Medical and Dental TPA, Pharmacy, and Cobra Administrative Services

The vendor required to provide medical and dental TPA, pharmacy, and cobra administrative services to deliver cost-efficient, high-quality health benefits that support employee well-being, regulatory compliance, and fiscal responsibility through innovative administration, technology, and service excellence.
- Provide comprehensive employee health benefits administration services effective October 1, 2026 (fy27).
- Requirement:
1. Medical third-party administration
•    Administer self-funded medical benefits in full compliance with ACA, HIPAA, CAA (consolidated appropriations act), transparency in coverage, and all other applicable laws. 
•    Maintain a broad network of providers offering open access (no referral requirements). 
•    Provide utilization management, case management, and disease management programs. 
•    Offer wellness and preventive-care initiatives, including telehealth and digital engagement options. 
•    Deliver real-time eligibility and claims processing with EDI and secure data exchange. 
•    Provide comprehensive standard and ad-hoc reporting, including plan performance, utilization, cost drivers, and trend analysis. 
•    Support integration with county HRIS and payroll systems for eligibility, billing, and reporting. 
•    Provide aca and act compliance reporting, including 1094/1095 processing, machine-readable files, and price transparency tools.
•    Ensure robust member and administrative portals for self-service and analytics. 
•    Assign a dedicated account manager and provide annual performance review meetings.
2. Pharmacy benefit management (PBM)
•    Administer pharmacy benefits either stand-alone or integrated with the medical plan.
•    Offer transparent pass-through pricing and full rebate disclosure.
•    Manage formulary design, prior authorization, specialty pharmacy coordination, and mail-order options.
•    Provide member support tools, including cost comparison, preferred pharmacy locators, and mobile app access.
•    Supply quarterly rebate reconciliation and utilization reporting.
•    Ensure full compliance with drug pricing transparency and rebate reporting laws.
•    Offer coordination with the county’s wellness and chronic-condition programs.
3. Dental third-party administration
•    Administer self-funded PPO dental plan with a state-wide network.
•    Provide competitive provider reimbursement and broad network access.
•    Manage claims, coordination of benefits, and customer service.
•    Supply network adequacy reports and member access tools.
•    Offer preventive-care outreach and reporting on utilization and cost trends.
4. Cobra administration
•    Provide full cobra administrative services for all health, dental, and pharmacy plans.
•    Issue all required notifications and manage participant elections and payments.
•    Maintain accurate records and monthly eligibility reports for county hr.
•    Provide online access for participants and county staff.
•    Ensure compliance with all applicable federal cobra regulations.
- Implementation and account management
•    Develop and manage a comprehensive implementation plan, including timelines, milestones, testing, data conversion, and communication strategies. 
•    Assign a dedicated implementation manager and account team.
•    Provide employee communication materials and assist with open-enrollment support. 
•    Conduct quarterly performance reviews and annual strategic planning sessions. 
•    Maintain 24/7 access to account management contacts for escalations.

- Questions/Inquires Deadline: February 17, 2026