The vendor required to provide medical and dental TPA, pharmacy, and cobra administrative services to deliver cost-efficient, high-quality health benefits that support employee well-being, regulatory compliance, and fiscal responsibility through innovative administration, technology, and service excellence.
- Provide comprehensive employee health benefits administration services effective October 1, 2026 (fy27).
- Requirement:
1. Medical third-party administration
• Administer self-funded medical benefits in full compliance with ACA, HIPAA, CAA (consolidated appropriations act), transparency in coverage, and all other applicable laws.
• Maintain a broad network of providers offering open access (no referral requirements).
• Provide utilization management, case management, and disease management programs.
• Offer wellness and preventive-care initiatives, including telehealth and digital engagement options.
• Deliver real-time eligibility and claims processing with EDI and secure data exchange.
• Provide comprehensive standard and ad-hoc reporting, including plan performance, utilization, cost drivers, and trend analysis.
• Support integration with county HRIS and payroll systems for eligibility, billing, and reporting.
• Provide aca and act compliance reporting, including 1094/1095 processing, machine-readable files, and price transparency tools.
• Ensure robust member and administrative portals for self-service and analytics.
• Assign a dedicated account manager and provide annual performance review meetings.
2. Pharmacy benefit management (PBM)
• Administer pharmacy benefits either stand-alone or integrated with the medical plan.
• Offer transparent pass-through pricing and full rebate disclosure.
• Manage formulary design, prior authorization, specialty pharmacy coordination, and mail-order options.
• Provide member support tools, including cost comparison, preferred pharmacy locators, and mobile app access.
• Supply quarterly rebate reconciliation and utilization reporting.
• Ensure full compliance with drug pricing transparency and rebate reporting laws.
• Offer coordination with the county’s wellness and chronic-condition programs.
3. Dental third-party administration
• Administer self-funded PPO dental plan with a state-wide network.
• Provide competitive provider reimbursement and broad network access.
• Manage claims, coordination of benefits, and customer service.
• Supply network adequacy reports and member access tools.
• Offer preventive-care outreach and reporting on utilization and cost trends.
4. Cobra administration
• Provide full cobra administrative services for all health, dental, and pharmacy plans.
• Issue all required notifications and manage participant elections and payments.
• Maintain accurate records and monthly eligibility reports for county hr.
• Provide online access for participants and county staff.
• Ensure compliance with all applicable federal cobra regulations.
- Implementation and account management
• Develop and manage a comprehensive implementation plan, including timelines, milestones, testing, data conversion, and communication strategies.
• Assign a dedicated implementation manager and account team.
• Provide employee communication materials and assist with open-enrollment support.
• Conduct quarterly performance reviews and annual strategic planning sessions.
• Maintain 24/7 access to account management contacts for escalations.
- Questions/Inquires Deadline: February 17, 2026
