NIGP 94976: Self Insured Program, Medical

NIGP 94976 Self Insured Program, Medical is an Item code encompassing medical plan administration, pharmacy benefit management, and stop-loss reinsurance for self-funded employee health plans operated by state and local public bodies. State and local governments procure comprehensive medical third-party administration (TPA) services, pharmacy benefit management (PBM) services delivered as carved-out or bundled offerings, claims processing and payment, utilization and disease management, wellness program coordination, and reinsurance or stop-loss coverage to cap catastrophic claim exposure. Solicitations show buyers evaluating self-funded medical administration alongside fully-insured alternatives, with vendors frequently competing to provide integrated TPA and PBM solutions or standalone PBM services layered atop existing medical plans. School districts and local health care districts represent the primary issuing bodies under this code, supplemented by municipal employee benefits trusts and county human resources departments.

Recent activity concentrates in Texas and Georgia. Northside Independent School District in San Antonio issued RFP 2026-076 (due May 6, 2026) for Medical TPA and Pharmacy Benefit Management Services serving approximately 18,000 covered members, replacing an expiring contract and requiring vendors to choose between standalone TPA, standalone PBM, or fully integrated bundled offerings, with transparent pass-through pharmacy pricing and dedicated member services staffing mandated. Austin Independent School District posted RFP 27RFP016 (due August 4, 2026) seeking Pharmacy Benefit Management services for its self-funded employee health plan, explicitly evaluating traditional, alternative, and emerging pharmacy models. Travis County Healthcare District d/b/a Central Health issued two overlapping RFPs—RFP 2605-004 (due June 11, 2026) for comprehensive medical ASO, prescription drug benefits, fully-insured dental, and vision coverage spanning approximately 2,000 eligible lives with $4.68 million in rolling 12-month catastrophic claims, and RFP 2604-002 (due May 26, 2026) covering the same scope with mandatory pre-proposal conference on May 5, 2026. The City of Temple (on behalf of the City of Temple Employee Benefits Trust) posted RFP270327 (due June 26, 2026) for self-insured medical and pharmacy administrative services with stop-loss reinsurance. The Unified Government of Athens-Clarke County, Georgia, issued RFP 26034 (due May 12, 2026) for employee and retiree medical benefits administration serving approximately 1,500 benefit-eligible employees and 800 retirees, accepting self-funded medical administration, fully-insured plans, or both.