Medical Services

The vendor is required to provide medical benefits administrator for their self-funded PPO plans, currently through Aetna.
1. Plan design
• The city’s employees are governed by collective bargaining agreements.
• Approximately 70% of the city's workforce are members of 16 unions.
• Any medical plan administrator must be able to administer all of the current plan designs – some of which are grandfathered as defined by the aca.
• The city of offers 12 separate PPO medical plan options, consisting of 8 active plans and 4 pre-65 retiree plans.
• Plan designs are outlined in the 'plan designs' tab of the “medical RFP plans and financial template” document.
• Plan SPDs are also provided for reference. vendors are asked to match each plan design as it's currently stated.
• Any deviations must be outlined in the 'plans deviations' tab of the “medical RFP plans and financial template” document.
2. Provider network
• Provide a proposal based on your broad PPO network to ensure minimal member disruption.
• All financial proposals should be based on this broad PPO network.
• Network should include a robust mental health/substance abuse network, as well as virtual primary care and specialty care.
• Complete the network access and provider disruption (NAPD) templates in order for the city to review potential member disruption
• Learning about your capabilities in offering alternate networks (high performing, narrow or other) for the future.
• Provide information about these networks in your responses on the 'network' tab of the “medical custom questionnaire exhibit” document.
3. Member service and administration
• Provide concierge level service for members, including superior clinical programs and support integration.
• Implementing and serving similarly sized public entity employers, provide flexible administration to accommodate the city’s unique benefit configurations, and provide exceptional service for the city's benefits team.
• The “medical custom questionnaire exhibit” document - tabs: 'member service & advocacy', 'clinical support and high cost', 'general administration, and 'account manag. and references.
4. Inclusion and belonging
• The city is looking for a partner who can support and enhance the city’s inclusion and belonging efforts.
5. Innovation and technology
• Provide member access to a user-friendly, customizable online web portal and app, widely accessible from work and home.
• This should include advanced technology tools and superior user experience with digital tools, as well as innovative patient-engagement tools or programs to promote improved care outcomes and plan efficiency.
6. Financial
• The following tabs on the "medical RFP plans and financials template" document: 'ASO fees exhibit', 'underwriting assumptions', 'carrier credits', 'shared savings' and 'performance guarantees'.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: June 13, 2025