How does your health insurance plan work?
Your health plan involves several organizations, each with specific responsibilities. Understanding the roles of your agent, carrier, and TPA will help you get answers faster.
How health insurance plan works — each role explained
- Your agent sold you your plan and explained your coverage options
- Your carrier underwrites your coverage and decides claims
- Premier Health Solutions handles billing and account administration after enrollment
- Each party has a specific job and knowing who does what saves time when you have questions
Understanding these roles helps you get answers faster when you have a question or concern.
What Is a TPA?
A Third-Party Administrator (TPA) is a company that handles the day-to-day operations of your health plan — things like billing, claims processing, member support, and account management. The insurance carrier or employer contracts with a TPA to manage these services. When you see PHS-HEALTH-BILL on your billing statement, that's Premier Health Solutions performing these administrative services for your plan. This is completely normal and expected.
Your agent sold your plan
Your health or supplemental benefit plan was sold by a licensed independent insurance agent or agency. These professionals are not employed by Premier Health Solutions.
Contact your agent with questions about:
- Enrollment and enrollment confirmation
- Plan options you discussed
- What was explained during the sales process
- How you were enrolled (online, by phone, in person)
Your agent's information is usually in your welcome email or enrollment documents.
Your carrier underwrites your coverage
Your coverage is provided and underwritten by the insurance carrier or program administrator named in your plan documents.
This carrier:
- Assumes the insurance risk
- Sets your coverage terms and benefits
- Decides claims and coverage questions
- Handles any appeals you may file
You'll find the carrier's name on your ID card, in your plan documents, and in your Member Portal. Questions about what's covered or how your benefits work should go to this carrier.
Premier Health Solutions is your TPA
Premier Health Solutions, LLC is a Third-Party Administrator (TPA). Our role begins after you enroll.
We handle:
- Billing and payment processing
- Account administration and updates
- Member portal access and support
- Helping you find the right contact or document
- Billing and account questions
We do NOT:
- Sell health insurance or health-related products to consumers or enroll members directly
- Underwrite coverage
- Make claims decisions
Common questions
A licensed independent insurance agent or agency sold your plan. They are not employed by Premier Health Solutions. Questions about enrollment should go to that agent.
The insurance carrier or program administrator shown in your plan documents underwrites (provides) your coverage. They also decide claims and coverage questions.
Premier Health Solutions is a Third-Party Administrator (TPA). We handle billing, account administration, member portal access, and support after you enroll. We do not sell health insurance or health-related products to consumers or enroll members directly.
Contact the carrier or program administrator listed on your ID card for coverage, claims, or benefit questions. These are the people who actually manage your benefits.
Your plan documents are in your Member Portal at myhealthmembers.com. You should have received a link in your welcome email.
If something about your plan doesn't match what you were told during enrollment, you can report it through our Consumer Protection and Complaints process for review.