PERS)coreStrategic or Co-development PartnerPERS is the state agency that established and sponsors PHIP for Oregon public employees. PERS provides the RHIA and RHIPA premium subsidies through employer assessments and state legislation.

Scale indicators3 records

Recent moves4 records

Expansion highlights3 records

Direct peers

• NYSHIP (New York State Health Insurance Program): New York State Health Insurance Program provides retiree health coverage for state and local government retirees, serving a comparable public-pension retiree population with multiple plan options.
• CalSTRS Health Benefits Program: California State Teachers' Retirement System health benefits program serving public school retirees with group Medicare and non-Medicare plans, directly comparable in target population and program structure to PHIP.
• TRS-Care (Teacher Retirement System of Texas): Texas TRS-Care provides health insurance for Texas public school retirees, a state-sponsored retiree health program with similar Medicare Advantage and supplemental plan structure to PHIP.
• Colorado PERA Health Benefits: Colorado Public Employees' Retirement Association health benefits program, offering retiree group health plans through multiple contracted carriers, structurally analogous to PHIP for Oregon public pension retirees.
• CalPERS Health Benefits: California Public Employees' Retirement System health benefits program, which is structurally identical to PHIP: state-sponsored retiree group health plans administered for public pension retirees with multiple contracted carriers and Medicare/non-Medicare options.
• State Health Benefits Program (New Jersey): New Jersey Division of Pensions and Benefits' State Health Benefits Program provides group health coverage for state and public-sector retirees, comparable in scale and retiree-focused design to PHIP.
• State Employees Group Insurance (Illinois): Illinois Department of Central Management Services' State Employees Group Insurance offers retiree health plans to Illinois public-sector retirees, a comparable state-sponsored retiree health program structure.

Broad incumbents

• TRICARE: TRICARE provides group health coverage for U.S. military retirees, comparable as a large government-sponsored retiree health program with multi-carrier plan options, though at federal scale.
• FEHB (Federal Employees Health Benefits): Federal Employees Health Benefits Program is the federal-government analog serving federal employees and retirees with multi-carrier group health plans, a broader-scale incumbent version of PHIP's model.

Others

• Moda Health: Moda Health is a contracted carrier partner of PHIP that also sells Medicare Supplement plans more broadly. Listed as an ecosystem/partner participant rather than a direct competitor, illustrating the regional carrier ecosystem in which PHIP operates.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat3 records

Key risks5 records

Key highlights6 records

Customer concentration

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 PERS Health Insurance Program