Harvard Pilgrim Health Care, Inc.
Harvard Pilgrim Health Care is a private regional health insurer serving individuals, employers, and Medicare beneficiaries across four New England states (ME, MA, NH, RI) as a subsidiary of Point32Health, offering commercial, individual, Medicare Supplement, and self-funded plans via direct, broker, and exchange channels.
- Company typePrivate
- Founded1969
- HeadquartersCanton, United States
- Headcount1,001–5,000
- GTM typeB2B and B2C
- OfferingServices
What Harvard Pilgrim Health Care, Inc. does
Harvard Pilgrim Health Care, Inc. is a private regional health insurance company headquartered at 1 Wellness Way in Canton, Massachusetts, operating as a subsidiary of Point32Health, Inc. (the parent organization formed through its merger with Tufts Health Plan). The company provides health insurance products and services to members across four New England states — Maine, Massachusetts, New Hampshire, and Rhode Island — including Individual & Family ACA-compliant plans (on and off state exchanges), Employer-Sponsored plans for both large group (51+ employees) and small group (1-50 employees), Medicare Supplement plans (Supplement 1, 1A, and Core in Massachusetts; Plan A, F, G, M, N in New Hampshire and Maine), and Medicare Enhance. It also operates Health Plans, Inc. (HPI), a wholly-owned subsidiary providing self-funded benefit administration for large employers, including joint Choice Plus and Options offerings with UnitedHealthcare.
The technology stack is a conventional health insurance administration platform: a secure member dashboard (harvardpilgrim.org/member) for benefits, claims, and digital ID cards (Apple Wallet compatible), mobile applications on iOS and Android, a 24/7 Employer Account Portal with real-time enrollment transactions and analytics for groups with 100+ subscribers, and a third-party HealthTrio platform for member data collection governed by HIPAA business associate agreements. The company runs the SmartStart pre-enrollment and onboarding program (96% member satisfaction) and offers Point32Health Dental and Vision cross-sell products to large employers. It is HIPAA-compliant and operates with no disclosed AI/ML capabilities or API/SDK platform.
Harvard Pilgrim generates revenue primarily through subscription-based recurring health insurance premiums from commercial, individual, and Medicare Supplement lines, with ancillary fee revenue from self-funded administration (managed services) via the HPI subsidiary. Go-to-market combines a dedicated direct employer sales force, an extensive broker network with a dedicated service team and broker portal, state-based health insurance exchange presence for individuals, and self-serve digital platforms. The company exited the Rhode Island small group market effective July 1, 2025, signaling focused consolidation on its core regional footprint.
Harvard Pilgrim Health Care, Inc. firmographics
Firmographics- Name
- Harvard Pilgrim Health Care, Inc.
- Legal name
- Harvard Pilgrim Health Care, Inc.
- Website
- https://harvardpilgrim.org
- Company type
- Private
- Founded year
- 1969
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- Harvard Pilgrim Health Care is a private regional health insurer serving individuals, employers, and Medicare beneficiaries across four New England states (ME, MA, NH, RI) as a subsidiary of Point32Health, offering commercial, individual, Medicare Supplement, and self-funded plans via direct, broker, and exchange channels.
- Ownership category
- akta.pro rank
Harvard Pilgrim Health Care, Inc. industry classification
Industry- Product category
- Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Fully Insured Group Health Plans (Employer-Sponsored) (FSAIAFAA)
- akta.pro secondary industries
- Small Group Health Insurance (2–50/100) (FSAIAFAD), Off-Exchange Individual Major Medical Plans (FSAIAEAB), Medicare Supplement (Medigap) (FSAIAEAG)
Keywords
Where Harvard Pilgrim Health Care, Inc. is headquartered
LocationHeadquarters
- HQ city
- Canton
- HQ country
- United States
- HQ region
- North America
Offices5 records
Markets served
Harvard Pilgrim Health Care, Inc. business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Operations, Personnel, Marketing or Sales, Technology or R&D, Infrastructure
Revenue model
- Commercial Health Insurance Premiums: Collection of recurring premiums from employer-sponsored health plans (large group 51+ employees, small group 1-50 employees) and individual/family plans. Revenue is primarily risk-based premiums with coverage including HMO, PPO, EPO, and POS plan options.
- Medicare Supplement Insurance: Medicare Supplement plans (Supplement 1, Supplement 1A, Core, and Plan A, F, G, M, N) generating premium revenue. Available in Massachusetts, New Hampshire, and Maine. No prescription drug coverage included.
- Self-Insured Administration: Custom benefit administration and health management services through subsidiary Health Plans, Inc. (HPI) for large self-funded employers, including Choice Plus and Options plans offered jointly with UnitedHealthcare.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Employer-sponsored health plans for groups of 51+ employees |
| Subscription | Monthly | Small group employer plans for 1-50 employees |
| Subscription | Monthly | Individual and family ACA-compliant plans |
| Subscription | Monthly | Medicare Supplement plans |
Go-to-market motion2 records
Distribution channels5 records
Marketing channels6 records
Harvard Pilgrim Health Care, Inc. product offering
Product offeringCore offering
Harvard Pilgrim Health Care sells fully insured and self-funded health insurance products across Maine, Massachusetts, New Hampshire, and Rhode Island. Core product lines include Individual & Family Plans, Employer-Sponsored Plans (Large Group 51+ and Small Group 1-50 employees), Medicare Supplement Plans, and Medicare Enhance. The company also offers Dental & Vision add-ons through Point32Health sub-brands and jointly markets Choice Plus and Options plans with UnitedHealthcare for self-funded employers.
Product overview
Harvard Pilgrim Health Care, Inc. is a health insurance company operating as a subsidiary of Point32Health, offering a comprehensive portfolio of health insurance products and services across four New England states (Maine, Massachusetts, New Hampshire, and Rhode Island). The core product portfolio includes Individual & Family Plans, Employer-Sponsored Plans (Large Group and Small Group), Medicare Supplement Plans (Supplement 1, 1A, Core in MA; Plan A, F, G, M, N in ME/NH), and Medicare Enhance employer-sponsored plans. These are complemented by add-on offerings including Dental & Vision coverage (through Point32Health sub-brands), the SmartStart onboarding program, COVID-19 coverage, and Choice Plus/Options plans offered jointly with UnitedHealthcare. Harvard Pilgrim provides digital member engagement through mobile apps (iOS and Android), a secure Employer Account Portal for benefits administration, and digital ID cards with Apple Wallet compatibility. The company exited Rhode Island small group market effective July 1, 2025.
Differentiator
Problem solved
Functional benefit
Brands
- SmartStart: Market-leading pre-enrollment, onboarding and transitions of care support team that helps employers and employees get up and running smoothly with health coverage.
- Harvard Pilgrim Health Care Physician Group Honor Roll
Products and services
- Individual & Family Plans ACA-compliant health insurance plans for individuals and families purchasing coverage outside of employer-sponsored insurance, available in Maine, Massachusetts, and New Hampshire through the individual market on or off the state health insurance exchanges.
- Large Group Plans (51+ employees) Fully insured health insurance plans for large employer groups with 51 or more employees, offering full, tiered, and select network plan options with customizable benefits to suit employer needs. Dedicated account management and a 95% employer account satisfaction rate support these groups.
- Small Group Plans (1-50 employees) Fully insured health insurance plans for small businesses with 1 to 50 FTE employees, offering full, tiered, and select network plan options. HMOs require PCP selection and referrals for most specialist visits. Rhode Island small group sales discontinued July 1, 2025.
- Medicare Supplement Plans Supplemental health insurance for Medicare beneficiaries that fills gaps in Original Medicare. Plan options include Supplement 1, Supplement 1A, and Core in Massachusetts, and Plan A, F, G, M, N in New Hampshire and Maine. Prescription drug coverage is not included.
- Medicare Enhance Employer-sponsored Medicare supplemental plans that fill gaps Original Medicare does not cover; members can visit any provider that accepts Medicare nationwide.
- Dental & Vision Plans Dental and vision coverage offered through Point32Health Dental and Point32Health Vision sub-brands, available to large employer groups (51+ employees) and typically combined with Harvard Pilgrim medical plans.
- Choice Plus and Options Plans Self-funded health plans jointly offered by Harvard Pilgrim with UnitedHealthcare for employers, providing access to UnitedHealthcare's broader provider network and services.
Quantifiable outcome
- 95% employer account satisfaction rate
- +3 more outcomes
Companies that use Harvard Pilgrim Health Care, Inc.
Customer profileNamed customers2 records
Segments4 records
Ideal customer profiles4 records
Harvard Pilgrim Health Care, Inc. technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature4 records
Harvard Pilgrim Health Care, Inc. partnerships and signals
Strategic signalPartnerships
Seven partnerships are on record, tiered core, major and minor.
- Point32HealthcoreParent organization of Harvard Pilgrim Health Care and Tufts Health Plan. Combined entity delivers health care experiences across diverse New England communities. Harvard Pilgrim operates as a brand under Point32Health umbrella.
- HealthTriocoreThird-party partner that collects personally identifiable data on behalf of Harvard Pilgrim. Covered under business associate agreement per HIPAA requirements. Platform used in normal course of member data collection.
- UnitedHealthcaremajorJoint offering of Choice Plus and Options plans for self-funded employers. Harvard Pilgrim offers these plans jointly with UnitedHealthcare, with separate employer services portal at employereservices.com.
- Maine Department of Health and Human ServicesminorState health department resource link for COVID-19 vaccine information in Maine
- Massachusetts Department of Public HealthminorState health department resource link for flu prevention information in Massachusetts
- New Hampshire Department of Health and Human ServicesminorState health department resource link for flu prevention information in New Hampshire
- Rhode Island Department of HealthminorState health department resource link for flu prevention information in Rhode Island
Scale indicators8 records
Recent moves5 records
Expansion highlights5 records
Harvard Pilgrim Health Care, Inc. competitors and assessment
Company assessmentRegional players
- Fallon Health: Massachusetts-based regional health plan with commercial and Medicare Advantage products; competes most directly with Harvard Pilgrim in central and western Massachusetts.
- Health New England: Springfield, MA-based regional health insurer serving employer groups and individuals in western Massachusetts and northern Connecticut; overlapping product mix with Harvard Pilgrim in a contiguous geography.
- Neighborhood Health Plan of Rhode Island: Rhode Island-focused health plan serving Medicaid, commercial, and individual members; a relevant comparator in one of Harvard Pilgrim's four service states, especially given the small-group exit.
Broad incumbents
- UnitedHealthcare: National incumbent carrier that is simultaneously a partner (Choice Plus/Options) and a direct competitor across employer, individual, and Medicare lines; the most relevant scale benchmark for Harvard Pilgrim.
- Aetna (CVS Health): National fully insured and self-insured carrier with deep broker relationships across the U.S.; competes for large group employers headquartered in or with significant presence in New England.
- Anthem Blue Cross Blue Shield: Large multi-state Blue Cross Blue Shield licensee with employer, individual, and Medicare Advantage products that competes with Harvard Pilgrim for large group and national employer accounts touching New England.
- Cigna Group: National health services and insurance carrier with Evernorth pharmacy benefits and broad employer stop-loss; competes for self-funded and large group accounts overlapping Harvard Pilgrim's footprint.
Direct peers
- Tufts Health Plan: Sister brand under the same Point32Health parent; operates overlapping commercial, Medicare, and Medicaid products in Massachusetts and Rhode Island and is the most directly comparable carrier in the same region.
- Blue Cross Blue Shield of Massachusetts: Largest competing health insurer headquartered in Massachusetts with overlapping employer group, individual, and Medicare Supplement footprints. Directly competes with Harvard Pilgrim in its core New England market.
Others
- Point32Health: The parent company of Harvard Pilgrim Health Care and Tufts Health Plan; included as the closest corporate and operational umbrella, providing integrated administration, technology, and capital allocation.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights6 records
Customer concentration
Harvard Pilgrim Health Care, Inc. compliance and trust
Trust signalCompliance1 record
Harvard Pilgrim Health Care, Inc. financial estimates
Financial estimateRevenue estimate
Valuation estimate
Harvard Pilgrim Health Care, Inc. leadership team
Management profileNumber of profiles
Profiles1 record
Harvard Pilgrim Health Care, Inc. subsidiaries and ownership
Company hierarchySubsidiaries1 record
Harvard Pilgrim Health Care, Inc. funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Harvard Pilgrim Health Care, Inc. M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Harvard Pilgrim Health Care, Inc.
What does Harvard Pilgrim Health Care, Inc. do?
Harvard Pilgrim Health Care sells fully insured and self-funded health insurance products across Maine, Massachusetts, New Hampshire, and Rhode Island. Core product lines include Individual & Family Plans, Employer-Sponsored Plans (Large Group 51+ and Small Group 1-50 employees), Medicare Supplement Plans, and Medicare Enhance. The company also offers Dental & Vision add-ons through Point32Health sub-brands and jointly markets Choice Plus and Options plans with UnitedHealthcare for self-funded employers.
Is Harvard Pilgrim Health Care, Inc. a public or private company?
Harvard Pilgrim Health Care, Inc. is a private company. It is classified as corporate owned and is currently operating.
When was Harvard Pilgrim Health Care, Inc. founded?
Harvard Pilgrim Health Care, Inc. was founded in 1969. It employs 1,001 to 5,000 people.
Where is Harvard Pilgrim Health Care, Inc. based?
Harvard Pilgrim Health Care, Inc. is headquartered in Canton, United States, in the North America region.
How does Harvard Pilgrim Health Care, Inc. make money?
Three revenue lines are on record. Commercial Health Insurance Premiums are the primary driver. The others are medicare Supplement Insurance and self-Insured Administration.
Who are Harvard Pilgrim Health Care, Inc.'s main competitors?
Regional players on record are Fallon Health, Health New England and Neighborhood Health Plan of Rhode Island. Broad incumbents are UnitedHealthcare, Aetna (CVS Health), Anthem Blue Cross Blue Shield and Cigna Group. Direct peers are Tufts Health Plan and Blue Cross Blue Shield of Massachusetts. Point32Health is listed as an others.
Does Harvard Pilgrim Health Care, Inc. have an API?
No public API is recorded for Harvard Pilgrim Health Care, Inc..
What industry is Harvard Pilgrim Health Care, Inc. in?
Harvard Pilgrim Health Care, Inc.'s product category is Health Insurance. Its primary akta.pro industry code is FSAIAFAA, Fully Insured Group Health Plans (Employer-Sponsored), with a secondary code of FSAIAFAD, Small Group Health Insurance (2–50/100). Its NAICS code is 524114 and its SIC code is 6324.