Medical and Pharmacy Benefits Manager Services

The Vendor is required to provide to procure medical plan administration services and pharmacy benefit management services for the Consortium employees, pre-65 retirees and their qualified dependents for a five (5) year period beginning January 1, 2028 through December 31, 2032, with the possibility of one (1) additional five-year renewal.
- The Consortium prefers a carved-in approach to these benefits to ensure ease of administration, capture bundled pricing considerations, and avoid disjointed reporting, however, it will consider separate proposals for medical and pharmacy services if, in its sole discretion, the Consortium determines that separate proposals provide the best value to the Consortium.
- The Consortium with the following health care strategies:
• Aggressively engage in efforts to improve the health of the employee population and their covered dependents, including wellness improvement, incentive programs, health risk assessment and chronic care management;
• Spreading risk across Consortium participants to reduce individual group cost volatility;
• Obtaining the best pricing for health care services by taking advantage of available medical, pharmaceutical, and provider network discounts for employees and their dependents;
• Implementing progressive coverage elements (i.e. value-based benefit designs and using the best providers incentives) to encourage and reward participants who seek high value care.
- All full-time employees working 30 or more hours per week and all permanent part-time employees working at least 20 hours per week with at least 36 calendar weeks per calendar year new employees have 14 days to make an election. Benefits begin on the first day of the month on or after date of hire.
- Provide high quality, innovative programs that offer comprehensive clinical support, seamless operations, effective administration and account management services, as well as comprehensive provider network access that best meet the needs of the Consortium’s population.
- Medical networks proposed for the Consortium allow 90% or more in-network accessibility to covered participants based on the criteria of 2 Primary Care Physicians (PCPs) within 8 miles and 85% or more in-network accessibility to covered participants based on the criteria of 2 Pediatricians within 8 miles.