Verdegard

What Verdegard does

Verdegard Administrators, LLC, operating as Verdegard, is a privately held third-party administrator (TPA) headquartered in Tempe, Arizona. The company administers self-funded health benefit plans on behalf of employer groups across the United States, with provider network access in all 50 states delivered primarily through a partnership with PNOA and supplemented by Aetna, Cigna, and PHCS networks. Verdegard is organized around a spectrum of plan designs—Navigator PPO, Navigator VBP (value-based pricing), Navigator RBP (reference-based pricing), level-funded options under the Peoni sub-brand, and Essential MEC/MiniMED plans for hourly and seasonal workers—accompanied by add-on modules covering dental, vision, telehealth, mail-order pharmacy via Birdi, specialty medication advocacy through Ray Savings Solutions, and pharmacy benefit management through MedImpact. The Advanta Care Advocates service provides personalized member support aimed at reducing out-of-pocket costs.

The company's revenue model is anchored on TPA administration fees charged to self-funded employer groups for claims adjudication, customer service, case management, electronic banking, compliance management, and reporting, supplemented by stop-loss insurance commissions. Pricing is quote-based across deductible tiers ranging from $1,000 to $6,000, with the company claiming value-based pricing savings up to 40% versus traditional PPO networks and level-funded savings up to 25% versus fully insured comparables. Distribution runs through a hybrid GTM combining a primary broker channel with dedicated broker support, a direct employer sales motion (phone and online quote requests), and stakeholder-specific portals (broker, employer, member, provider). Customer segments span small businesses (5–50 employees through Peoni), mid-market and enterprise self-funded employers, public-sector entities, Native American tribes (including a dedicated Navajo Nation member line), labor trust funds, healthcare systems, and association groups.

Verdegard operates from a single Tempe, AZ headquarters with 51–100 employees and no disclosed parent company, institutional investors, or venture funding. Strategic partnerships form the backbone of the platform: MedImpact, Birdi, Ray Savings Solutions, PNOA, MG Insurance Agency, Integrated Payor Solutions (for No Surprises Act compliance), and the national carrier networks. The company is actively investing in regulatory compliance, having released machine-readable files under the federal Transparency in Coverage Rule, and continues to extend its product surface with value-based and reference-based pricing models targeting cost-containment segments.

Name

Verdegard

Legal name

Verdegard Administrators, LLC

Website

https://verdegard.com

Company type

Private

Operating status

Operating

Headcount range

51–100 employees

Short description

Verdegard Administrators, LLC is a privately held third-party administrator headquartered in Tempe, Arizona that administers self-funded health benefit plans for US employers across small, mid-market, public sector, and tribal segments, delivering PPO, value-based, reference-based, level-funded, and MEC plan designs through an integrated TPA platform.

Ownership category

akta.pro rank

Product category

Third-Party Health Plan Administration (Self-Funded Benefits)

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Self-Funded Employer Plan TPA (ASO Administration) (HLAEALAA)

akta.pro secondary industries

Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ), Care Management & Population Health Program Administration (HLAEALAG), Ancillary Benefits TPA (Dental/Vision/Life/Accident/Critical Illness) (HLAEALAN)

Keywords

• Third-party administration
• Self-funded health plans
• Employee benefits
• Pharmacy benefit management
• Healthcare administration

Headquarters

HQ city

Tempe

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, Infrastructure

Revenue model

1. TPA Administration Fees: Verdegard acts as a third-party administrator (TPA) for self-funded health benefit plans. Revenue is generated through administrative fees charged to employer groups for managing their self-funded plans, including claims adjudication, customer service, case management, compliance management, and reporting/analytics services.
2. Stop-Loss Insurance: Stop-loss insurance provides catastrophic protection for self-funded medical and specialty prescription drug plans. Verdegard offers flexible options based on group size and budget.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels4 records

Core offering

Verdegard Administrators, LLC operates as a third-party administrator (TPA) for self-funded employer health benefit plans, providing integrated plan administration services including claims adjudication, customer service, case management, electronic banking, compliance management, reporting and analytics, COBRA administration, and stop-loss insurance. The company offers a spectrum of plan designs (PPO, value-based, reference-based, level-funded, hybrid, and MEC/Essential) under brands including Navigator, Essential, and Peoni, augmented by member-facing services such as Advanta Care Advocates, telehealth, dental/vision coverage, and prescription home delivery.

Product overview

Verdegard is a third-party administrator (TPA) offering a comprehensive suite of integrated employee benefit solutions for self-funded employer plans. The core platform is built around Navigator PPO Plans, Navigator VBP Plans (Value-Based), and Navigator RBP Plans (Reference-Based), supplemented by Essential Plans (MEC/MiniMED) and the Peoni sub-brand for small businesses. Key add-on services include Advanta Care Advocates for patient advocacy, Telehealth Services, Birdi for prescription home delivery, Ray Savings Solutions for specialty medications, MedImpact for pharmacy benefit management, PNOA Provider Networks, and MG Insurance Agency for ancillary benefits. The platform also provides full TPA services encompassing claims adjudication, electronic banking, compliance management, reporting and analytics, stop-loss insurance, and COBRA administration. Dental and Vision Plans are offered as add-on coverage options.

Differentiator

Problem solved

Functional benefit

Brands

• Peoni: Small business health plans offering level-funded medical coverage. Part of Verdegard's suite of plan options for small businesses, with potential savings of up to 25% compared to fully insured plans.
• Advanta

Products and services

• Navigator PPO Plans A suite of preferred provider organization health plans offering tiered access to a nationwide provider network through partnerships with Aetna, Cigna, PNOA, and PHCS, with variants including PPO Prime, PPO Choice, PPO Advantage HDHP, and PPO Value and varying deductible and out-of-pocket structures for self-funded employer groups.
• Navigator VBP Plans Value-Based Plans using negotiated pricing to reduce benefit costs up to 40% compared to traditional PPO networks, with Advanta advocates assisting members in hospital and facility care selection; deductibles range from $1,000 to $5,000 single / $3,000 to $10,000 family.
• Navigator RBP Plans Reference-Based Plans delivering pricing transparency for major medical services based on economical reimbursement levels, designed to be fair and reasonable based on various pricing data sets, for self-funded employer groups seeking transparent reference pricing.
• Essential Plans (MEC/MiniMED) Six affordable Minimum Essential Coverage (MEC) plans covering preventive and wellness services, with some plans offering limited outpatient and inpatient medical benefits; tiers include Simple, Basic, Advantage, Edge, Care 1, Plus, and Premier, designed for employers providing basic coverage to hourly and seasonal employees.
• Dental Plans Dental coverage including preventive services (exams, x-rays, cleanings), basic services at 80% coverage, and major services at 50% coverage after deductible, with a $1,000 annual maximum benefit; offered as an add-on to Verdegard self-funded medical plans.
• Vision Plans Vision coverage including annual eye exams up to $130, frames up to $200, eyeglass lenses with various allowances by lens type, and contact lenses up to $200 per year; offered as an add-on to Verdegard self-funded medical plans.
• Peoni Health (Small Group Level-Funded Plans) Level-funded health plans for small businesses (typically 5-50 employees) offering PPO, value-based, and essential plan options, where organizations pay only for healthcare services employees actually need and keep 100% of any year-end surplus if spending is less than projected.
• TPA Services (Third-Party Administration) Third-party administrator services for self-funded employer plans, including claims adjudication, customer service, case management, electronic banking solutions, compliance management, reporting and analytics, stop-loss insurance, and COBRA administration.

Quantifiable outcome

• Value-based pricing reduces cost of employee medical benefits up to 40% when compared to traditional PPO networks
• +2 more outcomes

Named customers2 records

Segments8 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Nine partnerships are on record, tiered core and minor.

• MedImpactcoreTechnology or IntegrationMedImpact is the nation's largest independent health solutions and pharmacy benefits provider. Through partnership with MedImpact, Verdegard offers organizations a broad portfolio of claims and clinical services, savings solutions, and wellness programs.
• BirdicoreTechnology or IntegrationBirdi is the digital drug store offering mail-order prescription services. Employers can offer home delivery prescription services to employees through Birdi with competitive prices, fast turnaround times, and exceptional experience.
• Ray Savings SolutionscoreTechnology or IntegrationRay Savings Solutions provides advocacy services for specialty medications and high-cost procedures. Leveraging deep healthcare expertise, advocates can cut the cost of expensive medications and procedures—in some cases to $0 for members.
• PNOA (Provider Networks of America)coreTechnology or IntegrationPNOA provides nationwide provider network including hospitals, ancillary facilities, and providers. Direct contracting model maximizes savings for patients who utilize in-network providers. Network available in all 50 states.
• MG Insurance AgencyminorChannel Partner/ Reseller/ DistributorMG Insurance Agency provides cost containment solutions and ancillary benefits identification. Helps partners and customers identify gaps and fill them with ancillary benefits in one solution.
• AetnacoreTechnology or IntegrationNationally recognized carrier partnership providing provider network access for PPO plans.
• CignacoreTechnology or IntegrationNationally recognized carrier partnership providing provider network access for PPO plans.
• PHCS (Private Healthcare Systems)coreTechnology or IntegrationPHCS is a national network provider partnership offering access to one of the nation's largest physician networks.
• Integrated Payor SolutionsminorImplementation/ SI/ Consulting PartnerIntegrated Payor Solutions supports required capabilities for applicable provisions of the final Transparency in Coverage Rule and No Surprises Act requirements. Verdegard has released machine-readable files (MRF) through this partnership.

Scale indicators3 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Lucent Health: TPA for self-funded employer health plans combining claims administration, stop-loss coverage, and care management. Matches Verdegard's positioning across plan administration plus stop-loss plus care advocacy services.
• Allied Benefit Systems: Full-service third-party administrator for self-funded employer health plans, providing claims processing, stop-loss coordination, and ancillary benefits. Direct competitor serving a similar employer segment with a comparable integrated plan administration model.
• Surency: Third-party administrator for self-funded employer benefit plans covering medical, dental, vision, and COBRA administration. Overlaps directly with Verdegard's TPA + ancillary benefits stack for self-funded employers.
• Key Benefit Administrators: Independent third-party administrator of self-funded benefit plans providing claims, customer service, and utilization management. Closely comparable on services, structure, and target employer client profile.
• MedWatch: Mid-market-focused third-party administrator providing claims processing, care management, and stop-loss coordination for self-funded employer plans. Direct competitor in the mid-market self-funded TPA segment.
• Star Casualty / StarLine: TPA and stop-loss insurance provider focused on small and mid-sized employer self-funded plans with integrated claims administration. Closely mirrors Verdegard's bundled plan design plus stop-loss structure.
• HealthEZ: Third-party administrator focused on self-funded health plans for small and mid-sized employers, offering integrated claims administration, population health, and pharmacy benefit management. Directly comparable to Verdegard's self-funded TPA model and target customer base.

Broad incumbents

• Cigna Group (Evernorth): Major carrier and benefits administrator offering self-funded health plan administration, PBM (via Express Scripts), and stop-loss through Evernorth. Provides overlapping capabilities to Verdegard's integrated stack but at significantly larger scale.
• CVS Health (Aetna): National health benefits carrier (Aetna) with self-funded plan administration, integrated PBM (Caremark), and ancillary benefits, serving employers of all sizes. Competes broadly with Verdegard's integrated model from a position of significant scale and capital.
• UnitedHealth Group (Optum Health): Largest U.S. health insurance carrier and benefits administrator via UnitedHealthcare and Optum, providing TPA, PBM, and stop-loss services at scale. Operates broadly in the same self-funded administration space that Verdegard competes in.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/@Verdegard
• Facebookfacebook.com/verdegard
• LinkedInlinkedin.com/company/verdegard
• Xx.com/verdegardllc

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 Verdegard