Medicare Supplement and Part D Pharmacy Insurance Services

The Vendor is required to provide Medicare Supplement Plans, and a Medicare Part D Employer Group Waiver Plans (EGWP) benefits to retirees on a fully insured basis for government and participating agencies as their County-sponsored health plans for their eligible Medicare retirees and eligible Medicare spouses.
- Medicare eligible retirees and Medicare eligible dependents under the age of 65 are offered the Medicare plans but allowed to remain on the self-funded plan. Medicare eligible retirees and Medicare eligible dependents age 65 and older will only be allowed to enroll in the County’s Medicare plans.
- The County’s Third Party Administrator (TPA), currently WEX, handles eligibility, enrollment, and billing for county retirees.
- The plans and premiums being provided by the Contractor will be for 2026 and currently approved by the Centers for Medicare & Medicaid Services (CMS) and the Office Regulation, as applicable. 
- A client service manager or Project Manager, with experience in retiree health and pharmacy plans, will be assigned to work with the County or the County’s Third Party Administration (TPA) during the implementation process, during annual enrollment, and through the life of the contract. 
- A telephonic customer service component for specific questions on the Contractor’s plans will be provided and will be accessible to Members and the County during regular business hours.
- Eligibility information will be updated monthly and accessible on-line. Eligibility discrepancy reports shall be provided to the County or the County’s TPA on a monthly basis. 
- Online web-based and telephonic customer service and education tools will be made available to Plan Members. 
- The Contractor shall have the ability to accept monthly premium payments from the County or the County’s TPA on a group billing basis. 
- The Plans will have no pre-existing condition limitations and will be guaranteed, issued for current and future plan Members.
- Premiums for plans in County, when added to the Medicare Supplement Plan N benefit, will be lower than the current medical and pharmacy premium charged by the County for coverage which is currently nine hundred seventy-one dollars ($971) per month.