Group Medical Insurance Services

The vendor required to provide group medical insurance coverage and administrative services are being solicited for an effective date of July 1, 2026, for an ongoing plan year of July 1, 2026, through June 30, 2027.
- Provide medical claims administration, provider network, medical management and utilization review, disease management, and wellness services on an ASO basis.
- Important information regarding
•    The county is interested in a medical carrier (or carriers) who will provide a “bundled” medical plan, to include ASO services, for medical claims administration, disease management, utilization and case management, and wellness. 
•    Carriers must be able to securely share incoming and outgoing files with clear script for accumulators and stop loss purposes. 
•    The county is interested in obtaining medical ASO services on both a sole carrier and slice carrier arrangement.
•    The county will be looking at all possible network options including a single network option and multiple network options. however, it is the county’s primary goal to offer its members access to both Lovelace, UNM, and presbyterian networks 
•    Stop loss closer to the July 1, 2026 effective date. 
•    The county may also wish to consider a stand-alone stop loss contract, so vendors quoting medical ASO services must allow the county to carve out stop loss. 
•    Stand- alone stop loss quotes will not be accepted at this time.
•    The county is not interested in considering stand-alone wellness proposals. 
•    The county is seeking vendors who will offer performance guarantees. 
•    All proposals should include details of the performance guarantees being offered.
•    The county currently has approximately 2,370 eligible employees. refer to the census for an exact count. 
•    The county covers the following eligible members: 
o    Employee: permanent employees (including those on probation), elected officials, and unclassified employees working 20+ hours per week. no retiree coverage. 
o    Spouse: legal spouse, including domestic partners (same and opposite sex). 
o    Children: birth to end of the month dependent becomes 26. 
o    Date eligible for coverage: first day of current pay period. 
•    No commission or any other broker compensation is to be included in proposed rates or fees.
- Medical coverage
1. Self-funded medical
•    ASO fees must be guaranteed for 2 years (no increase in year 2). 
•    A 3-year guarantee is preferred.
•    Proposals will be accepted from ASO carriers capable of offering the following services on a bundled basis:
o    Medical claims administration
o    Provider network (in and out of state)
o    Utilization management, case management, and disease management. 
o    Required to identify those disease management and wellness services that are included in your ASO fee, as well as optional services available at an additional cost.
o    Communication materials (including plan document, booklet and SPD, and open enrollment materials)
- Plan designs and parameters:
1. Medical
•    Duplicate the current plan designs as closely as possible.
•    Quote on a self-funded basis only.
•    Self-funded coverage should be quoted both as a sole carrier offering and as a slice carrier offering.
•    Quote ASO fees on a PEPM basis.
•    Provide a dedicated account management and service team to support the county benefits staff. 
•    Include the names, positions and background of the team that will be assigned to service the account.
•    Concise resumes must be included as well.
2. Medical geo access parameters
•    2 PCPs within 10 miles
•    1 specialist within 10 miles
•    1 hospital within 10 miles.

- Contract Period/Term: 4 years
- Non-Mandatory Pre-Proposal Conference Date: December 17, 2025
- Questions/Inquires Deadline: January 5, 2026