NIGP 94976: Self Insured Program, Medical

NIGP 94976 Self Insured Program, Medical, an Item code, encompasses administrative services, pharmacy benefit management (PBM), and reinsurance (stop-loss) solutions for government employee health plans that operate on a self-funded or partially self-funded basis. State and local governments currently solicit under this code for comprehensive medical plan administration, integrated pharmacy benefits, and catastrophic-claims protection, often bundled with ancillary coverage such as dental, vision, FSA, HRA, and HSA administration. The scope includes administrative services only (ASO) models where the government retains claims risk, as well as fully-insured alternatives where carriers assume underwriting risk. Issuing bodies span city governments, county healthcare districts, independent school districts, and municipal employee benefits trusts—typically mid-sized jurisdictions serving 400 to 2,000 active employees and their families.

Recent activity concentrates in Texas, with solicitations from the City of Pflugerville, Austin Independent School District, Travis County Healthcare District d/b/a Central Health, and the City of Temple all posted between April and August 2026. The City of Pflugerville issued RFP 2026-028 on August 19, 2026, due September 22, 2026, seeking fully insured medical, dental, vision, FSA, HRA, HSA, and COBRA administration for 422 employees with evaluation weighted toward cost (50%), claims processing capabilities (20%), integrated systems and technology (10%), network adequacy (10%), and past performance (10%). Travis County Healthcare District issued RFP 2604-002 on April 23, 2026, due May 26, 2026, for comprehensive medical ASO with bundled or carved-out pharmacy, fully-insured dental, and fully-insured vision across approximately 2,000 eligible lives, with 12-month medical claims experience showing $4.68 million in catastrophic claims alone. Austin Independent School District solicited pharmacy benefit management services under RFP 27RFP016 on July 17, 2026, due August 4, 2026, explicitly evaluating traditional, alternative, and emerging pharmacy models for its self-funded employee health plan. The City of Temple issued RFP 270327 on June 3, 2026, due June 26, 2026, for self-insured medical and pharmacy administration paired with reinsurance (stop-loss coverage).