The Vendor is required to provide fully insured medicare advantage and prescription drug (MAPD) services to its medicare-eligible retirees and their medicare-eligible dependents.
- Comprehensive, high quality, cost-effective benefits to its medicare-eligible retirees and their medicare-eligible dependents.
- Considerations for the MAPD plan options being solicited include:
• Value of the benefit plans and services, taking into consideration the requirements of the proposal, proposed services and any "value-added" terms, conditions and service levels
• Cost of the proposed benefits and/or services
• Programs provided by the proposer designed and proven to minimize claim cost through medical management strategies and proper risk adjustment approaches
• Proven strategies to maximize star ratings and receive bonus subsidies from CMS
• Qualifications of the firm including financial capacity and staffing, and availability of staff to work with county during open enrollment and continue to support the county throughout the contract
• Proposer's experience with MAPD plans, commitment to such plans, and experience offering such plans to public sector employers
• Network management and provider access (medical and pharmacy)
• Formulary and clinical program management
• Ability to educate and communicate with retirees and families/caretakers
• Ability to educate, communicate with and support provider entities.
- Member services
• Include a toll-free line, with live representatives available 8:00 am – 8:00 pm ET, Monday-Friday.
• Weekend hours are strongly encouraged.
• The ability to communicate with member services via email or online “chat” is also desired
• Concierge/advocacy services for members – e.g., benefit education, assistance with confusing bills and claim issues, guidance and health resources following a difficult diagnosis, etc.
• Services to accommodate senior populations, non-English speaking, hearing and vision impaired members
• Accessible, user-friendly and robust website/member portal and mobile app – including decision tools.
- Network and provider management
• Maintain comprehensive national network of qualified cost-effective providers
• Maintain “current” directory of providers, and provider search tool
• Audit for un-bundling and up-coding of services
• Provide education and advocacy to providers regarding your MAPD plan offering(s)
- Communications to members regarding health-related topics, education, and benefit information
• Ability to translate materials into non-English languages and Braille
• Provide effective multi-modal member communications and education to Medicare-eligible retirees and their Medicare-eligible dependents
- Contract Period/Term: 1 year
- Pre-Proposal Conference Date: June 10, 2025
- Questions/Inquires Deadline: June 16, 2025