The Vendor is required to provide network in administrative services only (ASO) medical plans services include:
• The county intends to keep their pharmacy portion of their program self-funded PBM (currently pro-act combined with CanaRX).
• Vendors are not to propose bundling the prescription drug benefit under the fully-insured premium scenarios.
• Responsible for all levels of claim appeals as required by law.
• The plan will have out of area coverage with a national network.
• Right to audit: the county reserves the right to an independent audit by an auditor of their choice.
• Bidder agrees to not charge for any expense incurred by the bidder for time necessary to prepare claim files.
• The cost of the third party to audit will be the responsibility of the vendor.
• provide your estimated network administration expense on a per employee per month (PEPM) basis on the proposed fee/rate structure.
• Please provide your estimated network administration expenses on a per employee per month (PEPM) basis on the fee/rate proposal.
• Provide a yearly guaranteed discount rate above two percent from the negotiated discount rates for inpatient, outpatient, ambulatory, professional services, and other services.
• Quarterly and annual analytical reports must show discounted rates from charges by type of services.
• Must provide upcoming yearly increases in discounted rates by October 1 of each year.
- Questions/Inquires Deadline: June 30, 2025