11-RFP 28-26-NH Group Medical Proposal Document (Final).pdf

Bernalillo County

Request for Proposal # 28-26-NH

Group Medical Insurance Services

Non-Mandatory Pre-Proposal Conference December 17, 2025: 10:00 am (MST)

Deadline for Receipt of Proposals: January 14, 2026, 4:00 p.m. (MST)

The County eProcurement System will not allow Proposals to be submitted after this date and time.

Prepared by:

Bernalillo County

Purchasing Section November 2025

TABLE OF CONTENTS PAGE

I. INTRODUCTION

A. PURPOSE OF THIS REQUEST FOR PROPOSALS 3

B. SUMMARY SCOPE OF WORK 3

C. PROCUREMENT MANAGER 3

D. DEFINITION OF TERMINOLOGY 3-5

II. CONDITIONS GOVERNING THE PROCUREMENT

A. SEQUENCE OF EVENTS 6

B. EXPLANATION OF EVENTS 6-7

C. EVALUATION PROCESS 7-8

D. GENERAL REQUIREMENTS 8-11

III. RESPONSE FORMAT AND ORGANIZATION

A. NUMBER OF RESPONSES 12

B. PROPOSAL FORMAT 12

C. PROPOSAL ORGANIZATION 12-14

IV. SCOPE OF WORK 15-17

V. SUBMITTAL REQUIREMENTS 17

VI. EVALUATION CRITERIA 17-18

VII. PROPOSED DRAFT AGREEMENT 19-28

APPENDIX A - RANKING INFORMATION 29

APPENDIX B - APPLICATION OF PREFERENCES 30-31

APPENDICIES & ATTACHMENTS BELOW ARE REFERENCED IN THIS RFP AND UPLOADED

SEPARATELY

APPENDIX C - SUBMITTAL LETTER FORM

APPENDIX D - CAMPAIGN CONTRIBUTION DISCLOSURE FORM

APPENDIX E - UNFAIR BUSINESS PRACTICES DISCLOSURE FORM

ATTACHMENT 1 - PRESBYTERIAN EPO PLAN CERTIFICATE

ATTACHMENT 2 - BLUE CROSS BLUE SHEILD EPO PLAN CERTIFICATE

ATTACHMENT 3 - PRESBYTERIAN PPO PLAN CERTIFICATE

ATTACHMENT 4 - BLUE CROSS BLUE SHIELD PPO PLAN CERTIFICATE

ATTACHMENT 5 - CENSUS

EXHIBIT 1 - RFP DEVIATIONS

EXHIBIT 2 - MEDICAL COST AND SERVICES

EXHIBIT 3 - CLAIMS REPRICING

EXHIBIT 4 - QUESTIONNAIRE

I. INTRODUCTION

A. PURPOSE OF THIS REQUEST FOR PROPOSALS

The Bernalillo County (“County”) Purchasing Section of the Procurement and Business Services Department (“Purchasing”) is soliciting proposals from Offerors to provide superior claims administration related services to the County and their employee population.

Gallagher Benefit Services, Inc. (GBS), a division of Arthur J. Gallagher has been retained by Bernalillo County as their benefit consultants. Representatives from GBS are assisting Bernalillo County with review and analysis of all proposals submitted to Bernalillo County relating to their benefit programs. GBS will be providing consulting services only. Final selection of carriers and/or vendors to be contracted with will be done at the sole discretion of Bernalillo County.

B. SUMMARY SCOPE OF WORK

On behalf of Bernalillo County (“County”) the Purchasing Section of the Procurement and Business Services Department (“Purchasing”) is soliciting proposals from Offerors to provide medical claims administration, provider network, medical management/utilization review, disease management, and wellness services on an ASO basis.

The County will be looking at all possible network options including a single network option and/or multiple network options.

All insurance coverage and administrative services are being solicited for an effective date of July 1, 2026, for an ongoing Plan year of July 1, 2026, through June 30, 2027.

C. PROCUREMENT MANAGER CONTACT

Any inquiries or requests regarding this procurement should be submitted in writing to the designated Procurement Manager listed below. Attempts to contact anyone other than the Procurement Manager that the prospective Offeror believes can influence the procurement decision, i.e., Elected Officials, County Manager, Evaluation Committee Members, etc., may lead to immediate elimination from further consideration. All responses will be in writing and will be distributed to all potential Offerors who receive a copy of this Request for Proposals.

Nate Hopkins, Purchasing Manager Bernalillo County Purchasing 415 Silver Ave. SW, 6th Floor Albuquerque, New Mexico 87102

Telephone: (505) 527-2331 Fax: (505) 468-7067 E-mail nhopkins@bernco.gov

D. DEFINITION OF TERMINOLOGY

This Section contains definitions that are used throughout this Request for Proposals (RFP), including appropriate abbreviations.

“Addendum” means a change, addition or supplement to the information provided in this RFP document.

“Agreement” means a duly executed and legally binding contract.

“Contractor” means successful Offeror.

“Confidential” shall mean confidential financial information concerning Offeror’s organization and data that qualifies as a trade secret in accordance with the Uniform Trade Secrets Act NMSA 1978 57-3-A-1 to 57-3A-7 or as provided by the Confidential Materials Act (14-3A-1, 1978 14-3A- 2 NMSA 1978), and as otherwise provided by law. As one example, no information that could be obtained from a source outside this request for proposals can be considered confidential information.

“County” shall refer to the County of Bernalillo, New Mexico.

“Central Purchasing Office” means the County Purchasing Section.

“County Purchasing Section” means the purchasing agent for the County of Bernalillo, New Mexico, or a designated representative thereof.

“Desirable” means the terms “may”, “can”, “should”, “preferably”, or “prefers” identifies a desirable or a discretionary item or factor for the Department to determine.

“Determination” means the written documentation of a decision of a procurement manager including findings of fact required supporting a decision. A determination becomes part of the procurement file to which it pertains.

“Evaluation Committee" means a body appointed to perform the evaluation of Offerors’ proposals.

“Evaluation Committee Report” means a report prepared by the Procurement Manager on behalf of the Selection Committee that contains all written determinations resulting from the conduct of a procurement requiring the evaluation of competitive sealed proposals.

“Finalist” is defined as an Offeror who meets all the mandatory specifications of the RFP and whose score on evaluation factors is sufficiently high to qualify that Offeror for further consideration by the Selection Committee.

“Local Business Preference” means a business that holds a valid Resident or Native American Business/Contractor certificate issued by the State of New Mexico Taxation and Revenue Department and maintains an office and place of business in Bernalillo County, which is staffed and open to the public on a regular basis. If necessary, the County may seek additional information or proof to verify eligibility for the Local Business Preference, pursuant to §13-1-22 NMSA 1978 and Ordinance §2-367.

“Mandatory” means the terms “must”, “shall”, “will”, “is required”, or “are required”, identify a mandatory item or factor. Failure to meet a mandatory item or factor may result in the rejection of the Offerors’ proposal, without exception.

“Minor Technical Irregularities” means anything in the proposal that does not affect the price quality and quantity or any other mandatory requirement.

“Notice of Award” shall mean a formal written notice by the Purchasing Section.

“Offeror” is any person, corporation, or partnership who chooses to submit a proposal.

“Ordinance” means the Bernalillo County Procurement Ordinance, Chapter 2, Article V, Division 1 – 3 (§2-356 through 2-402).

“Pay Equity Preference” means any business that maintain a zero percent (0%) deviation between the salaries paid to men and salaries paid to women for comparable positions, as reported in the Pay Equity Reporting form that has been submitted by the Offeror.

“Preference Limitations” means the total amount of all preferences applied including the applicable State of New Mexico preferences, for the purchase of Tangible Personal Property, Services or Construction in any single award shall not exceed 18%, with the limit on State of New Mexico preferences as set forth under the New Mexico State Procurement Code. When applying the Bernalillo County preferences set forth in Ordinance §2-367, the total dollar amount of Bernalillo County preferences shall never exceed $180,000.00.

“Procurement Manager” means the person or designee authorized by the Purchasing Section to manage or administer procurements requiring the evaluation of competitive sealed proposals.

“Purchase Order” means the document, which directs a contractor to deliver items of tangible personal property or services pursuant to an existing Agreement.

“Request for Proposals” or “RFP” means all documents, including those attached or incorporated by reference, used for soliciting proposals.

“Resident Business Preference” means a business that has a valid resident or Native American resident business certificate issued by the New Mexico Taxation and Revenue Department pursuant to §13-1-22 NMSA 1978 and Ordinance §2-367 but does not include a resident veteran business.

“Resident Veteran Business Preference” means a business that has a valid resident veteran or native American Veteran business certificate issued by the New Mexico Taxation and Revenue Department pursuant to §13-1-22 NMSA 1978 and Ordinance §2-367.

“Responsible Offeror” means a business entity or individual who has the ability to fulfill the solicitation expectations and requirements, including but not limited to financial and technical capacity to perform the requirement of the solicitation and subsequent Contract.

“Responsive Offer” or “Responsive Proposal” means an offer or proposal which conforms in all material respects to the requirements set forth in the request for proposals, including all mandatory requirements and all of its requirements including all form and substance.

“Selection Committee” means a team established to evaluate proposals, conduct interviews, and assist with negotiations during proposal evaluation for a specific product or services. Teams typically represent the functional areas to be addressed in the discussions. The Procurement Manager shall provide only technical assistance requested by the committee.

“Small Business Preference” means a business that has a Local Business Preference eligibility documentation as well as an affidavit from a Certified Public Accountant (CPA) affirming that the business employs an average of fewer than 50 full-time employees in a calendar year. Ordinance 2-367.

“User Department” means a county department, office, unit or staff member for which procurement services are provided.

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II. CONDITIONS GOVERNING THE PROCUREMENT

This section of the RFP outlines and describes the major events of the Selection Process and specifies general requirements.

A. SEQUENCE OF EVENTS

The Procurement Manager will make every effort to adhere to the following schedule:

Action Responsibility Date

Issue of RFP County Purchasing Section December 14, 2025 Pre-Proposal Conference Purchasing/Committee/Offerors December 17, 2025

Deadline to Submit Questions Due 10:00 A.M.

Potential Offerors January 5, 2026

Written Response to Questions

Purchasing/Committee January 9, 2026

Submission of Proposal Offerors January 14, 2026 Proposal Evaluation Committee February 16, 2026 Status Notification:

Finalist(s)/non-finalist(s) Purchasing TBD

Interviews (if applicable) Committee/Finalist TBD Contract Negotiations Purchasing/Selection

Committee TBD

Award Bernalillo County Commission TBD

B. EXPLANATION OF EVENTS

1. Distribution of RFP Document – This RFP is issued by the Purchasing Section in accordance with the provisions of Ordinance §2-365 and 2-395. The Purchasing Section is the only organization who is authorized to make copies and/or distribute this RFP in any format. A distribution list of those who receive the RFP will be maintained throughout the procurement process and will become part of the procurement file. Receipt of a Proposal from Offerors not included on the distribution list shall result in immediate disqualification and Proposal shall be rejected. Additional copies of the RFP can be obtained from the Procurement Manager.

2. Pre-Proposal Conference – A non-mandatory pre-proposal conference will be held as indicated in the sequence of events beginning at 10:00 a.m. Mountain Standard Time on MS Teams only. To participate, join the meeting by phone, (Dial-In Number): 1-505-225- 7962. Phone conference ID: 977 360 621#. Meeting ID: 270 359 176 919 5, Passcode:

ht7CN34D. Attendance at the pre-proposal conference is not a prerequisite for submission of a proposal.

3. Deadline to Submit Written Questions – Prospective Offerors may submit written questions via the County’s public purchasing portal at https://bernco.bonfirehub.com (the “Portal”) and initiate the communication electronically through the Opportunity Q&A, https://bernco.bonfirehub.com/Opportunities until 10:00 am Mountain Standard Time/Daylight Time as indicated in the sequence of events. Questions shall be clearly labeled and shall cite the Section(s) in the RFP or other document which form the basis for the question.

The identity of the perspective Offeror submitting the question(s) will not be shared. A public log will be kept of the names of perspective Offerors that attended the conference.

4. Response to Written Questions – An Addendum will be issued in response to written questions. If the RFP requires a time extension, the proposal submission date will be changed as part of the written Addendum. Any Addendum issued prior to the submittal deadline shall become a part of the RFP.

5. Response to Written Additional Questions - An Addendum will be issued in response to additional written questions and will be distributed to all recipients of the original RFP. If the RFP requires a time extension, the proposal submission date will be changed as part of the written Addendum. Any Addendum issued prior to the submittal deadline shall become a part of the RFP.

6. Submission of Proposal – All Offeror proposals must be received for review and evaluation, no later than 4:00 PM Mountain Standard Time/Daylight Time on January 7, 2026. Submit your complete Proposal including all forms, attachments, exhibits, Technical Proposal, Cost Proposal, etc. using the eProcurement System at https://bernco.bonfirehub.com/login. If you do not have a username and password, please register as this is the only method to submit electronically at https://bernco.bonfirehub.com.

on the Portal.

All proposals must be received by the County’s Purchasing Section as specified herein.

Failure to comply with the submission requirements shall be cause for the County to determine the proposal submittal nonresponsive.

C. EVALUATION PROCESS

The Evaluation Process section contains specific information about the process of evaluating Offeror proposals.

1. Notice of Non-Responsiveness - For any proposal submitted which is deemed non-responsive the Offeror will be notified in writing of such determination by the Purchasing Section.

2. Selection Process - The Selection Committee will review each Offerors proposal. Points will be allocated, as outlined in Section VI of this RFP, by each member. Each member’s point totals will be translated into a numeric ranking of all proposals. The individual member rankings will be totaled together to determine the overall ranking of proposals. During this time, the Procurement Manager may initiate discussions with Offerors who submit responsive or potentially responsive proposals for the purpose of clarifying aspects of the proposal through oral presentations (interview) or the provision of information (either orally or written) deemed necessary to assist in the evaluation process. However, proposals may be accepted and evaluated without such discussion. Discussions SHALL NOT be initiated by the Offerors. Offerors are advised that the Selection Committee, at its option, may enter into the negotiation process with the highest ranked Offeror on the basis of the evaluation of the written proposals only, and may not require discussion and/or interviews. Upon completion of the selection process, the Selection Committee shall recommend the award of contract to the County Commission or their designee for approval. Each responsive Offeror will be notified in writing as to their status following the selection process.

3. Status Notification of Finalists/Non-Finalists – Each responsive Offeror will be notified in writing about the status of their proposal. This notification will include information regarding whether or not their proposal has been selected for the interview, negotiation process or award. Finalists will be those Offerors whose proposals have been selected to continue in either the interview, negotiation process or award. Non-finalists are those Offerors whose proposals have not been selected to continue in either the interview, negotiation process or award.

4. Best and Final Offers – Offeror(s) may be asked to submit revisions to their proposals for the purpose of obtaining best and final offers. Revisions may be for clarification of the proposal or to get the best price or for both. When applicable, the notification to Finalist(s) who have been selected to submit a best and final offer will include the date and time, the best and final offer must be submitted.

5. Interviews with Finalists – If applicable the notices for the Finalists who have been selected for interviews, will include the interview date and time. The interview location is at the discretion of the Selection Committee. Interview questions will be sent to finalists prior to interview by the Purchasing Section. Interview scoring will total 100 points. Each member’s https://bernco.bonfirehub.com/login https://bernco.bonfirehub.com/ point totals will be translated into a numeric ranking of all interviewed Finalists. The individual member rankings will be totaled together to determine the overall ranking of Finalists.

Rankings for the evaluation of written proposals are weighted 55% and ranking from the interviews are weighted 45% in determining the final selection as shown in Appendix A. The Offeror with the highest combined ranking (lowest numerical score) from the interview shall be recommended for award.

6. Negotiations – The County will begin negotiations with the highest ranked Offeror(s) following Finalist notification. Actual fees shall be negotiated based upon specific services, reimbursable expenses, and specific successful Offeror requirements. If negotiations are successful, the County shall prepare an Agreement for approval by the County Commission or its designee. If an agreement on terms cannot be reached within a reasonable time the County shall terminate negotiations and begin negotiations with the next firm on the ranking list. This process will continue until an Agreement has been negotiated with one of the firms on the ranking list. If an Agreement cannot be negotiated with the firms on the ranking list, the County may choose to negotiate with other qualified Offerors scored by the Committee or to terminate negotiations.

D. GENERAL REQUIREMENTS

The General Requirements section contains specific information about the process, general conditions, and instructions, which govern this procurement.

1. Protests - In accordance with Procurement Ordinance, §2-385, §2-367 and applicable procurement regulations, any Offeror who is aggrieved in connection with a solicitation, application of preferences and or award of an Agreement may protest to the Procurement and Business Services Director. The protest must be submitted in writing within fifteen (15) calendar days after knowledge of the facts or occurrences giving rise to the protest to:

Annie Baca, Procurement and Business Services Director Purchasing Section, 6th floor 415 Silver Ave. SW Albuquerque, NM 87102

Protests must include the name and address of the protestant, the solicitation number, and a statement of grounds for protest, including appropriate supporting exhibits. Protests received after the deadline will not be accepted.

2. Incurring Cost - Any cost incurred by the Offeror in preparation, transmittal, or presentation of any proposal or material submitted in response to this RFP shall be borne solely by the Offeror.

3. Application of Preferences - To ensure adequate consideration and application of Preferences pursuant to §13-1-21, NMSA 1978 and Ordinance 2-367, Offerors must include a copy of their State of New Mexico preference certificate and any additional documentation required for the County preferences with their proposal. Offerors are not eligible to receive both a Resident Business/Contractor Preference and a Resident Veteran Business/Contractor preference. The Preferences shall not apply when the expenditures for this RFP includes federal funds. See Appendix B for explanation and application for Preference eligibility.

4. Pay Equity Documentation - All Offerors shall include with their proposal submittal, a Pay Equity Reporting Form, or valid Pay Equity Business Certificate, which can be accessed at www.bernco.gov/general-services/pay-equity.aspx.

Offerors who are located out-of-state or have no facilities and no employees working in the State of New Mexico are not required to report pay equity data but must verify their out-of-state status on the Pay Equity Reporting Form. Failure to provide a Pay Equity Reporting Form at the time of submission may result in the Offer being deemed nonresponsive. The County may allow for a revised Pay Equity Reporting Form to be submitted by the Offeror within 24 business hours of the proposal due date and time if; (i) the originally submitted form requires a technical change; or (ii) the Offeror fails to include a Pay Equity Reporting

Form at the time of submission, provided that the Offeror submits the Pay Equity Reporting Form within the 24 hour business period.

NOTE: THE REQUIRED PAY EQUITY REPORTING FORM IS NOT A PAY EQUITY

BUSINESS CERTIFICATE, NOR DOES IT QUALIFY AN OFFEROR FOR THE PAY

EQUITY PREFERENCE. FOR QUESTIONS ON HOW TO OBTAIN A PAY EQUITY

BUSINESS CERTIFICATE AND QUALIFY FOR THE PREFERENCE, PLEASE CONTACT

THE PROCUREMENT MANAGER IN SECTION I.C BY TELEPHONE: (505) 527-2331 OR

EMAIL: nhopkins@bernco.gov

5. Subcontractors - The successful Offeror is responsible for performance by any subcontractor providing Services in connection with this RFP; payments to a subcontractor(s) are the responsibility of the successful Offeror. The successful Offeror is solely responsible for fulfillment of the contract agreement resulting from this RFP.

6. Amended Proposals - An Offeror may submit an amended proposal before the deadline for receipt of proposals. Such amended proposals must be complete replacements for a previously submitted proposal and must be clearly identified as such in the transmittal letter.

Purchasing Section personnel will not collate or assemble proposal materials.

7. Right to Reject Proposal - The County reserves the right to reject a proposal from any Offeror who has previously failed to perform properly, has caused the County to incur unreasonable costs or expense, failed to complete on time an agreement of a similar nature, or who is not in a position to perform the work governed by this RFP.

8. Offerors Rights to Withdraw Proposal - Offerors will be allowed to withdraw their proposals at any time, prior to the deadline for receipt of proposals. The Offeror must submit a written withdrawal request signed by the Offerors duly authorized representative addressed to the Director of the Purchasing Section. The approval or denial of withdrawal requests received after the deadline for receipt of the proposals is at the discretion of the Director of the Purchasing Section.

9. Disclosure of Proposal Contents - A public log will be kept of the names of all Offerors which submitted proposals. The proposals and documents pertaining to the proposals will be kept confidential throughout the duration of the procurement process and until a contract is awarded. At that time, all proposals will be open to the public, except for the material, which has been previously noted and deemed as proprietary or confidential.

10. Confidentiality/Public Records - Confidential data is normally restricted to confidential financial information concerning the Offerors organization and data that qualifies as trade secrets in accordance with the Uniform Trade Secrets Act, 57-3-A-1 to 57-3A-7 NMSA 1978, or as provided by the Confidential Materials Act (14-3A-1, 1978 14-3A-2 NMSA 1978), and as otherwise provided by law. With the exception of the aforementioned, information and materials received by the County in connection with this RFP response shall be deemed to be public records, subject to public inspection, upon award of the RFP and execution of an Agreement by the County Commission or their designee. If the Offeror believes any of the information contained in its response is exempt from the Inspection of Public Records Act (NMSA 1978, Chapter 14, Article 2), then the Offeror must identify the material deemed to be exempt and cite the legal authority for the exemption. Any pages of a proposal on which the Offeror has stamped or imprinted “proprietary” or “confidential” must be readily separable from the proposal in order to facilitate public inspection of the non-confidential portion of the proposal.

The County’s determination of whether an exemption applies shall be final, and the Offeror agrees to defend, indemnify, and hold harmless the County elected officials, employees and agents against any loss or damages incurred by any person or entity as a result of the County’s treatment of records as public records.

11. Cancellation - This RFP may be canceled at any time and any and all proposals may be rejected as a whole or in part when the Director of the Purchasing Section determines such action to be in the best interest of the County.

12. Sufficient Appropriation - Any Agreement awarded as a result of this RFP process may be terminated if sufficient appropriations or authorizations do not exist. Such termination will be effective by sending written notice to the Contractor. The County’s decision as to whether sufficient appropriations and authorizations are available is in the sole discretion of the County and shall be final and binding upon the Contractor.

If the determination is made that there is insufficient funding to continue or finalize the services the Contractor will be compensated to the level of effort performed, as authorized by the County prior to that determination.

13. Code of Conduct - The successful Offeror shall abide by the Code of Conduct (https://www.bernco.gov/compliance-office/bernalillo-county-code-of-conduct/) of the County as it applies to the successful Offeror’s interactions with the County. Any violation of the Code of Conduct shall be considered a breach of the Agreement (a draft of the proposed Agreement is included in Section VII).

14. Acceptance of Conditions Governing the Procurement - Offerors must indicate their acceptance of the Conditions Governing the Procurement, Section II, in the Submittal Letter Form. Submission of a proposal constitutes acceptance of all conditions contained herein including the evaluation factors contained in Section VI.

15. Standard Agreement - A draft copy of the proposed Agreement to be entered into is included in Section VII. However, the County reserves the right to negotiate with the successful Offeror provisions in addition to those contained in this RFP. The contents of this RFP, as revised and/or supplemented, and the successful Offeror's proposal will be incorporated into and become part of the Agreement.

16. Offeror Qualifications - The Selection Committee may make such investigations as necessary to determine the ability of the Offeror to adhere to the requirements specified within this RFP. The Selection Committee will reject the proposal of any Offeror who is not a responsible Offeror or fails to submit a responsive offer as defined in Ordinance §2-358

(oo) and (pp).

17. Right to Waive Minor Irregularities - The Purchasing Section reserves the right to waive minor irregularities. The Purchasing Section also reserves the right to waive mandatory requirements if all of the otherwise responsive proposals failed to meet the same mandatory requirements and the failure to do so does not otherwise materially affect the procurement.

This right is at the sole discretion of the Purchasing Section.

18. Notice - The County Ordinance and the New Mexico criminal statutes impose felony penalties for bribes, gratuities and kickbacks.

19. Release of Information - Only the County is authorized to release information covered by this RFP. The Offerors must refer to the County any requests to release any information that pertains to the work or activities covered by any action or award related to this RFP.

20. Ownership of Documents - Any specifications, and other project documents are the property of the County.

21. Costs Incurred in Responding - This solicitation does not commit the County to pay any costs incurred in the preparation and submission of proposals or in making necessary studies or designs for the preparation thereof, nor to procure or contract for services.

22. Proposal Firm Offer - It is anticipated that an Agreement will be awarded within 90 days after receipt of proposals. Responses to this RFP will be considered firm for that time frame. The anticipated Agreement term is for four (4) years with an option to renew for two additional two (2) years periods. Not to exceed eight (8) years.

23. Insurance Requirements - Insurance is required of the Contractor in the limits identified in the Proposed Draft Agreement, Paragraph 15, attached hereto.

24. Proof of licensing - The County reserves the right to request proof of licensing for which licensure by the State of New Mexico, or another agency is required, (e.g., Professional Architect/Engineer Number, State Bar Member Number, Contractor, etc.).

25. W-9 Information - Pursuant to Federal Tax Law (Internal Revenue Code, Section 6041), the County is required to obtain a Taxpayer Identification Number (TIN) and a completed W-9 from the successful Offeror; according to Federal Income Tax Law (Internal Revenue Code, Section 3406), failure to furnish this information promptly and correctly (within 30 days) may result in a $50.00 penalty imposed by the Internal Revenue Service. In addition, the Internal Revenue Service may require the County to withhold 28% or payments made, if the information is not furnished by the successful Offeror.

If the successful Offeror’s business is classified as a corporation, tax-exempt organization, government agency, or other exempt payee, the County will not file an Annual Information Return (Form 1088 Misc.) on your behalf. However, the law requires your TIN in addition to informing the County of payee type. If classified as an individual or sole proprietor, the TIN is your Social Security Number; otherwise, your Federal Employer Identification Number serves as your TIN.

26. Applicable Law - This procurement and any Agreement that may result from this procurement shall be governed by the laws of the State of New Mexico.

27. Unfair Business Practices - A system or pattern of acts or practices that a relevant federal or enforcement agency has made a formal finding within the last three years to be discriminatory, deceptive, fraudulent, or abusive (or similar terms) under the New Mexico Unfair Practices Act, NMSA 1978, §57-12-1 et seq, or an applicable federal or other state consumer protection law relating to the subject matter of the procurement) or that has violated a relevant criminal statute, as evidenced by a public enforcement order or judgment, settlement with the enforcement agency or other formal finding by the relevant enforcement agency with regulatory enforcement authority under the applicable consumer protection law, or criminal conviction.

The County finds that it is a priority to protect its interests and the public's trust by conducting its business with partners that are committed to and consistently demonstrate engaging in fair and responsible business practices. The general purpose and intent of the New Mexico Unfair Practices Act is to ensure to the maximum extent practicable that contracting practices support conducting government business with partners who are committed to and consistently demonstrate engaging in fair and responsible business practices and avoid conducting its business with partners that engage in criminal or systematic deceptive, fraudulent or abusive business practices.

Offerors must submit with their proposal the completed “Unfair Business Practices Disclosure Form” found in Appendix E. Failure to complete and return the signed unaltered form may result in disqualification.

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III. RESPONSE FORMAT AND ORGANIZATION

This section describes the format and organization of the Offerors’ responses. Failure to conform to these guidelines may result in the disqualification of the proposal.

A. NUMBER OF RESPONSES

Offerors may submit only one (1) proposal.

B. PROPOSAL FORMAT

Format. Each file uploaded to the eProcurement System shall be in Optical Character Recognition (OCR) searchable PDF format unless otherwise indicated. Do not encrypt files and do not password protect the documents submitted.

Offeror’s Technical Proposal The proposal must be limited in format and length. The length of the Proposal shall be limited to a maximum of four hundred (400) pages (printed sheet faces) of text and/or graphic material.

Supporting Documentation Material excluded from the four hundred (400) page maximum count shall include and shall be limited to:

Proposal Summary (one page maximum) Submittal Letter Form Certificate(s) of insurance Resident Business Certificate

Resident Veteran Business Certificate Campaign Contribution Disclosure Form Unfair Business Practices Disclosure Form Pay Equity Reporting Form

ANY SHEETS OR PAGES INCLUDED IN THE PROPOSAL, BUT NOT SPECIFICALLY

EXCLUDED, AS NOTED ABOVE, SHALL BE COUNTED TOWARDS THE FOUR HUNDRED

(400) PAGE MAXIMUM.

C. PROPOSAL ORGANIZATION

The proposal is to be organized and indexed in the following format, uploaded to Euna Procurement into the appropriate Requested Information Tab, and must contain, as a minimum, all listed items in the sequence indicated.

Group A

1. Offeror’s Technical Proposal (DO NOT INCLUDE COST, RATES, EXPENSES, OR

OPERATION FEE)

2.

A. Proposal Summary (Optional)

B. Response to Submittal Requirements (Section V.)

C. Additional Required Materials (if applicable) as identified in Section V. (Submittal Requirements)

Proposal documents must be uploaded into the appropriate Requested Information Tab.

Group B

1. Submittal Letter Form. Proposals must be accompanied by a Submittal Letter Form

(Appendix C), which contains the following information:

a. Identity of the submitting business, including name and address of organization, firm, or Department and nature of organization (individual, partnership of corporation, private or public, profit or non-profit).

b. Identifies the name and title of the person(s) authorized by the company to contractually obligate the business for the purpose of this RFP.

c. Identifies the names, titles, and telephone numbers of persons to be contacted for clarification questions regarding this RFP and person(s) to be contacted for negotiations.

d. Acknowledges receipt of any and all Addendums to this RFP.

e. By signing the form, the Offeror is explicitly indicating the following:

i. Acceptance of Conditions Governing the Procurement as stated in Section II of this RFP.

ii. A concurrence to comply with the Pay Equity Reporting Requirements as stated in Section II of this RFP.

iii. A commitment to comply and act in accordance with the following:

Federal Executive Orders relating to the enforcement of civil rights.

New Mexico State Statutes and County of Bernalillo Ordinances regarding enforcement of civil rights.

Federal Code, 5 USCA 7201 et. seq., Anti-discrimination in Employment.

Executive Order No. 11246, Equal Opportunity in Federal Employment.

Title 6, Civil Rights Act of 1964.

Requirements of the Americans with Disabilities Act of 1990 for work performed as a result of this RFP.

iv. Signature on the form must be form a person authorized to contractually obligate the Offeror.

2. “Campaign Contribution Form”

In accordance with Appendix D, Offeror’s must comply with Procurement Ordinance, Chapter 2, Article V, Division 1-3, Section 2-390 (b), pertaining to the disclosure of campaign contributions made to an applicable public official of a local public body.

Offeror(s) shall submit the “Campaign Contribution Disclosure Form” with their proposal submittal. Any Offeror who fails to comply with this requirement will be disqualified, no exception. NOTE: THIS FORM SHALL BE SUBMITTED IN ITS

ORIGINAL FORMAT AND SHALL NOT BE MODIFIED OR CHANGED IN ANY WAY.

3. “Unfair Business Practices Disclosure Form” found in Appendix E. Failure to complete and return the signed unaltered form may result in disqualification.

4. Pay Equity Reporting Form (Section II, D)

5. Resident Business Certificate or Resident Veteran Business Certificate (see Section II.D.3 and Appendix B for additional information).

Group C

1. Exhibit 2 – Medical Cost and Services

2. Exhibit 3 – Claims Repricing

3. Exhibit 5 – Provider Disruption Analysis

4. Offeror’s Additional Terms and Conditions*

*If no exceptions or modifications have been included and Offeror has explicitly indicated acceptance on the “Submittal Letter” and no additional proposed Terms and Conditions are included, so state on a single sheet, following the tabbed divider.

Within each section of their proposal, offerors should address the items in the order in which they appear in this RFP. All discussion of proposed costs, rates or expenses must be uploaded separately into the appropriate Requested Information Tab within Euna Procurement.

Offerors may attach other materials that they feel may improve the quality of their responses.

However, these materials should be included as items in a separate appendix and counted towards the four hundred (400) page maximum.

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IV. SCOPE OF SERVICES

A. IMPORTANT INFORMATION REGARDING SCOPE OF SERVICES

1. The County is interested in a medical carrier (or carriers) who will provide a “bundled” medical plan, to include ASO services, for medical claims administration, disease management, utilization and case management, and wellness. Note: Prescription drug services are currently carved out to Clear Script and not included in this solicitation.

Carriers must be able to securely share incoming and outgoing files with Clear Script for accumulators and stop loss purposes.

2. The County is interested in obtaining medical ASO services on both a SOLE carrier and SLICE carrier arrangement.

3. The County will be looking at all possible network options including a single network option and/or multiple network options. However, it is the County’s primary goal to offer its members access to both Lovelace, UNM, and Presbyterian networks

4. The County will issue an RFP for Stop Loss closer to the July 1, 2026 effective date. The County may also wish to consider a stand-alone Stop Loss contract, so vendors quoting Medical ASO services must allow the County to carve out Stop Loss. Stand- alone stop loss quotes will not be accepted at this time.

5. The County is not interested in considering stand-alone Wellness proposals.

6. The County is seeking vendors who will offer Performance Guarantees. All proposals should include details of the Performance Guarantees being offered.

7. The County currently has approximately 2,370 eligible employees. Refer to the Census for an exact count.

8. The County covers the following eligible members:

a. Employee: Permanent employees (including those on probation), Elected Officials, and Unclassified employees working 20+ hours per week. NO Retiree coverage.

b. Spouse: Legal spouse, including Domestic Partners (same and opposite sex).

c. Children: Birth to end of the month dependent becomes 26.

d. Date Eligible for Coverage: First day of current pay period.

9. No commission or any other broker compensation is to be included in proposed rates or fees.

B. PLANS / SERVICES AVAILABLE FOR QUOTATION:

1. Medical Coverage

Plans should be quoted as close as possible to existing plan design. Any deviation from the current plan designs should be highlighted in your proposal.

a) Self-funded medical

Quotes will be accepted for both stand-alone (SOLE carrier) and co-exist (SLICE carrier) offerings. If you are quoting a SLICE arrangement, be sure to indicate any pricing differences in the RFP Cost Exhibit 2A.

1. ASO fees must be guaranteed for 2 years (no increase in year 2). A 3-year guarantee is preferred.

2. Proposals will be accepted from ASO carriers capable of offering the following services on a bundled basis:

i. Medical claims administration

Your proposal must allow the County to carve out Stop Loss coverage, in the event the County elects to unbundle Stop Loss, and place it with an outside carrier.

Your proposal must clearly indicate any difference in rates for a SOLE versus SLICE carrier arrangement.

ii. Provider network (in and out of state)

Limit your response to one (1) network solution. Note: if necessary, you may provide an additional network for out of area coverage. You will need to identify if this is a network that is owned by your company or if it’s a rented/leased network. You will also be asked to identify the cost of this network and how the fee is collected (included in ASO, separate fee, etc.)

NOTE: You must currently have an established medical provider network in the Bernalillo County area. Proposals from vendors who do not have an existing medical provider network will not be considered.

iii. Utilization Management, Case Management, and Disease Management. You will be required to identify those Disease Management and Wellness services that are included in your ASO fee, as well as optional services available at an additional cost.

iv. Communication materials (including plan document, booklet/SPD, and open enrollment materials)

v. HIPAA administration

NOTE: ONLY bundled proposals (excluding Stop Loss and PBM services) will be accepted. Your proposal must allow the County to carve out Stop Loss coverage and PBM services.

C. QUOTE THE FOLLOWING PLAN DESIGNS AND PARAMETERS:

1. Medical

a. Duplicate the current plan designs as closely as possible.

b. Quote on a self-funded basis only.

c. Self-funded coverage should be quoted both as a SOLE carrier offering and as a SLICE carrier offering.

d. Quote ASO fees on a PEPM basis.

e. Must provide a dedicated account management and service team to support the Bernalillo County benefits staff. Proposals must include the names, positions and background of the team that will be assigned to service the account.

Concise resumes must be included as well.

2. Medical Geo Access Parameters

a. 2 PCPs within 10 miles

b. 1 Specialist within 10 miles

c. 1 Hospital within 10 miles

Geo-Access should be based on entire eligible population included in the census.

Include a copy of your Geo-Access report with your proposal.

D. CURRENT PLAN DESIGN

1. Current Medical plan design information is provided in the Certificate of Coverage documents attached to this RFP. See RFP Attachments for more details.

2. Currently, the County offers employees two plan design options for medical coverage – EPO and PPO, both of which are self-funded and provided through the following vendors:

• Presbyterian Health Plan

• Blue Cross Blue Shield of New Mexico (BCBSNM)

It is the intent of the County to offer identical coverage between carriers if in a slice arrangement.

E. CENSUS. CLAIMS DATA. AND PREMIUM RATE / FEE SCHEDULE

1. Due to PHI restrictions, the census and claims data files are not physically attached to this RFP. Offerors must contact Mary Kay Oakes at Gallagher Benefit Services (marykay_oakes@ajg.com) to request these exhibits.

F. RFP ATTACHMENTS

1. The following Attachments have been provided to assist in providing a complete response to this RFP:

NOTE: Due to PHI restrictions, Attachment 5 is not physically attached to this RFP Offerors must contact Mary Kay Oakes at Gallagher Benefit Services (marykay_oakes@ajg.com) to request this exhibit.

• Attachment 1 – Presbyterian EOP Plan Certificate

• Attachment 2 – BCBSNM EPO Plan Certificate

• Attachment 3 – Presbyterian PPO Plan Certificate

• Attachment 4 – BCBSNM PPO Plan Certificate

• Attachment 5 – Census

V. SUBMITTAL REQUIREMENTS

1. ORGANIZATIONAL STRENGTH (225 Points)

2. CLIENT MANAGEMENT TEAM (200 Points)

3. NETWORK ACCESSIBILITY (300 Points)

4. COSTS (300 Points)

A. PROPOSAL RESPONSE

Must include the following completed Exhibits and Questionnaires. NOTE: Some of the Exhibits contain multiple spreadsheets.

• Exhibit 1 – Deviations

• Exhibit 4 – RFP Questionnaires

Completed Exhibits and Questionnaires must be submitted in the format provided (Word or Excel). DO NOT convert to PDF.

B. COMPLETE COST RESPONSE

Must include the following completed Exhibits. NOTE: Some of the Exhibits contain multiple spreadsheets.

Note: Due to the PHI restrictions, exhibits 3&5 are not physically attached to this RFP.

Offerors must contact Mary Kay Oakes at Gallagher Benefit Services (marykay_oakes@ajg.com) to request these exhibits.

• Exhibits 2 A through 2 D – Medical Costs and Services

• Exhibit 3 – Claims Repricing

• Exhibit 5 – Provider Disruption Analysis

Completed Exhibits and Questionnaires must be submitted in the format provided (Word or Excel). DO NOT convert to PDF.

VI. EVALUATION CRITERIA

A. Selection Process: A Selection Committee that may include internal and external members has been selected for the purpose of evaluating the proposals. On the basis of the evaluation criteria established in this RFP, the Selection Committee shall submit to the Purchasing Manager a list of qualified Offerors in the order in which they are ranked. The proposal documentation requirements set forth in this RFP are designed to provide guidance to the Offeror concerning the type of documentation that will be used by the Selection Committee.

Offerors should be prepared to respond to requests by the Purchasing Manager on behalf of the Selection Committee for clarification, best and final offers, finalist interviews, demonstrations or other areas deemed necessary to assist in the detailed evaluation process. Offerors are advised that the County, at its option, may award this request on the basis of the evaluation of the initial offers without conducting interviews.

B. Evaluation Criteria: A maximum total of 1025 points are possible in scoring each proposal for the evaluation. A brief explanation of each evaluation criteria and the corresponding point values for each is listed below. Information in one criterion may overlap information in other criteria. Offerors are encouraged to fully address each criteria completely, as points are assigned for responses to each separately. The evaluation criteria to be used by the Selection Committee for the proposal and the corresponding point values for each criteria are as follows:

C. Evaluation Factors:

1. Organizational Strength

a. Administration / Systems Strength 25 points

b. Public Sector Experience 25 points

c. Overall Claims Administration Strength 25 points

d. Support / Educational Tools for Employer and Member 25 points

e. Ability to Offer Requested Plan Design 25 points

f. Agreement to Offer and/or Enhance Performance Guarantees 25 points

g. Reporting Capabilities 25 points

h. Disease Management / Wellness Programs Strength 25 points

i. Utilization / Cost Management Programs 25 points

Sub Total 225 Points

2. Client Management Team

a. Experience 50 points

b. Size / Dept 50 points

c. Strength of Local Personnel 50 points

d. Assignment of Dedicated Representative 50 points

Sub Total 200 Points

3. Network Accessibility

a. Network Access 150 points

b. Provider Disruption 150 points

Sub Total 300 Points

4. Costs

a. Fixed Costs / Premiums 75 points

b. Claims Cost 200 points

c. Fixed Fee Rate Guarantee / Cap 25 points

Sub Total 300 Points Cost of Lowest Offeror X Maximum Cost Score (300) = Cost Score of this Offeror

Total Possible Points 1025 D. Interviews (applicable to Finalists only)

If an interview is held, the Purchasing Manager will distribute questions and instructions to the finalists prior to scheduled interview. A maximum total of 100 points are possible in scoring each interview for this RFP. The Selection Committee may, at their discretion, request additional clarification as to the contents of the RFP submittal from any of the Offeror(s).

E. Application of Preferences (Point-Based): The preference points shall be calculated by multiplying the applicable preference percentage (see Appendix B for applicable preference percentage) by the “Total Possible Points” in Section VI. C above. Only those Offerors who provide the required preference certificate in accordance with Section II.D.3 and Appendix B will receive additional points, which will be added to their already evaluated score.

Application of Preferences (Weight-Based): (applicable only if an interview is held): rankings for the evaluation of written proposals are weighted 55% and ranking from the interviews are weighted 45% in determining the final selection as shown in Appendix A. The preference points shall be calculated by multiplying the applicable preference percentage (see Appendix B for applicable preference percentage) by the “weighted points”. Only those Offerors who provide the required preference certificate in accordance with section II.D.3 and Appendix B, will receive additional points, which will be added to their already evaluated score.

Note: If an interview is not held, the preference points will be based on the “Total Points” of Section C only.

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SECTION VII

PROPOSED DRAFT AGREEMENT

THIS AGREEMENT, made and entered into this _________day of _________________, 2022, by and between the County of Bernalillo, New Mexico, a political subdivision in the State of New Mexico, (hereinafter referred to as the "County"), and ________________________________________, (hereinafter referred to as the "Contractor").

WITNESSED:

WHEREAS, the County issued a Request for Proposals for Group Medical Insurance Services, RFP No.

28-26-NH, attached hereto as Exhibit A; and

WHEREAS, the Contractor submitted its Proposal, dated _____________ 2026, in response to RFP…