T J UNIVERSITY GRP Market Analysis: Market Share and Coverage by State

Payer Overview

T J UNIVERSITY GRP is a regional health insurer with a focused national footprint that places it among the mid-tier commercial and A&H payers. The organization ranks as the #60 largest US A&H payer by premium, reporting $2.63B in US premium and a 0.18% US market share while operating across 2 states. The carrier serves an estimated 301.5K members and operates through 2 affiliated subsidiaries, which supports its concentrated position in a small number of markets.

The payer does not hold a #1 ranking in any state. Its premium is concentrated in a limited geographic footprint, and there is no reported presence in US territories or foreign markets in the available data. This concentrated scale suggests negotiating leverage and network strategy will be state-specific rather than nationally uniform.

Premium by Scope

T J UNIVERSITY GRP's premium is exclusively reported in the US States & DC scope, representing 100.00% of its documented premium. There is no reported premium for US territories or foreign jurisdictions in the provided data. For providers, this concentration means contracting and network strategy should focus on the onshore state markets where the payer operates rather than allocating resources to territory or international negotiations.

T J UNIVERSITY GRP's premium and membership are highly concentrated in Pennsylvania, with $2.62B of premium and about 301K members located there. New Jersey represents a very small footprint by comparison at $3.36M and 466 members. This level of concentration means the payer's negotiating leverage and network design will be heavily influenced by Pennsylvania market dynamics rather than by a broad multi-state strategy.

For provider contracting nationally, the payer's presence implies that large provider systems with significant Pennsylvania exposure should prioritize engagement. National provider groups with limited footprint in Pennsylvania will see limited impact from this payer, whereas systems anchored in the Northeast, especially Pennsylvania, should expect meaningful commercial enrollment and reimbursement interactions with T J UNIVERSITY GRP.

State-by-State Market Position

T J UNIVERSITY GRP's strongest presence is in the Northeast, specifically Pennsylvania, where it holds its highest market share and the vast majority of premium and members. There is a minimal presence in adjacent New Jersey. Other US regions (Midwest, South, West, Southwest) show no reported exposure, indicating a geographically narrow operating area.

For multi-state provider groups, this distribution means the payer is primarily relevant to networks and contracting teams operating in the Northeast. Health systems concentrated in Pennsylvania will find the payer strategically important for commercial negotiations, while those with limited or no Pennsylvania exposure will see little benefit from dedicating significant contracting resources to this carrier.

The Affordable Care Act (ACA) established federally-facilitated health insurance marketplaces ("exchanges") where individuals and small businesses can shop for and enroll in health plans, often with income-based subsidies. Issuers that participate in these marketplaces are required to report enrollment, claims, and denial data to CMS (Centers for Medicare & Medicaid Services) each year.

The sections below cover this payer's ACA marketplace-specific footprint — enrollment, plan portfolio, and claims/denial-rate data. This is a narrower, separate population from the NAIC-based commercial data shown earlier on this page (total premium, market share, and membership across all lines of business): ACA marketplace enrollment is typically a small fraction of a payer's total commercial book, and the two datasets should not be treated as equivalent. CMS claims-transparency reporting has also been inconsistent industry-wide since 2020 — many issuers have little or no data for 2021 onward, so a single reporting year is common and does not necessarily indicate anything about the payer's current ACA presence.

Estimated Member Demographics

Nationally, the largest age bands for T J UNIVERSITY GRP are 55–64 (45,678 members), 6–18 (43,900 members), and 35–44 (41,276 members). The adult population (ages 26–64) makes up the majority of the membership, with a significant presence in the 65+ segment as well. The pediatric population (under 18) is substantial but not dominant.

State-level analysis shows Pennsylvania as the overwhelming center of membership, with over 301,000 members compared to just 466 in New Jersey. The age distribution in both states closely mirrors the national profile, with no state showing a dramatic skew toward either younger or older populations. This suggests a relatively balanced risk pool, though the small New Jersey population may be more variable year-to-year.

Estimated Members by State

T J UNIVERSITY GRP's estimated membership is highly concentrated in Pennsylvania, which accounts for 301,033 of the total national members. New Jersey has a very small presence, with only estimated members. No other states report a significant member count for this payer, and the aggregate 'Other' categories do not provide specific member estimates.