11-RFP-27-00026 Benefits Consulting and Actuarial Services.pdf

Request for Proposals Benefits Consulting and Actuarial Services

RFP-27-00026

RFP-27-00026 Page 1

IMPORTANT! PLEASE READ CAREFULLY BEFORE SUBMITTING PROPOSAL

SOLICITATION TYPE: Competitive Sealed Proposals

SOLICITATION NUMBER: RFP-27-00026

SOLICITATION TITLE: Benefits Consulting and Actuarial Services

BRIEF DESCRIPTION: The Hillsborough County Board of County Commissioners (County) is seeking competitive sealed proposals from experienced and well-qualified Contractors to provide comprehensive employee benefits consulting and actuarial services in support of the County's employee benefits and wellness programs for a five (5)-year period.

DUE DATE & TIME: December 9, 2026, 2:00 PM Eastern Time as recorded by the County’s Electronic Bidding System)

ISSUING DEPARTMENT DIRECTOR:

The Director of Procurement is considered the issuing department director for the purpose of Section 2-567(c) of the Hillsborough County Procurement Protest Policy and Procedures Ordinance.

PROPOSAL SUBMISSION: The County will only accept proposals submitted through its electronic bidding system (Euna Procurement). Proposals that are submitted or delivered by non-electronic means (hard-copy paper), facsimile, electronic mail (e-mail), electronic file, or means other than through the County's electronic bidding system (Euna Procurement) will not be accepted or considered. Please visit our vendors webpage (hcfl.gov/vendors) for information regarding vendor registration, electronic bid submission, procurement opportunities, and other important resources.

TIMELINESS: To preserve the integrity of the competitive sealed proposal process, proposals submitted after the due date and time listed above, unless otherwise amended, cannot and will not be accepted. Please do not wait until the last minute, hour, or day to submit your proposal, as you may encounter technical difficulties or issues that cannot be resolved before the due date and time. When preparing to submit your proposal, please read and follow all instructions regarding formatting and other details related to the form(s) to be used. Again, please do not wait until it’s too late for assistance. We value and need your participation, so the last thing we want is for you to miss this opportunity.

QUESTIONS: ● Questions regarding technical difficulties or errors encountered while submitting proposals through Euna Procurement must be directed to Euna Procurement Support at 1-844-226-3862 or support.bonfire@eunasolutions.com.

mailto:support.bonfire@eunasolutions.com

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● Questions regarding the specifications or solicitation document must be directed to Procurement Services using the “messages” section in Euna Procurement for this particular procurement.

● To be given consideration, such requests must be received no later than 14 calendar days after the date of Solicitation issuance in Euna Procurement, site visit, or pre-proposal conference, whichever is later.

● Questions regarding vendor registration, training, or general questions must be directed to the Supplier Engagement Team at (813) 272-5790 or iSupplier@HCFL.gov.

CONE OF SILENCE: A Cone of Silence is in effect for this procurement; therefore, no proposer, interested party and/or their principals, officers, employees, attorneys, or agents shall communicate with County employees, the Hearing Master assigned to hear the applicable protest appeal and/or members of the Board of County Commissioners, including their aides and employees regarding this procurement and/or a related protest, except as otherwise provided in the Hillsborough County Procurement Protest Policy and Procedures Ordinance. The Cone of Silence does not prohibit a proposer from communicating with the Director of Procurement, staff in the Procurement Services Department, or the County’s attorney assigned to this procurement. Violating the Cone of Silence may disqualify the proposer from consideration for award. Please refer to the Instructions for complete details about the Cone of Silence.

INSURANCE: Insurance coverage is required for this procurement. Please see RFP-27-00026 Insurance Requirements Attachment and Special Terms and Conditions.

SURETY (BONDS): Proposal, performance, and/or payment surety is not required for this procurement.

E-VERIFY: The Department of Homeland Security's Image Program and E-Verify apply to this procurement. Please see General Terms and Conditions for complete details and requirements.

DIGITAL ACCESSIBILITY COMPLIANCE:

Any and all information and communications technology developed, provided, procured, maintained, or otherwise made available under this Contract and intended for public access or use, shall comply with various accessibility standards. Please see General Terms and Conditions for complete details and requirements.

INSTRUCTIONS TO PROPOSERS:

Please see Sections 1.7., 1.8., and 4. for various instructions for Proposers.

https://library.municode.com/fl/hillsborough_county/codes/code_of_ordinances,_part_a?nodeId=HICOCOORLA_CH2AD_ARTVIPR_DIV3HICOPRPRPOPR_S2-562TI https://library.municode.com/fl/hillsborough_county/codes/code_of_ordinances,_part_a?nodeId=HICOCOORLA_CH2AD_ARTVIPR_DIV3HICOPRPRPOPR_S2-562TI

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1. SPECIFICATIONS

1.1. Scope

1.1.1 The Hillsborough County Board of County Commissioners (County) is seeking competitive sealed proposals from experienced and well-qualified Contractors to provide comprehensive employee benefits consulting and actuarial services in support of the County's employee benefits and wellness programs.

1.1.2 The County seeks to establish a long-term strategic partnership with an experienced, innovative consulting firm to serve as its trusted advisor in the planning, administration, evaluation, procurement, financial management, and continuous improvement of employee and retiree benefit programs, with particular emphasis on the County's self-funded medical and pharmacy plans.

1.1.3 Services shall include in-house actuarial analysis; integrated medical and pharmacy claims analytics; specialized pharmacy consulting; financial forecasting; industry benchmarking and best-practice analysis; cost-management strategy; implementation support; procurement assistance;

vendor evaluation and performance management; compliance support; wellness and population health strategy; retiree health strategy; and other related employee benefit consulting services.

1.1.4 The Successful Contractor shall provide objective, data-driven, vendor-neutral recommendations; exceptional customer service; and strategic guidance that supports competitive, sustainable, accessible, and financially responsible employee benefit programs. The Contractor shall convert analytics into practical recommendations, implementation plans, quantified financial impacts, and measurable results.

1.2. Objectives

1.2.1 The purpose of this solicitation is to procure a qualified employee benefits consulting and actuarial services firm that will serve as the County's strategic advisor in the planning, administration, evaluation, procurement, financial management, and improvement of its employee and retiree benefits program.

1.2.2 The Contractor shall assist the County in maintaining a financially sound self-funded health plan; provide actuarial analysis and financial forecasting; conduct integrated medical and pharmacy claims analysis; identify and prioritize opportunities to improve employee health outcomes while controlling costs; provide robust plan-design and industry benchmarking; support procurement, implementation, and vendor management; provide proactive compliance guidance; utilize advanced analytics to support decision-making; and deliver objective, innovative consulting services throughout the Contract term.

1.2.3 The County seeks a long-term consulting partner to:

1.2.3.1 Maintain the financial sustainability of the self-funded health plan while protecting access, quality, and affordability.

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1.2.3.2 Improve forecasting accuracy, reserve management, contribution modeling, and multi-year budget planning.

1.2.3.3 Provide robust, integrated medical and pharmacy claims analysis that identifies the specific drivers of cost, trend, utilization, and member outcomes.

1.2.3.4 Optimize pharmacy plan performance through specialized clinical, financial, contractual, formulary, specialty drugs, medical-benefit drugs, and pharmacy benefits management analysis.

1.2.3.5 Provide credible public- and private-sector industry analysis regarding plan design, emerging practices, vendor strategies, and market developments.

1.2.3.6 Develop and support implementation of cost-management initiatives with quantified savings, implementation costs, member impacts, risks, timelines, and accountable owners.

1.2.3.7 Enhance behavioral health, wellness, preventive care, chronic-condition management, and population health initiatives based on demonstrated value.

1.2.3.8 Strengthen vendor accountability, procurement outcomes, contract compliance, and financial recovery.

1.2.3.9 Ensure County and County program(s) compliance with applicable federal and state laws and maintain clear accountability for required filings, analyses, and notices.

1.2.3.10 Improve the employee and retiree experience through clear communications, informed decision support, and responsive administration.

1.2.3.11 Provide strategic leadership, measurable outcomes, and continuous improvement throughout the Contract term.

1.3. Background

1.3.1 Hillsborough County administers a large public-sector employee benefits programs in the State of Florida. The County currently administers employee and retiree benefit programs for approximately 12,000 covered members which include active employees, benefits-enrolled retirees, and family members. Participating agencies include:

1.3.1.1 Administrative Office of the Courts

1.3.1.2 County Administrator's Office

1.3.1.3 Clerk of the Circuit Court

1.3.1.4 Children’s Board of Hillsborough County

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1.3.1.5 Hillsborough County Property Appraiser

1.3.1.6 Tampa Hillsborough County Expressway Authority

1.3.1.7 Tampa Sports Authority

1.3.2 The County sponsors a comprehensive employee benefits program designed to attract and retain a highly qualified workforce while maintaining long-term financial sustainability and responsible stewardship of public funds.

1.3.3 The following attachments have been provided for your reference and use.

1.3.3.1 Attachment A - Sample Plan Design Modeling

1.3.3.2 Attachment B - Sample Health Plan Projection

1.3.3.3 Attachment C - Sample Financial Medical Report

1.3.4 Current Benefits Program Overview:

1.3.4.1 The County currently sponsors or administers self-funded medical and pharmacy plans, a high-deductible health plan with a health savings account, preferred provider organization medical plan, flexible spending accounts, wellness program, employee assistance program, section 125 cafeteria plan, dental, vision, life insurance, short- and long-term disability, stop-loss insurance, and a variety of employee-paid voluntary benefits.

1.3.4.2 During the term of this Contract, the County reserves the right to add consulting and brokerage services for existing employee-paid benefit programs, including dental, vision, and voluntary benefits, when such services are determined to be in the best interest of the County.

1.3.4.3 Nothing herein shall obligate the County to transfer any existing employee-paid benefit contracts to the awarded Contractor.

1.4. Applicable Publications, Terminology, and Acronyms

The following publication(s) of the issue in effect on date of this solicitation, forms a part of this specification:

1.4.1 State of Florida Statutes, 112.08, Group insurance for public officers, employees, and certain volunteers; physical examinations.

https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&U RL=0100-0199/0112/Sections/0112.08.html https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0100-0199/0112/Sections/0112.08.html https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0100-0199/0112/Sections/0112.08.html

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1.4.2 Governmental Accounting Standards Board (GASB)

https://gasb.org/

1.4.3 Patient-Centered Outcomes Research Institute.

https://www.pcori.org/

1.4.4 American Institute of Certified Public Accountants, Certified Investment Management Analyst, System of Organization Controls, Key Elements of a SOC 2 Report.

https://www.aicpa-cima.com/resources/video/key-elements-of-a-soc-2-report-resources-for-management

1.4.5 Centers for Medicare & Medicaid Services, No Surprises Act https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills

The following terminology forms a part of this specification:

1.4.6 “Cadence” shall mean the regular frequency or schedule of an activity.

1.4.7 “Cafeteria Plan” shall mean the County’s Section 125 employee-benefits plan. It allows employees to choose certain benefits, such as pre-tax health-plan premiums, health FSA, or dependent-care FSA and pay for eligible benefits with pre-tax salary deductions.

The following acronyms form a part of this specification:

ACA Affordable Care Act AI Artificial Intelligence AICPA American Institute of Certified Public Accountants CIMA Certified Investment Management Analyst COBRA Consolidated Omnibus Budget Reconciliation Act EAP Employee Assistance Program FSA Flexible Spending Account GASB Governmental Accounting Standards Board GLP Glucagon Like Peptide HSA Health Savings Account IBNR Incurred But Not Reported KPI Key Performance Indicator NDC National Drug Code NQTL Nonquantitative Treatment Limitation OPEB Other Post-Employment Benefits PCORI Patient-Centered Outcomes Research Institute PBM Pharmacy Benefits Management https://gasb.org/ https://www.pcori.org/ https://www.aicpa-cima.com/resources/video/key-elements-of-a-soc-2-report-resources-for-management https://www.aicpa-cima.com/resources/video/key-elements-of-a-soc-2-report-resources-for-management https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills

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PMPM Per Member Per Month PPO Preferred Provider Organization ROI Return on Investment Rx Prescription RxDC Prescription Drug Data Collection SOC System and Organization Controls TPA Third-Party Administrator

1.5. Minimum Requirements

1.5.1 The Proposer or principal thereof shall demonstrate recent and relevant experience in providing services substantially similar in scope, size, and complexity to those required under this solicitation. Failure to demonstrate appropriate and verifiable experience is grounds for rejection.

As the customer, the County will have sole discretion in determining whether a Proposer or principal thereof possesses adequate experience and capability.

1.5.2 The Contractor shall comply with the requirements outlined in Attachment D - Cyber Security Requirements.

1.5.3 The Contractor shall not limit its role to producing standard renewal reports or vendor summaries. The Contractor shall independently analyze available data, explain methodology and limitations, translate findings into actionable recommendations, support implementation, and measure actual results against projected outcomes.

1.5.4 The Contractor shall provide comprehensive employee benefits and actuarial consulting services; prepare and complete self-funded health plan filings; prepare Governmental Accounting Standards Board (GASB) 74/75 valuations; complete employee benefits audits; and provide ad hoc consulting and special projects services, as per the Bid Pricing Table, to support the County's employee and retiree benefit programs. Services shall be performed in accordance with industry best practices, applicable federal and state law, and the requirements of this solicitation.

1.5.5 The Contractor’s analyses and recommendations shall identify the data source, measurement period, methodology, assumptions, material limitations, estimated financial impact, operational requirements, employee and retiree impacts, labor-relations considerations when applicable, implementation timeline, and method for measuring results.

1.5.6 Key Personnel

The Contractor shall provide, at a minimum, the following key personnel, ensuring personnel are properly qualified and certified in accordance with applicable federal and state law, and the requirements of this solicitation:

1.5.6.1 Lead Benefits Consultant with demonstrated experience in public-sector consulting.

1.5.6.2 Dedicated in-house Actuary.

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1.5.6.3 Dedicated in-house Pharmacy Consultant with demonstrated experience in PBM, pharmacy claims, specialty-drugs, and medical-benefits drugs. A Pharmacist or other clinically qualified pharmacy professional is preferred.

1.5.6.4 Dedicated Medical Claims/Data Analytics Lead with experience integrating and analyzing large self-funded plan datasets.

1.5.6.5 Dedicated Account Manager to serve as the primary point of contact.

1.5.6.6 Subject matter experts available for compliance, behavioral health, wellness, retiree health, communications, procurement, audit, data security, and implementation support.

1.5.6.7 The County reserves the right to approve proposed replacements for key personnel.

Replacements shall have qualifications equal to or greater than the individual being replaced.

1.5.7 Strategic Benefits Consulting

1.5.7.1 The Contractor shall develop a three (3) to five (5) year strategy for self-funded medical, pharmacy, behavioral health, wellness, retiree health, ancillary benefits, funding, and employee contributions.

1.5.7.2 The Contractor shall evaluate plan design, affordability, competitiveness, workforce needs, administrative feasibility, and financial sustainability.

1.5.7.3 The Contractor shall provide proactive executive guidance on material market, regulatory, clinical, and vendor developments.

1.5.7.4 The Contractor shall provide an annual strategic benefits plan, annual renewal strategy, and executive decision memos.

1.5.7.5 The Contractor shall prepare and provide Board presentations, quarterly market updates, and a decision calendar.

1.5.8 Integrated Data Management & Governance

1.5.8.1 The Contractor shall obtain, inventory, normalize, and validate available eligibility, medical, pharmacy, medical-benefit drug, stop-loss, vendor, provider, and financial data.

1.5.8.2 The Contractor shall integrate medical and pharmacy data using de-identified member-level identifiers when permitted.

1.5.8.3 The Contractor shall reconcile consultant analytics to TPA, PBM, stop-loss, and County financial reports.

1.5.8.4 The Contractor shall identify data gaps, delays, inconsistencies, and limitations.

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1.5.8.5 The Contractor shall provide the following:

1.5.8.5.1 Data inventory and data map

1.5.8.5.2 Data dictionary

1.5.8.5.3 Implementation data-validation reports

1.5.8.5.4 Monthly data-feed status

1.5.8.5.5 Quarterly reconciliation reports

1.5.8.5.6 Secure County dashboard access

1.5.8.5.7 Downloadable data and other reports, as requested.

1.5.9 Medical & Health Plan Performance

1.5.9.1 The Contractor shall analyze claims, paid and allowed costs, PMPM costs, utilization, trend, high-cost claimants, chronic and complex conditions, episodes of care, provider performance, quality, network access, out-of-network use, behavioral health, preventive care, avoidable emergency care, site of care, place of service, value-based arrangements, care-management programs, member cost sharing, disparities, and member experience.

1.5.9.2 The Contractor shall distinguish changes in unit cost, utilization, intensity, and population mix.

1.5.9.3 The Contractor shall provide the following:

1.5.9.3.1 Monthly executive dashboard

1.5.9.3.2 Quarterly claims and utilization reports

1.5.9.3.3 Annual medical-plan deep dive; cost-driver analyses

1.5.9.3.4 High-cost claimant and emerging-risk reports

1.5.9.3.5 Network and site-of-care analyses

1.5.9.3.6 Prioritized recommendations with financial estimates.

1.5.10 Pharmacy Benefits Performance

1.5.10.1 The Contractor shall provide specialized pharmacy consulting using pharmacy and medical claims.

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1.5.10.2 The Contractor shall analyze NDC-level and therapeutic-class trends, unit cost, utilization, drug mix, brand/generic/specialty use, adherence, discontinuation, prescriber patterns, formulary performance, rebates, biosimilars, specialty channels, emerging therapies, GLP-1 drugs, cell and gene therapies, infused and injectable drugs, J-code claims, and site-of-care opportunities.

1.5.10.3 The Contractor shall evaluate PBM pricing guarantees, spread, administrative fees, rebate arrangements, specialty-pharmacy margins, affiliate revenue, contract compliance, and market competitiveness.

1.5.10.4 The Contractor shall provide the following:

1.5.10.4.1 Quarterly pharmacy trend reports

1.5.10.4.2 Annual specialty and emerging-therapy forecasts

1.5.10.4.3 PBM performance scorecards

1.5.10.4.4 Rebate and fee reconciliation

1.5.10.4.5 Guarantee testing

1.5.10.4.6 Formulary and utilization-management reviews

1.5.10.4.7 Biosimilar and site-of-care analyses

1.5.10.4.8 Pharmacy forecasts

1.5.10.4.9 Annual PBM market checks

1.5.10.4.10 Recommendations with savings and member-impact estimates.

1.5.11 Behavioral Health & Wellness

1.5.11.1 The Contractor shall evaluate behavioral health access, utilization, network adequacy, EAP, tele-behavioral health, substance-use services, preventive care, wellness participation, chronic-condition management, health coaching, navigation, vendor overlap, engagement, outcomes, administrative burden, and return on investment.

1.5.11.2 The Contractor shall recommend continuation, redesign, consolidation, or termination based on demonstrated value.

1.5.11.3 The Contractor shall provide the following:

1.5.11.3.1 Behavioral health access and utilization reports

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1.5.11.3.2 Wellness and population-health dashboards

1.5.11.3.3 Annual program-value and ROI assessments

1.5.11.3.4 Vendor overlap analyses

1.5.11.3.5 Prioritized program recommendations.

1.5.12 Retiree Health Strategy

1.5.12.1 The Contractor shall evaluate pre-Medicare and Medicare-eligible retiree claims, plan design, contribution and subsidy policy, Medicare Advantage, Employer Group Waiver Plan options, retiree drug subsidy alternatives, access, affordability, communications, transition support, and OPEB implications.

1.5.12.2 The Contractor shall coordinate recommendations with the County's active employee and long-term financial strategies.

1.5.12.3 The Contractor shall provide the following:

1.5.12.3.1 Annual retiree-health strategy reviews

1.5.12.3.2 Pre-Medicare and Medicare market analyses

1.5.12.3.3 Financial and OPEB impact modeling

1.5.12.3.4 Implementation alternatives

1.5.12.3.5 Retiree communication recommendations.

1.5.13 Actuarial & Financial Services

1.5.13.1 The Contractor shall prepare funding analyses, reserve studies, IBNR estimates, contribution modeling, budget-to-actual monitoring, stop-loss analyses, claim projections, trend development, plan migration modeling, three (3) to five (5)-year forecasts, GASB and OPEB valuations, PCORI analysis, Florida Statute 112.08 analyses, and other financial modeling.

1.5.13.2 The Contractor shall reconcile projections to actual experience and explain material variances.

1.5.13.3 The Contractor shall provide the following:

1.5.13.3.1 Actuarial reports

1.5.13.3.2 Monthly or quarterly budget-to-actual reporting

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1.5.13.3.3 Annual funding and contribution recommendations

1.5.13.3.4 Three (3) to five (5)-year forecasts

1.5.13.3.5 Reserve certifications

1.5.13.3.6 Stop-loss analyses

1.5.13.3.7 Financial models

1.5.13.3.8 Projection variance reports

1.5.14 Data Analytics, Benchmarking & Predictive Modeling

1.5.14.1 The Contractor shall develop accessible dashboards, predictive models, trend analyses, KPIs, demographic analyses, customized reports, and executive analytics.

1.5.14.2 The Contractor shall benchmark the County against relevant public and private sector employers. For every benchmark, disclose source, effective date, population, sample size, percentile, methodology, and material limitations. Include plan design, employee contributions, actuarial value, utilization, total cost, pharmacy, specialty drugs, network strategy, vendor fees, and emerging practices.

1.5.14.3 The Contractor shall provide the following:

1.5.14.3.1 Executive dashboards

1.5.14.3.2 Annual Benefits Market and Best-Practice Reports

1.5.14.3.3 Peer-group analyses

1.5.14.3.4 Predictive-risk reports

1.5.14.3.5 KPI scorecards

1.5.14.3.6 Methodology appendices

1.5.14.3.7 Ad hoc analyses

1.5.15 Cost-Management Roadmap & Implementation

1.5.15.1 The Contractor shall identify, evaluate, prioritize, and support implementation of initiatives to reduce or avoid cost while maintaining appropriate access, quality, affordability, and employee experience. Each initiative shall include gross and net savings, implementation cost, assumptions, timing, member disruption, labor-relations impact, operational workload, risks, mitigation, accountable owner, and measurement approach. Examples may include

RFP-27-00026 Page 13 plan design, network strategy, site of care, centers of excellence, direct contracting, navigation, specialty pharmacy, formulary, stop-loss, eligibility, vendor consolidation, and care management.

1.5.15.2 The Contractor shall provide the following:

1.5.15.2.1 Annually: A three (3) to five (5)-year Health Plan Cost-Management Roadmap.

1.5.15.2.2 Initiative business cases, as requested.

1.5.15.2.3 Implementation workplans, as requested.

1.5.15.2.4 Executive decision materials, as requested.

1.5.15.2.5 Quarterly progress reports.

1.5.15.2.6 Annually: Actual-versus-projected savings validations.

1.5.16 Vendor Management & Procurement (does not include any Voluntary Benefits procurement that the awarded Contractor may bid on).

1.5.16.1 The Contractor shall evaluate the TPA, PBM, stop-loss carrier, wellness, behavioral health, navigation, communications, and all other benefit vendors.

1.5.16.2 The Contractor shall establish service and financial performance measures; monitor guarantees; conduct market checks; support RFP development, evaluation, negotiations, contracting, implementation, transition, renewal, and performance remediation.

1.5.16.3 The Contractor shall maintain vendor-neutral recommendations and document potential conflicts.

1.5.16.4 The Contractor shall provide the following:

1.5.16.4.1 Vendor scorecards

1.5.16.4.2 Procurement strategy and documents

1.5.16.4.3 Proposal evaluations

1.5.16.4.4 Financial normalization

1.5.16.4.5 Finalist support

1.5.16.4.6 Negotiation recommendations

1.5.16.4.7 Implementation and transition plans

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1.5.16.4.8 Contract-performance reports

1.5.16.4.9 Corrective action plans

1.5.17 Audits & Financial Validation

1.5.17.1 The Contractor shall, upon County request, perform or coordinate independent review of medical claims administration, PBM claims and contract performance, rebates, administrative fees, pricing guarantees, stop-loss reimbursements, eligibility, and other material financial terms.

1.5.17.2 The Contractor shall use claims-level testing where appropriate.

1.5.17.3 The Contractor shall identify overpayments, underperformance, and recoveries

1.5.17.4 The Contractor shall support corrective action and recovery through resolution.

1.5.17.5 The Contractor’s audit personnel shall be appropriately qualified and independent of the vendor being reviewed.

1.5.17.6 The Contractor shall provide the following:

1.5.17.6.1 PBM rebates, fees, and guarantees reconciliation

1.5.17.6.2 Annual vendor-guarantee validation

1.5.17.6.3 PBM contract and claims audit

1.5.17.6.4 Medical and pharmacy claims administration audit

1.5.17.6.5 Recovery logs

1.5.17.6.6 Final audit and remediation reports

1.5.18 Compliance & Regulatory Support

1.5.18.1 The Contractor shall provide proactive guidance and assigned responsibility for ACA, HIPAA, COBRA, Section 125, HSA/FSA, Mental Health Parity, transparency requirements, No Surprises Act, RxDC, Gag Clause Prohibition Compliance Attestation, nondiscrimination testing, plan documents, required notices, and other applicable requirements.

1.5.18.2 The Contractor shall monitor legislative and regulatory developments; assess operational impact; and support audits, inquiries, and corrective action.

1.5.18.3 The Contractor shall provide the following:

1.5.18.3.1 Annual compliance calendars

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1.5.18.3.2 Quarterly compliance updates

1.5.18.3.3 Annual compliance reviews

1.5.18.3.4 RxDC and attestation support

1.5.18.3.5 NQTL comparative-analysis support

1.5.18.3.6 Nondiscrimination testing

1.5.18.3.7 Plan-document review

1.5.18.3.8 Issue-specific guidance and corrective-action support

1.5.19 Communications and Employee Education

1.5.19.1 The Contractor shall develop clear, accessible, culturally responsive employee and retiree communications, benefit guides, open-enrollment materials, presentations, Board materials, decision-support resources, campaign strategies, and education plans.

1.5.19.2 The Contractor shall evaluate communication effectiveness, participation, comprehension, channel performance, and enrollment outcomes.

1.5.19.3 The Contractor shall provide the following:

1.5.19.3.1 Benefits guides

1.5.19.3.2 Open-enrollment communications, presentations, communication plan and calendar

1.5.19.3.3 Decision-support content

1.5.19.3.4 Post-enrollment effectiveness reports

1.5.19.3.5 Board materials

1.5.20 Implementation & Change Management

1.5.20.1 The Contractor shall provide project management for approved benefit, vendor, plan-design, data, and cost-management initiatives.

1.5.20.2 The Contractor shall define scope, roles, dependencies, decision rights, risks, testing, readiness, communications, training, escalation, and post-implementation validation.

1.5.20.3 The Contractor shall coordinate with the County, participating agencies, unions when applicable, Finance, Procurement, Information Technology, vendors, and other stakeholders.

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1.5.20.4 The Contractor shall provide the following:

1.5.20.4.1 Project charters

1.5.20.4.2 Integrated implementation plans

1.5.20.4.3 Responsibility matrices

1.5.20.4.4 Risk and issue logs

1.5.20.4.5 Readiness assessments

1.5.20.4.6 Testing and acceptance documentation

1.5.20.4.7 Post-implementation reviews

1.5.21 Optional Employee-Paid Benefits Brokerage

1.5.21.1 The Contractor shall, upon County authorization, provide brokerage and consulting for dental, vision, life, disability, and voluntary benefits, including market analysis, procurement, financial review, implementation, and ongoing vendor management.

1.5.21.2 The Contractor shall maintain complete compensation transparency and avoid tying the award of core consulting services to transfer of brokerage arrangements.

1.5.21.3 The Contractor shall provide the following:

1.5.21.3.1 Market analyses

1.5.21.3.2 Procurement support

1.5.21.3.3 Financial disclosures

1.5.21.3.4 Vendor recommendations

1.5.21.3.5 Implementation assistance

1.5.21.3.6 Ongoing performance reports

1.5.22 Ad Hoc Consulting and Special Projects

1.5.22.1 The Contractor shall provide dependent eligibility audits, upon County request, market studies, executive presentations, legislative analyses, plan-document updates, nondiscrimination testing, special financial or workforce analyses, and other HR or benefits consulting services reasonably related to the Scope of Work.

1.5.22.2 The Contractor shall provide the following:

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1.5.22.2.1 Audit reports

1.5.22.2.2 Market studies

1.5.22.2.3 Special analyses

1.5.22.2.4 Plan-document review

1.5.22.2.5 Executive presentations

1.5.22.2.6 Project-specific recommendations and workplans

1.5.23 Performance Management and Service Delivery

1.5.23.1 The Contractor shall provide proactive account management, continuity of key personnel, timely responses, regular onsite and virtual meetings, performance monitoring, issue escalation, continuous-improvement recommendations, and an annual work plan.

1.5.23.2 The Contractor shall maintain a central action log and ensure that recommendations are completed or formally dispositioned by the County.

1.5.23.3 The Contractor shall provide the following:

1.5.23.3.1 Annual work plans

1.5.23.3.2 Monthly operational meetings

1.5.23.3.3 Quarterly strategic reviews

1.5.23.3.4 Annual planning sessions

1.5.23.3.5 Action and decision logs

1.5.23.3.6 Service metrics

1.5.23.3.7 Annual performance reports

1.5.23.3.8 Continuous improvement plans

1.5.24 Consulting Responsibility and Analytical Standards

1.5.24.1 The Contractor shall independently analyze available data and shall not rely solely on summaries produced by the TPA, PBM, carrier, or other vendor.

1.5.24.2 All material conclusions shall be traceable to source data and supported by documented methodology, assumptions, limitations, and calculation logic.

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1.5.24.3 The Contractor shall distinguish observations from recommendations and shall identify the expected financial, operational, clinical, workforce, employee-relations, and labor-relations implications of each material recommendation.

1.5.24.4 The Contractor shall provide editable work products and explain analytical models sufficiently for County staff and auditors to understand and validate material results.

1.5.24.5 The County retains final decision-making authority. The Contractor remains accountable for the quality, completeness, and professional defensibility of its analyses and recommendations.

1.5.25 Cost-Management and Savings Validation

1.5.25.1 Savings estimates shall separately identify gross savings, implementation costs, vendor fees, member cost shifts, net County savings, timing, one-time versus recurring impact, and the degree of confidence in the estimate.

1.5.25.2 The Contractor shall not characterize member cost shifting as plan savings without separately disclosing the transfer of cost to employees or retirees.

1.5.25.3 The Contractor shall maintain an initiative register showing status, owner, milestones, projected savings, actual savings, barriers, and corrective action.

1.5.25.4 At least annually, the Contractor shall reconcile projected savings to actual results and explain material variances.

1.5.25.5 Recommendations involving clinical management shall consider access, quality, continuity of care, equity, member disruption, and appropriate clinical oversight.

1.5.26 Meeting Cadence and Responsiveness

1.5.26.1 The Contractor shall attend the following:

1.5.26.1.1 Annual strategic planning session

1.5.26.1.2 Annual renewal strategy meeting.

1.5.26.1.3 Monthly operational and financial review meetings, unless the County approves another cadence.

1.5.26.1.4 Quarterly strategic performance reviews with HR leadership and other County stakeholders.

1.5.26.1.5 In-person participation in Executive Team, Board, procurement, labor, vendor, annual reviews, strategic, and implementation meetings upon County request.

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1.5.26.2 The Contractor shall acknowledge any request, marked as urgent by the County within four (4) Business Hours and routine requests within one (1) Business Day, with a mutually agreed completion date for substantive work.

1.5.26.3 The Contractor shall provide a current action, decision, risk, and issue log maintained by the Contractor and reviewed at regular meetings.

1.5.27 Performance Guarantees

1.5.27.1 The Proposer shall recommend meaningful, measurable performance guarantees covering service responsiveness, data timeliness and accuracy, deliverable quality, reporting cadence, financial reconciliation, implementation support, and key-person continuity.

1.5.27.2 The proposal shall place no less than ten percent (10%) of the annual consulting fee at risk, subject to final negotiation and County approval.

1.5.28 Data Ownership, Security, Technology, and AI

1.5.28.1 County Data Ownership: All County data, data extracts, normalized data files, dashboards, models developed specifically for the County, analyses, reports, and other work products shall remain the property of the County, subject to any documented pre-existing proprietary tools of the Contractor.

1.5.28.2 Data Access and Portability: The County shall have timely access to its data and reports in commonly used, nonproprietary formats. Upon request or termination, the Contractor shall provide a complete data export, current data dictionary, open items, and transition documentation.

1.5.28.3 HIPAA and Confidentiality: The Contractor and applicable subcontractors shall execute a Business Associate Agreement and comply with all applicable privacy, confidentiality, and records requirements.

1.5.28.4 Security Controls: The Contractor shall describe encryption, access controls, multifactor authentication, logging, vulnerability management, incident response, business continuity, disaster recovery, secure development, and independent security assessments. A current SOC 2 Type II report or equivalent evidence is strongly preferred.

1.5.28.5 Incident Notification: The Contractor shall notify the County, by email, within 24 hours of any suspected or confirmed incident affecting County data and shall comply with contractual investigation, mitigation, notification, and cooperation requirements.

1.5.28.6 Subcontractors and Sub-processors: The Contractor shall identify all subcontractors and sub-processors that may access County data and shall remain fully responsible for their performance and compliance.

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1.5.28.7 Artificial Intelligence: The Contractor shall disclose any use of artificial intelligence that influences or contributes to analysis, recommendations, communications, or service delivery. County data shall not be used to train a shared or public AI model without prior written County authorization. AI-assisted output shall be subject to qualified human review, quality control, security, privacy, and traceability requirements.

1.5.28.8 Data Retention and Destruction: The Contractor shall maintain a documented retention schedule and, upon County direction or termination, securely return or destroy County data and certify completion, subject to applicable law and records requirements.

1.5.29 Independence, Conflicts, and Compensation

1.5.29.1 The County requires objective, independent, and vendor-neutral advice. This Employee Benefits Consulting and Actuarial Services Contract shall be strictly fee-for-service and commission-free with respect to all consulting services performed for the County. The Contractor's sole compensation for services under this Contract shall be the fees paid directly by the County in accordance with the agreed-upon pricing and fee schedule, as per the Proposal Pricing Table.

1.5.29.2 The Contractor shall not solicit, accept, receive, retain, or otherwise benefit from any commission or other vendor-related compensation arising from or associated with County business or benefits consulting services provided under this Contract. This prohibition applies whether such compensation is paid directly or indirectly to the Contractor, an affiliate, subsidiary, parent company, subcontractor, or other related entity.

1.5.29.3 Nothing in this Contract shall entitle the Contractor to commissions or other brokerage compensation in connection with the consulting services provided to the County.

Any brokerage services separately requested or procured by the County shall be subject to separate Modification, written terms and compensation requirements and shall not alter the commission-free, fee-for-service nature of this Employee Benefits Consulting Contract.

1.5.29.4 The Contractor shall act in the County's best interest within the scope of the engagement and shall disclose actual, potential, or perceived conflicts before providing a recommendation.

1.5.29.4.1 Disclose ownership interests, affiliate relationships, preferred-vendor arrangements, revenue-sharing arrangements, and financial incentives that could influence recommendations.

1.5.29.4.2 Do not accept or retain vendor-related compensation associated with County business without prior written County approval. Any approved compensation shall be fully disclosed and, when required by the County, credited against County fees.

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1.5.29.4.3 Separate optional brokerage compensation from the fixed fee for core consulting services. The award of core consulting services shall not require transfer of existing brokerage arrangements.

1.5.29.4.4 Update conflict and compensation disclosures annually and whenever a material change occurs.

1.5.29.4.5 Identify any audit, consulting, or implementation service that would involve reviewing the Contractor's own work or the work of an affiliate and propose safeguards to preserve independence.

1.6. Cost Proposal

1.6.1 The annual Employee Benefits Consulting Services fee, as per the Bid Pricing Table Lines 1- 1 through 1-3 shall be a comprehensive, fixed fee that includes all services, tasks, deliverables, meetings, analyses, reports, routine data management, dashboard access, travel, implementation support, and consulting activities described in this solicitation, whether specifically requested on a recurring basis or provided on an as-needed basis, unless separately identified on the Pricing Proposal.

1.6.2 The annual Employee Benefits Consulting Services fee, as per the Bid Pricing Table Lines 1- 1 through 1-3 shall include, at a minimum, strategic consulting; integrated medical and pharmacy claims analytics; specialized pharmacy consulting; medical, pharmacy, retiree, behavioral health, and wellness strategy; vendor management; procurement support; compliance guidance;

employee communications; benchmarking; cost-management roadmap development;

implementation support; executive presentations; RFP development; proposal review and recommendations; routine actuarial consulting; PCORI fee analysis; nondiscrimination testing;

Section 125 Cafeteria Plan document reviews and updates; legislative analyses; travel and related expenses; meetings, both virtual and onsite; and all other routine consulting services required to perform the Scope of Work.

1.6.3 The County may negotiate audit timing and combine or separate audit services based on operational need, independence, and value.

1.7. Instructions to Proposers

The Proposer shall submit a comprehensive Proposal that meets or exceeds the minimum qualifications and requirements of these specifications. The Proposer’s response shall include the following:

1.7.1 Executive Summary:

1.7.1.1 Cover Page

1.7.1.2 Name and title of the Proposer’s contact representative for the County, as well as the name and title of the engagement manager, if different from the contact representative.

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1.7.1.3 Provide firm history, ownership, office locations, organizational structure, financial capacity, and public-sector client profiles.

1.7.2 Firm and Staff Qualifications.

1.7.2.1 Identify all proposed team members, roles, location, employment status, percentage of time, availability, years of experience, and relevant credentials.

1.7.2.2 Identify all affiliates, subcontractors, data partners, audit firms, and technology providers; describe their roles and contractual relationship.

1.7.2.3 Short biographies of the Lead Consultant, Actuary, Pharmacy Consultant, Medical Claims/Data Analytics Lead, Account Manager, and other key subject matter experts.

1.7.2.4 Unique qualifications and capabilities that distinguish the Proposer or Proposer’s key personnel from its competitors.

1.7.2.5 Firm’s ability to provide robust public- and private-sector benchmarking, plan-design analysis, and best-practice recommendations.

1.7.2.6 Firm’s ability to provide onsite and virtual consulting services.

1.7.2.7 Firm’s ability to provide presentations to the Executive Team and/or Board of County Commissioners upon request.

1.7.2.8 Firm’s ability to comply with the County's data-security, confidentiality, insurance, records, procurement, and contracting requirements.

1.7.2.9 Firm’s ability to provide redacted sample deliverables, dashboards, pharmacy reports, cost-management roadmaps, and executive reports that demonstrate the proposed level of service.

1.7.3 References

1.7.3.1 Provide a minimum of three (3) comparable public-sector client references, demonstrating the following:

1.7.3.1.1 Experience with a self-funded plan.

1.7.3.1.2 Experience performing integrated medical and pharmacy claims analysis.

1.7.3.1.3 Experience providing specialized pharmacy consulting, including PBM contract analysis, rebate and guarantee validation, specialty pharmacy, medical-benefit drugs, emerging therapies, and pharmacy cost-management strategy.

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1.7.3.1.4 Experience developing and implementing quantified health-plan cost-management initiatives and validating actual results.

1.7.3.1.5 Experience with retiree medical strategy and public-sector retiree populations.

1.7.3.1.6 Experience supporting competitive procurements for self-funded health plans, PBMs, stop-loss coverage, and other benefits such as dental, vision, life, and disability.

1.7.3.1.7 Experience with GASB, OPEB, PCORI, and Florida Statute 112.08 or comparable state reporting.

1.7.4 SOC 2 Type II or equivalent assessments

1.7.5 Disaster Recovery Plan

A copy of Proposer’s disaster recovery plan

1.7.6 Technical Approach

1.7.6.1 Describe Proposer’s understanding of the County's priorities, including robust medical and pharmacy analytics, specialized prescription-drug consulting, plan-design and best-practice analysis, cost-management initiatives, and implementation support.

1.7.6.2 Provide a summary of the proposed service model, key commitments, and expected value to the County.

1.7.6.3 Describe account governance, escalation, key-person continuity, quality assurance, succession, and executive sponsorship.

1.7.6.4 Describe the approach, methodology, staffing, frequency, and deliverables for each Scope of Work area.

1.7.6.5 Provide a detailed first-year work plan and recurring annual service calendar, including data onboarding, meetings, reports, renewal, strategy, audits, procurement, compliance, and implementation activities.

1.7.6.6 Describe how the Proposer will distinguish data findings from recommendations and translate analysis into executive decisions and implementation.

1.7.6.7 Describe how the Proposer will identify, quantify, prioritize, implement, and validate cost-management initiatives.

1.7.6.8 Describe the proposed performance guarantees and service metrics.

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1.7.7 Response Questionnaire

A completed Response Questionnaire.

1.7.8 Samples

1.7.8.1 Provide representative, redacted samples of the dashboards, reports, pharmacy analyses, benchmarking studies, strategic plans, cost-management roadmaps, implementation plans, scorecards, audit reports, and executive materials proposed for the County.

1.7.8.2 Provide redacted sample funding, forecast, retiree, or stop-loss deliverables.

1.7.8.3 Provide a redacted sample Benefits Market and Best-Practice Report.

1.7.8.4 Provide redacted sample pharmacy trend, specialty pipeline, PBM scorecard, and rebate or guarantee validation deliverables.

1.7.8.5 Provide a redacted sample medical-plan dashboard and quarterly or annual deep-dive report.

1.7.9 Case Studies

1.7.9.1 Provide at least two (2) case studies demonstrating measurable results for a self-funded employer, including baseline, intervention, implementation role, projected savings, actual savings, measurement period, member impact, and client reference.

Clearly distinguish results directly attributable to the Proposer from results attributable to plan changes, vendor performance, member cost shifting, market conditions, or other factors.

1.7.9.2 At least one (1) case study demonstrating advanced pharmacy analysis and measurable pharmacy cost-management results.

1.7.9.3 At least one (1) case study demonstrating integrated medical and pharmacy data analysis and implementation of a cost-management initiative.

1.8. Proposal Response (Attachments)

The Proposer shall submit as their proposal the following required attachments. Note: Euna Procurement has a file size limitation of 1GB.

1.8.1 Submit with Proposal

1.8.1.1 Proposer Requirements/Acknowledgements Questionnaire

1.8.1.2 Deviation(s) Questionnaire (Optional)

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1.8.1.3 Proposer Acknowledgement(s) of Addenda (if applicable)

1.8.1.4 Declaration of Documents Exempt from Public Disclosure (Optional, if applicable)

1.8.1.5 Executive Summary

1.8.1.6 Firm and Staff Qualifications

1.8.1.7 References

1.8.1.8 SOC 2 Type II or equivalent assessment

1.8.1.9 Disaster Recovery Plan

1.8.1.10 Technical Approach

1.8.1.11 Response Questionnaire

1.8.1.12 Samples

1.8.1.13 Case Studies

1.8.2 Complete upon County’s Request

1.8.2.1 Insurance Certificate

1.8.2.2 W-9 or Substitute W-9

1.8.2.3 Business Associate Agreement

1.8.2.4 Cyber Security Questionnaire

2. SPECIAL TERMS AND CONDITIONS

2.1. Evaluation/Selection Process

2.1.1 The County will review and evaluate all Proposals submitted in response to this Solicitation Document. The evaluation process is designed to award the Contract to the Proposer with the best combination of attributes as demonstrated in the Proposal scores. Scores are based on the evaluation of the information contained in Proposer's Proposal which include, but is not limited to, Proposer's responses to the questions set forth in the Requirements Section of this Solicitation Document and any corresponding attachments including a brief description of methodology, qualifications, experience, and the cost of the Services/Work.

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2.1.2 Evaluation Procedures

The evaluators will consider how well the Proposer's Proposal meets the needs of the County as described in the Proposer's response to each question in this Solicitation Document. It is important that the responses be clear and complete so that the evaluators can adequately understand all aspects of the response. Please follow all instructions carefully.