An innovative self-funded health plan platform that revolutionizes healthcare delivery through cutting-edge technology, with support on underwriting solutions and pharmacy benefit programs.
Healthcare has long been constrained by what economist William Kissik called the "Iron Triangle." The idea is that cost, quality, and access are in permanent tension. Improve one, and the others suffer.
Covet Health was built to challenge that assumption. Through technology, data, and a unified platform, we pursue all three simultaneously: lower costs, improved outcomes, and greater accessibility. No tradeoffs.
Lower Costs
Better Outcomes
Greater Access
Three outcomes. Zero tradeoffs.
A growing team of healthcare administrators, technologists, and operators united around a single mission.
From small businesses to large employers — Covet Health aims to serve all employers.
Mid-Atlantic, Midwest, Southeast, and Great Plains, with the ability to serve employers nationwide.
Medical and pharmacy administrative services with integrated ancillary partners.
National and regional networks, reference-based pricing, and direct contracts.
Four core capabilities that set Covet apart from traditional TPAs.
Our experienced administration and backroom support team averages 10+ years of industry experience in plan design, maintenance, claims adjudication, and examination. Automated workflows drive fast, accurate claim settlement so members and providers get timely answers and employers get a clean financial picture.
Our medical management philosophy is built around proactive steerage and active case management. We guide members toward high-value care settings before a claim ever happens, not simply reviewing claims for denial after the fact. Through high-performance networks, direct contracts, reference-based pricing, and virtual care partnerships, we deliver ~$150 in medical management savings per member per year, outperforming mainstream carriers.
Covet's team has deep experience in software engineering and data science. Our API and data infrastructure enables expedited implementation, automation in plan administration, and greater control of plan risk using clinical data. Real-time reporting sits on our SQL database and updates continuously.
We prioritize integrity and transparency with no hidden costs and no surprise vendor fees. Our pricing model is customized based on lives covered, demand, and specific benefit structuring. All SLA performance data is accessible to clients as a matter of policy.
A Third Party Administrator (TPA) plays a crucial role in the management of self-funded health plans. In a self-funded plan, the employer assumes the financial risk of providing healthcare benefits and contracts a TPA to handle the administration of that plan.
TPAs process and pay health claims according to the employer's plan design, ensuring charges are reasonable and payments are accurate and timely. Beyond claims, TPAs manage enrollment and member services, regulatory compliance (ERISA, ACA), and data reporting so employers can make informed decisions about their plan.
Employers choose TPAs to leverage expertise that leads to significant cost savings through established provider networks, negotiated rates, and customizable plan designs not available in fully-insured arrangements. The result: employers focus on their core business while the TPA ensures their benefits program runs smoothly.
Accurate, timely evaluation and payment of provider claims per your plan design.
Managing who is covered, handling life events, and guiding members through the enrollment process.
Keeping your plan compliant with ERISA and ACA mandates, with data you can act on.