2-MAC RFP Workbook.xlsx

XLSX spreadsheet 4 MB Posted Feb 23, 2026

Attached to: Medical Administration, Stop Loss Administration & Pharmacy Administration RFP
Solicitation number: Solicitation133
Issued by: Minnesota

About this file

Written by GovTribe AI · Feb 24, 2026

This is an RFP workbook for the Medical Administration, Stop Loss Administration, and Pharmacy Administration contract opportunity in Minnesota. The solicitation seeks proposals for comprehensive plan administration services covering medical, pharmacy, and stop loss components. The workbook appears to be a structured evaluation and response document designed to facilitate the proposal submission process and assessment of bidder qualifications and pricing for these healthcare administration services.

The workbook likely contains detailed scoring criteria, evaluation matrices, pricing templates, and requirements specification sections that bidders must complete as part of their response. It serves as a standardized tool to ensure consistent evaluation of proposals and to enable the MAC (Medical Administration Consortium or similar entity) to systematically assess each bidder's capability to deliver medical administration, stop loss administration, and pharmacy administration services. Specific details regarding contract term, renewal options, pricing structures, response deadlines, and other contractual terms would be contained within the associated RFP documents and bid instructions referenced alongside this workbook.

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Other files

File	Type	Posted
1-Medical RFP Final.pdf	PDF	Feb 23, 2026
3-W9 Blank.pdf	PDF	Feb 23, 2026

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Cover

Metropolitan Airports Commission (MAC)

RFP Workbook

Medical Administration, Stop Loss Administration, Pharmacy Administration

1/1/27

Instructions There are BLUE tabs that you are required to complete as part of the RFP.

Enter your responses in the PEACH highlighted cells provided in each tab of the Workbook.

Do NOT edit the formatting of the tabs in any way; if you edit the formatting of the tabs your response will not be considered.

Fees & Contract-Medical Admin

Medical Administration - Fees & Contract Terms

INSTRUCTIONS: All fees should be quoted on a MATURE basis (inclusive of 12 months of run-out administration).

	Administrative Fees (PEPM)	Current	Proposed
2027	Proposed
2028	Proposed
2029	Proposed
2030	Proposed

Claims Administration Fee	$46.77 PEPM
Full Claims Fiduciary (Appeal Administration + Liability)	Included
Omada Annual File Feed Fee	$.50 PMPY
Chronic Condition Management	Included
Network Access Fee (if additional)	Included
Total Monthly PEPM Administrative Fee
Administrative Fee Guarantee (Number of Years)

Requesting 3 year contract term, with an option to renew for an additional 2 years

Administrative Fee Guarantee Caveats
Please describe criteria under which you would re-evaluate rates and factors.
Claims Run Out Administration - Upon termination of the contract, the carrier is responsible for adjudicating and process all claims with service dates prior to the termination date of the contract that are received by the TPA within 180 days after the termintion date. Please note any applicable fees.
As a requirement of being awarded MAC's business, you agree to payment of $15,000 one-time Implementation Fee for Holmes Murphy Data Warehouse.
MAC will not agree to pay a percentage of savings for negotiated savings with Non-Network providers. You MUST quote a fixed fee expense for negotiated savings with Non-Network providers. Please provide annual estimated cost for such fees based on the historical claims experience provided (e.g. Shared Savings, NAP & Cost Containment).
Credits: Identify any additional credits given (e.g. implementation, communications, wellness, etc.). Please provide an attachment with the guidelines for credit utilization.
[Enter here]
[Enter here]
[Enter here]
[Enter here]
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Coverage Bundled Pricing*: If you administer dental and/or vision coverage, please provide applicable discount to admin fee below.
Dental Coverage Discount
Vision Coverage Discount
Dental and Vision Coverage Discount
*Any pricing provided for dental or vision coverage should not be required to be sold; we want to understand pricing for medical administration alone, while also understanding the medical administration fee if other lines of coverage are implemented.
Performance Guarantee Components
Implementation	Guarantee	Measured Client-Specific or Book of Business	% or $

At Risk

ID Card Production & Distribution

Client Readiness Performance Commitment

Overall Satisfaction with Implementation Services Performance Standard

Eligibility File Loading

Plan Design Coding Accuracy

Total Implementation Fees at Risk

Account Management

Client Satisfaction with Account Management Team

ID Card Production & Distribution (ongoing)

Eligibility Updates (ongoing)

Claim Administration* (Please see definitions below)

Turnaround Time

Financial Accuracy / Payment Incidence Accuracy / Overpayment Rate

Claim Processing Accuracy / Total Claim Accuracy

Member Services

Abandonment Rate

Average Speed of Answer

First Call Resolution

Overall Inquiry Resolution

Member Customer Satisfaction / Quality

Member Portal Up-Time

Additional Guarantees (if offered, complete rows below)

Guarantee Caveats / Special Notes or Comments

Total Service / Implementation Fees at Risk

*Definitions (for the purposes of this RFP)
Turnaround Time	Defined as the period beginning on the date the claim administrator receives a claim for processing through the date the claim passes all system edits and benefits are approved or denied by the claim administrator
Financial Accuracy / Payment Incidence Accuracy / Overpayment Rate	Defined as the percent of dollars paid accurately or inaccurately based on plan being administered
Claim Processing Accuracy / Total Claim Accuracy	Defined as the percent of claims processed accurately in accordance with the provisions of the medical benefit coverage administered by the claim administrator (claims without processing errors)

&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

&"Arial,Regular"&A &"Arial,Regular"Holmes Murphy - CONFIDENTIAL &"Arial,Regular"&P

Questionnaire-Medical Admin Medical Administration Services Questionnaire

INSTRUCTIONS: Enter an "Yes" in Column B if services are included in proposed pricing.

Any services that require additional pricing, note that below in Column C.

Add details or additional information regarding the service in Colum D.

		Included in Monthly ASO Administration Fee? (Yes/No)	If Not Included, Indicate Fee
If fee varies by contract year, please indicate here.	NOTES

Add additional information here

Value to Member

Describe available Enrollment and education materials.

Please specify which items are additional fees.

Is there a member services toll-free telephone number? Please note fee if applicable.
Do you have a member smart phone app? What are the top 3 things that members in your BOB for MAC's market segment use within the app? Please note fee if applicable.
Please note any other member self-service tools available and include any fees if applicable.
Describe your management/process of in-network providers and note any applicable fees associated with this process
Do you have an online in-network provider search tool? Please describe the tool and how frequently information is refreshed. Please note fee if applicable.
Where will the primary member service unit for MAC be located?	N/A	N/A
Will MAC have a dedicated customer service team? If not, how will calls be answered and by whom? Please note fee if applicable.
Will MAC have a designated contact within the customer service or claim unit to assist with elevated issues? Please describe their role and where they are located. Please note fee if applicable.
What are your weekday and weekend hours for live member services?	N/A	N/A
What provision do you have for handling after-hours telephone calls or emergency requests? Please note fee if applicable.
Do employees have email/online access to customer service? What is the turnaround time? Please note fee if applicable.
Do employees have real-time chat access to customer service? Please note fee if applicable.
What percentage of calls to customer service are recorded for retrieval and play-back later?	N/A	N/A
Does the customer services staff have the ability to make online corrections to the claim systems when additional information is received?	N/A	N/A
What training is done to ensure customer service representatives have the most up to date, accurate information?	N/A	N/A
Can your customer service unit provide warm transfers to the Plan's other vendors?	N/A	N/A
If a provider is not participating in a network, what is your customer service process for advising the participant and provider of the out of network status and channeling participants to network providers?	N/A	N/A
Describe how your customer service representatives initiate corrections to claims or activate the claim re-processing functions based on discussions/clarifications with participants or providers. Is this process on-line (real time-system input and correction) or does the re-processing function require that the customer service representative submit a correction form or perform other manual processes?	N/A	N/A
What is the turn-over rate for your customer service group within the proposed office over the most recent 24-month period?	N/A	N/A
What services are available to accommodate special populations, including (1) non-English speaking, (2) hearing impaired, (3) visual impaired, and (4) the elderly?	N/A	N/A
Describe your Behavioral Health Resources. Do you outsource mental health services or network? If yes, to whom? Please note any applicable fees.
Do members have access to an online Health Risk Assessment? Please note fee if applicable.
Do members have access to Personal Health Coaching (Virtual or Telephonic)? Please describe and note fee if applicable.
Are physicians sent alerts for improved care? Please note fee if applicable.
Are Employee Statements/Gaps in Care Notices created/provided? Please note fee if applicable.
Describe your hospice care support and coordination resources. Please note fee if applicable.
What clinical intervention or medical management programs are available? Please outline all programs and note if a fee outside of the administrative fee applies.
List the criteria used to identify individuals for case management. For your book of business and proposed case management model, what percentage of individuals ENGAGED in case management in the most recent calendar year? Please include how you define ENGAGED.
What concurrent review and discharge planning does your case management team perform?
What strategies and programs do you use to identify, intervene and manage high dollar claims? How do you keep MAC informed of the status of these high dollar claims, and how frequently?
Do you offer a health improvement portal where employee's can link to their tracking device? If so, please describe the portal/wellness program. Outline which devices are currently integrated. Please note fees if applicable.
Do you have preferred telehealth vendors in which you integrate for claims processing and member website purposes? If yes, please describe. Is there an additional administrative fee to utilize your telehealth vendor? Are communications that educate members on the telehealth offering and how to use the benefit included in the pricing?
Describe your overall management of transplants and include any applicable fees.
Do members have access to a 24/7 Nurse Line? Please note applicable fee.
Do you push out Preventive Care Reminders? What communication method? Please note applicable fee.
Describe the information available to employees regarding claim activity for their personal claims AND each of their participating dependents.	N/A	N/A
Do you have a Plan Cost Estimator Tool for members?
Provider Cost & Quality Transparency Tools for members - Describe your price and quality transparency tool for medical providers. Does it provide provider-specific pricing (not network average) for individual physicians, outpatient services, and hospitals? What types of procedures or services are included in your transparency tool?
Describe your Transition of Care process.
Do you outsource any services? If yes, outline which services and to whom.
Do you offer an Employee Assistance Program? Please describe. Please note any fees if applicable.
Please list out any other available services to members not called out above
Value to Client
COMPLIANCE
Please confirm quoted admin fee covers all items outlined in SPD. If not, please add information to this row, as well as the deviations tab in this workbook.
What support do you provide for clients to assist them in meeting their PPACA plan design, PCORI fee payment and ACA reporting requirements? Please specify and indicate any additional costs that apply.
Initial ID Cards – design, review, print and supply
Replacement ID Cards
SPDs – drafts, printing and distribution

(Confirm quantity limits, if applicable) Creation of Summary of Benefits and Coverage for all plans, including Rx benefits even if Rx is carved out.

Are you willing to guarantee timely delivery?

Do you charge any fees related to the No Surprises Act (NSA)? If yes, please specify.
Transparency Requirement Language: Please confirm you are willing to include the language in the provided attachment in your contract at no additional cost
Please provide your contract language regarding full claim fiduciary. Will MAC be responsible for legal fees and/or any claim settlement?
Will your organization be able to provide an annual SSAE 16 Type II review report?
Describe any areas where your organization is currently using AI.	N/A	N/A
The TPA is responsible for maintaining an automated system for providers for verification of participant eligibility, benefit summaries, deductible and co-insurance maximum accumulation amounts and claims status. This automated system must be available twenty- four (24) hours, seven (7) days a week. Describe the automated system your organization will maintain to meet this requirement.	N/A	N/A
The TPA is required to administer appeal and grievance procedures in accordance with all regulations required by PPACA. Confirm your agreement with this requirement.
The TPA is required to maintain contracts with independent review organizations (IRO) to conduct external reviews as required by PPACA. Confirm your agreement with this requirement.
Do you have experience partnering with Part D Advisors for purposes of retiree drug subsidies? Explain.
Do you provide written notice to retirees when they become age 65 that their coordination with Medicare will impact the coverage reimbursements under the Plan?
Do you notify participants in writing when they become age 65 that Medicare coverage is available to them?
The TPA must be in compliance with all applicable requirements of HIPAA and HITECH including the Administrative Simplification and Security Rule provisions and HIPAA 5010. Provide a description of your HIPAA security policies and procedures and describe how violations or breaches are documented and communicated to the client.
BANKING
~Banking Charges / Fees

~Describe your banking arrangements and requirements, including any mandatory deposits.

Required Banking Deposit - Insert amount of imprest balance required in column B
Weekly Claim Wire Batch/ACH
CLAIMS PROCESSING & CLAIMS ADMINISTRATION
What internal system edits and claim audit checks are in place to ensure claims are adjudicated correctly? List applicable fees in Colum B and describe process in Notes section
What is your external claim audit policy/process; list applicable fees in Colum B and describe any limitations in Notes section
Where would the primary claim paying unit be located for MAC?
How are your claim processing teams assigned to customers? Will MAC have dedicated or designated processors?
Are all claims submitted to a central scanning location or to individual claim offices?
What percent of all claims were processed within 30 calendar days of receipt, for claims incurred in calendar year 2024?
Outline the financial accuracy as a percent of total claims dollars paid (total under and over payments, do not net these amounts). Please use calendar year 2024.
Outline the processing accuracy as a percent of total claims submitted. Please use calendar year 2024.
Are claims processors also responsible for answering telephones and problem resolution?
Do all persons entering data/processing claims have the authority to pay COB, subrogation, Medicare, and high dollar claim amounts, or does the authority level vary with experience?
Indicate any maximum claim amount/limits which apply by staff level and any system/manual processes that trigger supervisory approval or internal/external audits.
Can a claims examiner "override" the system to process unique circumstances attributed to a claim? When, and under what circumstances?
How will you handle disallowed claims that have already been paid?
If claims are sent out to be reprocessed, what is the contract-stipulated turnaround time for repricing?
Do you use AI for any claim determinations?
Confirm that your organization maintains a system for tracking claims received, processing status, pending status, and participant correspondence.
Facility Charge Review (to ensure reasonable charge allowance instead of billed charges)
Itemized Bill Review (to ensure correct billing before claim adjudication)
What edits are in place to compare the number of inpatient hospital days against admission and discharge dates supplied by the medical management vendor?
Fraud and Abuse Management - Insert % of recovery amount in Column B
Credit Balance Recovery Services - Insert % of recovery amount in Column B
Analytics and Recovery Services - Insert % of recovery amount in Column B
Do you have any planned upgrades to your claims, eligibility or customer service systems? If so, how will clients and participants be impacted?
Under what circumstances do you deny or pend a claim for COB investigation? How is the member notified?
Describe your process for handling COB when a conflict exists between information on your system and claim form.
When new or requested COB information is received, describe the process for updating the information on your system. Are pended claims re-activated by a manual process or automatic by the system?
Based upon the group number, the MAC assumes any retiree eligible for Medicare has both Parts A and B, regardless of whether the retiree has selected Part B or not. Can your system estimate Part B reimbursement when adjudicating a claim in which the Plan is the secondary payor?
Does your claims system maintain other insurance information for members? How many occurrences of "other insurance" information can be stored for each employee/dependent on your system simultaneously?
Can your system allow the automatic electronic transfer of claims from Medicare for secondary coverage payments?
Describe your appeals process. Indicate how first level appeals are managed, who is responsible for making the determination and their respective industry experience/background and the timing for issuing a response. Assuming the first level appeal is not favorable to the participant, what procedures and processes would apply for a second appeal? Please note any fees if applicable.
What options are available for a 3rd Level External Appeal? Please note any fees if applicable.
Subrogation Services - Describe your process. Do you outsource subrogation services? If yes, to whom?
Describe your legal services available for services relative to disputed claims/litigation/subrogation. Confirm that the cost for this service is included in your administration fee.
Do you allow claims submitted via paper?
Describe the process used to evaluate claims for medical necessity.
What is your process for identifying potential cosmetic, investigational, or experimental treatments or procedures?
INTEGRATION CAPABILITIES/FLEXIBILITY
Please list all applicable Carve-out PBM Integration Fees
With which PBMs do you have automatic Deductible & Out of Pocket Maximum accumulator integration? How often is the data shared (daily, x times per day, etc.)? If it differs by PBM, please indicate the PBM and sharing frequency.
Please list all applicable Carve-out Third-Party Stop Loss Integration Fees
With which Stop Loss Carriers do you have automatic Deductible & Out of Pocket Maximum accumulator integration? How often is the data shared (daily, x times per day, etc.)? If it differs by Carrier, please indicate the Carrier and sharing frequency.
Do you currently integrate with Health Equity on HSA/FSA claims? Briefly describe how the integration works. What additional costs, if any, apply?
Please confirm your ability to integrate with Truveris
Does your platform support SSO (Single Sign On) connections to other carriers/vendors? If yes, add applicable carriers/vendors in notes section and additional fee if applicable
Please confirm your ability to accept 834 files on a weekly basis from MAC for eligibility maintenance. Please note any fee if applicable.
Please confirm online access for MAC benefits team to see eligibility and claims information. In addition to inquiry access, you must provide an electronic enrollment process for the purpose of approving/enrolling retiree coverage by the MAC.
Please confirm that you have the compatibility to implement data into Artemis
Payment of $15,000 one-time Implementation Fee for Holmes Murphy Data Warehouse	Yes	Must Be Included
External Vendor Data File Feed Capabilities; outline fees
How can the MAC partner with you to steer employees and dependents to high quality, low-cost providers?
Are you able to provide retiree plan administration? MAC offers the same benefits to both the active and retiree population in many cases. Some retirees are Medicare primary and sometimes they are not. Are you able to assist with CMS to ensure these are properly processed?
ACCOUNT MANAGEMENT
What market segment would MAC fall into within your company?
Describe your account management team structure and associated responsibilities. Who would have primary account management responsibility for MAC? An account management team member must be located in the Twin Cities metro area.
How many other clients will the account management team have in addition to MAC?
Part of the account management team must include a Provider Network Manager who will consistently evaluate and manage the provider network, including recruiting, negotiating, and contracting with providers on behalf of the plan. Please describe this role in the Notes section.
Client meetings (Open enrollment meetings, Health Fairs), plus initial and annual staff training on client & member resources. Requesting 12 open enrollment meetings
Are you willing to meet with the MAC monthly to discuss performance, address administration issues, and review reports?
Please outline resolution timeframes (response to issue, explanation of issue, resolution timeframe, confirmation that issue has been resolved).
REPORTING
Do you provide a Healthcare Cost Analysis/Trend Management Annual Report; will your team meet in person to review this report?
Management of MAC's benefit programs requires the following monthly reports. Please confirm that these are available at no additional cost: Enrollment and Claims Report by Plan and Division (monthly), Large Claimant Report with diagnosis (monthly), Lag Report (monthly).
By which date each month for each reporting period are standard utilization reports made available?
Please confirm monthly claim reports can be provided to a third party stop loss vendor, if necessary. Please confirm the cost for this reporting and if it is included in the administrative fees quoted.
Can you provide weekly notifications in advance of the weekly claim wire to notify MAC of a large claimant over $50k?
How will reports be accessed by and/or delivered to MAC and Holmes Murphy?
What types of reports are available via your online portal?
Ad Hoc Reporting. Please quote Additional Fees or Allowance of reporting hours, if applicable.
MAC's Plan requires, upon request and appropriate documentation (BAAs, written permission to release), full, complete and ongoing access by designated third-parties supporting MAC’s Plan to any and all data generated on MAC’s behalf at no additional charge and without restrictions. You hereby acknowledge that MAC's Plan has an operational, administrative and fiduciary obligation that requires access to full and complete access to the data specified below. You agree full and complete data is agreed to as follows:

1. Eligibility, claims, program participation cascade, and/or clinical data in vendor systems, as appropriate and purchased by MAC’s Plan. Eligibility will include identifiers for employee ID and/or SSN, member date of birth and gender and may include other data elements as provided by MAC’s Plan.

2. Medical claims data will include full financial adjudication details (submitted, allowed, discount and paid), unencrypted NPI or provider TIN, complete diagnosis information (no masked fields and all diagnoses that are populated on the claim, not just primary)

3. Program participation data will include program identified, targeted, participating, non-participating (by reason)

4. Clinical data will include case notes	Yes	Must Be Included
	Do you have the ability to track and report on individual participant actions/claims for purposes of incentive administration?
	How many months of reports are maintained on-line?
	NETWORKS/PLANS
	What process do you have in place to manage trend from a network contracting perspective?	N/A	N/A
	Do you have any significant network expansion OR reduction plans in the markets in where MAC employees reside?	N/A	N/A
	How do you inform your clients and participants of network reductions/changes?	N/A	N/A
	How do you inform your clients and participants of in progress provider negotiations? Do you provide impact analysis based on the client's specific population and claims?	N/A	N/A
	Describe your process for monitoring and addressing changes that impact total cost of care within your network. Please describe your process for both facilities and physicians, if different.	N/A	N/A
	How do you make sure In-Network providers are high performers delivering quality care?	N/A	N/A
	Do you allow physician clinics or group practices to have both in-network and out-of-network physicians?
	What contractual requirements does your organization have with network providers to hold them accountable for timely scheduling of elective appointments?
	Describe your provider pricing transparency initiatives (if available/offered) and indicate any future expansion or reduction plans.	N/A	N/A
	In what specialty care areas do you offer Centers of Excellence? What plan design options are available for these Centers (for example, mandatory COE; benefit differentials; etc.)	N/A	N/A
	Can you administer and manage travel and logistics for domestic tourism, Centers of Excellence, and/or Client-specific negotiated bundled arrangements? Please note fee if applicable.	N/A	N/A
	Has your organization developed high performance networks (based on quality and/or efficiency)? If yes, please describe philosophy, network composition, and future expansion/reduction plans.	N/A	N/A
	Nationally, what percentage of hospital and physician contracts are in value-based contracts (such as PCMH or ACO)? Briefly describe your value based contract methodology.	N/A	N/A
	Are there any additional costs for your value-based contracts, such as care coordination fees or risk sharing arrangements? How are these fees passed along to the employer, and what are they?
	Do any of your proposed networks require capitation payments for any services (i.e. behavioral health, high tech radiology)? If yes, please describe how these capitation payments are billed and expected PMPM cost to MAC.
	Describe your approach to complex plan design set up (retiree plans, multiple plan designs, multiple networks, different benefit amount based on provider or network). Please outline any plan set up restrictions (number of plans, number of networks, centers of excellence incentive, etc.)	N/A	N/A
	How do you support out-of-network claims pricing (your own claims, purchased data base, etc.)? If you use your own claims, what is your criteria for developing a geographically applicable value?	N/A	N/A
	Please describe your shared savings program (if any) for out-of-network providers? What percentage of the savings is kept by your company for this program? Is there a cap per claim or PEPM for this program?
	List any “Centers of Excellence” facilities by name and location and the area of specialty, such as organ transplants, bariatric surgery, cancer, etc., with which your organization contracted or has a letter of agreement.
	In addition to the shared-savings program mentioned above, do you negotiate with non-network providers on MAC's behalf? MAC will not agree to pay a percentage of savings for negotiated savings with Non-Network providers. You MUST quote a fixed fee expense for negotiated savings with Non-Network providers. Please provide annual estimated cost for such fees based on the historical claims experience provided (e.g. Shared Savings, NAP & Cost Containment).
	Business Profile
	Describe your organization’s financial conditions including annual revenue, net income, etc. Include a copy of your annual report or other statements of financial condition.	N/A	N/A
	List any ownership interest your company has in any health care facility, provider group or PBM, and describe the relationship.	N/A	N/A
	Is your organization licensed or authorized to do business in the State of Minnesota?	N/A	N/A
	Has your organization been cited or threatened with citation within the last three years by federal or state regulators for violations of any federal, state, or local law or federal, state or local regulation? If the answer is yes, describe the circumstances in detail.	N/A	N/A
	Has your organization had any HIPAA breaches or incidents examined for potential HIPAA breach within the last three years? If the answer is yes, describe the circumstances in detail.	N/A	N/A
	What are your top three strategic priorities for the next five years?	N/A	N/A
	What are your greatest organizational challenges, and how will this impact the MAC and participants? How do you differentiate your capabilities from your competitors?	N/A	N/A
	Total number of clients with over 500 covered employees.	N/A	N/A
	Total number of clients in the public sector.	N/A	N/A
	Please provide your current A.M. Best Rating or similar rating agency	N/A	N/A
	Confirm your ability to administer retirement plans with Medicare as a primary payor. Please provide details in the Notes section.	N/A	N/A
	Please provide a copy of your SOC1 reporting.	N/A	N/A
	Implementation Plan
	Please provide a proposed implementation timeline. Requested implementation start date of July 1, 2026, with OE communication in October 2026 and go live January 1, 2027.
	What is your deadline to receive eligibility in order for you to guarantee that ID cards will be received before the effective date?
	Will you be able to accommodate adding information to ID cards at no additional charge? For example, name and phone number for third party vendors or PBM?
	Will a separate implementation manager be assigned or will the account team manage the implementation?
	What is the minimum amount of lead time you believe is necessary to implement the Plan in an efficient and effective manner?
	Describe the most frequent problems you have encountered during previous transitions for plans of this size. How were these resolved?
	Do you provide a pre-enrollment customer service number for employee decision support / transition questions? Do you provide a pre-member website?
	Confirm that your fee proposal includes all costs associated with implementation services. You must provide a detailed description of any implementation service charge(s) not specifically included in your fee proposal.
	Other: Please list any other services not addressed above. You may add additional rows as necessary.
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&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

&"Arial,Regular"&A &"Arial,Regular"Holmes Murphy - CONFIDENTIAL &"Arial,Regular"&P

Provider Disruption Provider Disruption

You must complete the disruption analysis for each network quoted in the following requested format in order for your quote to be considered.

Do NOT Exclude ANY provider types. Definition is that "Yes" means Billing provider is directly contracted and "No" means they are NOT directly contracted.

Provider information included in "RFP Data" Workbook

					Carrier Name
					Network Quoted
	MPIN	Provider NPI	Provider TIN	Provider
Name	Provider
Address	Provider
City	Provider
State	Provider
Zip Code	Provider Specialty	Provider Category	Unique Member Count	Provider
Total Number of Claims	Provider
Total Paid Claims	Quoting Carrier Response:

In Network (Yes) Out of Network (No)

Yes or No

&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

&A Holmes Murphy - CONFIDENTIAL &P

Geo Access

Please note that you must this information in the following requested formats in order for your quote to be considered. Please provide the analysis for all employees/zip codes eligible for the medical plan in the grids below. Please provide a quote for each network (including narrow networks) that could be impactful for the MAC population.

Please provide full detailed report attachments for the Geo Access within your formal proposal.

Carrier Name
Measurement
Network Name
# of Employees / Zip Codes Evaluated	#	#	#	#

	Primary Care Physicians
	# of Providers Available to Employees
(Do not provide total national number of providers)	#	#	#	#
	# of Locations Available to Employees
(Do not provide total national number of locations)	#	#	#	#
	X Providers within X Miles	2 / 10	2 / 10	2 / 10	2 / 10
	% of Employee WITH access	%	%	%	%
	# of Employees WITH access	#	#	#	#
	% of Employee WITHOUT access	%	%	%	%
	# of Employees WITHOUT access	#	#	#	#

Average distance to 2 providers for employees WITH desired access (in miles)	# miles	# miles	# miles	# miles
Average distance to 2 providers for employees WITHOUT desired access (in miles)	# miles	# miles	# miles	# miles

	Specialists
	# of Providers Available to Employees
(Do not provide total national number of providers)	#	#	#	#
	# of Locations Available to Employees
(Do not provide total national number of locations)	#	#	#	#
	X Providers within X Miles	2 / 10	2 / 10	2 / 10	2 / 10
	% of Employee WITH access	%	%	%	%
	# of Employees WITH access	#	#	#	#
	% of Employee WITHOUT access	%	%	%	%
	# of Employees WITHOUT access	#	#	#	#

Average distance to 2 providers for employees WITH desired access (in miles)	# miles	# miles	# miles	# miles
Average distance to 2 providers for employees WITHOUT desired access (in miles)	# miles	# miles	# miles	# miles

	Hospitals
	# of Providers Available to Employees
(Do not provide total national number of providers)	#	#	#	#
	# of Locations Available to Employees
(Do not provide total national number of locations)	#	#	#	#
	X Providers within X Miles	2 / 20	2 / 20	2 / 20	2 / 20
	% of Employee WITH access	%	%	%	%
	# of Employees WITH access	#	#	#	#
	% of Employee WITHOUT access	%	%	%	%
	# of Employees WITHOUT access	#	#	#	#

Average distance to 2 providers for employees WITH desired access (in miles)	# miles	# miles	# miles	# miles
Average distance to 2 providers for employees WITHOUT desired access (in miles)	# miles	# miles	# miles	# miles

&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

&A Holmes Murphy - CONFIDENTIAL &P

Network Discounts Network Discounts

INSTRUCTIONS: You must enter information in the following requested format in order for your quote to be considered. Please use your Health Plan's historical commercial group market results and include the time period used to develop the average discount percentage.

Time period used: Most recent 6-month average.

If below discount percentages are not based upon the most recent 6-month average, please explain method and time period.

If below discount percentages are not based on the 5-digit zip codes, please indicate if it is based upon MSA, statewide or other, and define.

Discounts reported below include only in-network providers (i.e. do not include discounts when negotiating with a non-network provider through shared savings program).

Are you aware of any contracting change that would significantly alter the results as reported below?

Please note any exclusions included claim types, providers or large claims.

			Network Discount Percentage
5-Digit Zip Code	MSA/Other	Subscriber Count	Inpatient Facility	Outpatient Facility	Outpatient Professional	Professional
55044		89
55124		87
55024		74
55068		52
55123		49
55337		45
55129		45
55016		39
55122		39
55304		36
56071		32

&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

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Discount Guarantee Discount Guarantee

You may place a guarantee table below our grid to help illustrate the proposed guarantee. As an alternative, you may provide a total cost guarantee, or you can provide both for consideration (understanding that only one will be accepted). Please include a separate document detailing your total cost guarantee, underwriting workup to arrive at the claim target number, and all caveats.

Carrier Name
Discount Guarantee Components
Incurred Period
Paid Period
Network Name
Please specify: In Network and/or Out of Network Claims
Includes All Large Dollar Claims Under ISL ($350,000)
Includes All Capitated Claims (if excluded, please provide detail below)
Detailed description of any claims excluded
Network Discount Guarantee Target
Risk Free Corridor
Actual Discount Range	Fees at Risk
Less than xx%	%
xx% - xx%	%
xx% - xx%	%
xx% - xx%	%
xx% - xx%	%
Greater than xx%	%
Total Amount at Risk
Minimum Enrollment
Assumed Plan Design

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Claim Guarantee Total Cost of Care Guarantee

You may place a guarantee table below our grid to help illustrate the proposed guarantee. In addition to completing this tab, please include a separate document detailing your total cost guarantee, underwriting workup to arrive at the claim target number, and all caveats.

Claim Guarantee Components
Beginning Claim Base (please specify incurred and paid dates)
Average Membership
PEPY Claim Cost
Cost Control Savings	Applied Decrement
Network
Plan Design
Physician Tiering
Utilization Management/Case Management (if applicable)
Disease Management/Care Management (if applicable)
Pharmacy Integration (if applicable)
Dental Integration (if applicable)
STD/LTD Integration (if applicable)
Other - please specify
Other - please specify
Summary of Total Cost Guarantee
Guaranteed Trend
Trended PEPY Cost
Expected Enrollment
Projected Annual Claims
Summary of Cost Assuming No Changes
Baseline Medical Trend
Trended PEPY Cost
Expected Enrollment
Projected Annual Claims
Assumptions
Network Name
Please confirm: In Network and Out of Network Claims
Includes All Large Dollar Claims Under ISL ($350,000)
Includes All Capitated Claims (if excluded, please provide detail below)
Detailed description of any claims excluded
Minimum Enrollment
Assumed Plan Design
Assumed Enrollment % - specify % for each quoted network option and assumed plan design offering
Risk Free Corridor
PEPY Claim Target
Claim Guarantee	Fees at Risk
$ or less	$0.00
$ to $	$ PEPM
$ to $	$ PEPM
$ to $	$ PEPM
$ to $	$ PEPM
Greater than $	$ PEPM
Total Amount at Risk	$

&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

&"Segoe UI,Regular"&A &"Segoe UI,Regular"Holmes Murphy - CONFIDENTIAL &"Segoe UI,Regular"&P

Deviations

Deviations and Variations

For any benefits you cannot duplicate or administer per the in force SPD/booklet/certificate, please indicate on this tab. Please clearly note the differences or provide as a separate attachment.

Quoting Carrier:

&"Segoe UI,Bold"ASO MEDICAL RFP WORKBOOK

&A Holmes Murphy - CONFIDENTIAL &P

Fees & Contract - Stop Loss Stop Loss - Fees & Contract

Please note that you must complete rate information in the following requested format in order for your quote to be considered. All highlighted cells must be completed.

	Vendor Name
	Financial Rating (A.M. Best, etc.)
		Proposers Must Mirror Current Plan
ASO - Stop Loss Fees	2026

Current

(BCBS Carved In)	Proposed
2027	Proposed
2028	Proposed
2029	Proposed
2030	Proposed

ISL Monthly PEPM Administrative Fee*			$	$	$	$	$
Employee		$35.06	$	$	$	$	$
EE+SP		$87.68	$	$	$	$	$
EE+CH(REN)		$87.68	$	$	$	$	$
FAM		$87.68	$	$	$	$	$
	ISL Deductible Level	$350,000	$	$	$	$	$
	Annual Maximum	Unlimited
	Medical & Rx Included?	Medical & Rx	Medical & Rx	Medical & Rx	Medical & Rx	Medical & Rx	Medical & Rx
	ISL Contract Type?	Paid
	Individuals/Groups Excluded from the ISL?	N/A
	Lasers on Individuals?	N/A
	Terminal Liability Option?	Yes
Aggregate Stop Loss Admin Fee		Included in ISL fees above	$	$	$	$	$
	Attachment Point	125%
Optional Rider Fees		N/A
Commissions		Net of Commisions
Rate Cap		None for 2027
No New Laser Provision		No Lasers
Estimated Monthly Premiums		$789,258	$	$	$	$	$
Estimated Annual Premiums		$9,471,096	$	$	$	$	$
Other
Note: This Stop Loss RFP is managed by Holmes Murphy and Avant Specialty Benefits
*Please quote on a 4 tier basis

&"Segoe UI,Bold"

STOP LOSS RFP WORKBOOK

&"Arial,Regular"&10&A &"Arial,Regular"&10Holmes Murphy - CONFIDENTIAL &"Arial,Regular"&10&P

Questionnaire - Stop Loss Stop Loss Services Questionnaire

Vendor Name
General Questions	Response
1.1. Legal Entity Name*
1.2. Name of Person Completing RFI*
1.3. Date of Completion*
1.4. Responses effective until what date*
1.5. Provide your AM Best Rating*
1.6. Explain your ownership structure.*
1.7. How long has your organization been in business for stop loss insurance?*
1.8. Has your company done business under other names (legal or d/b/a)?*
1.9. Please provide historical background information.*
1.10. Identify any interests your organization may have with associated vendors (claims administrators, brokerage firms, managed care firms, etc.).*
1.11. Have you ever been suspended from writing stop loss coverage?*
1.12. If the answer to 1.11 was 'Yes', Please describe.*
1.13. Is your organization licensed to do business in all 50 states and U.S. territories?*
1.14. Identify the states/territories in which you are not currently licensed.*
1.15. What groups/organizational structures (tribal, MEWA, associations, trusts, etc) does your company consider to be “ineligible”? Please list.*
1.16. Please describe your product portfolio to us, and please let us know of any package discounting available for the sale of additional product lines/types.*
1.17. How often does actuarial complete evaluations of network (PPO) performance and adjust underwriting discounts based on evaluations? Is there information about network performance available to Avant based on those findings?*
1.18. What is your usual process to evaluate an RBP (referenced based pricing) vendor? What information is needed to evaluate the vendor and offer binding quotes?*
1.19. Do you provide any offsets for an employer implementing clinical programming (for example Regenexx, Livongo, etc)*
1.20. Please provide a list of approved vendors (we will complete an NDA if needed for this)*
1.21. Do you utilize AI platforms (Gradient, Verikai, Curv) to underwrite? If so can it be used on any groups or is it solely for fully-insured transitions?*
1.22. Please outline your underwriting structure. Do you have new and renewal underwriting teams, or does the selling underwriter continue with the case throughout the relationship?*
Experience
2.1. How much stop loss annualized premium do you currently have in your block of business?*
2.2. Please provide historical block renewal increases, loss ratio, and persistency for the last 5 years*
2.3. What percentage of the risk does your company assume? If less than 100%, please identify additional reinsurer(s) and the respective percentage of assumed liability.*
2.4. Who has final claim decision-making authority with respect to specific and aggregate claims?* If another carrier is involved, please described amounts for which they have authority?*
2.5. Formal Disclosure: Will you agree to no client signature required on new business (with no admin change)?*
2.6. Formal Disclosure: Will you agree to no client signature required on renewals (with no admin change and less than 25% change to population)?*
2.7. Please provide a full listing of your cost containment vendors*
2.8. If you offer any programs for a step down deductible please list them here*
2.9. Please list any gene therapy programs/solutions you currently have (or are in the pipeline)*
2.10. In the event of a one-time high-cost gene therapy claim, how do you handle (underwrite) at renewal?*
2.11. Please confirm that firm quotes will be issued with a minimum of 15 calendar days before expiring. If a firm quote is issued prior to the firm RFP due date, the 15 calendar days must 'start' on the RFP due date.*
2.12. Please confirm you will provide firm quotes with 8 months of data*
Contractual
3.1. What is your minimum group size (enrolled)?*
3.2. What is the minimum and maximum IER deductible offered?*
3.3. Are there any ineligible networks or TPAs?*
3.4. Please list any ineligible networks or TPAs*
3.5. Waive Active at Work: On new business, do you agree to waive actively at work for covered employees and dependents per the employer's plan document other than any lasers put in place on new business?*
3.6. Do you match exclusions and limitations to the underlying plan document? If not, please outline standard exclusions/limitations.*
3.7. Do you offer no new lasers/rate cap contracts?* Please advise if you have minimum premium/enrollment thresholds for this*
3.8. Under your no new laser contract, do you have the ability to increase the lasered amount at renewal?*
3.9. What is the standard rate cap %?*
3.10. Please outline costs* NOTE: We are requesting a maximum of a 5% load for NNLRC.*
3.11. Are No New Laser/Rate Cap Contracts Evergreen or can they be revoked?*
3.12. Please explain how your no new laser/rate cap contracts apply to Aggregating Specific Deductibles (does a 50% NNLRC increase the ASD by 50% as well)?*
3.13. For aggregating specific deductibles, do you apply a dollar for dollar offset? If not, please confirm percentage.*
3.14. Please confirm that No New Laser Rate Caps will be offered on all cases (above your minimum thresholds)*
3.15. Do you offer monthly aggregate accommodation?*
3.16. Which party is responsible for triggering the accommodation payment request, and what is the standard turnaround time of the accommodation payment from receipt of notification?*
3.17. What fees will be excluded as part of claims?*
3.18. Confirm how you handle fees related to arbitration under the No Surprises Act. Will they be covered under the stop loss policy?*
3.19. If a client acquires a new company during the contract year, do you agree to waive the actively at work, dependent non-confinement and pre-existing condition limitation provisions for the newly acquired employees, their dependents, spouses, domestic partners, FMLA, retirees (if applicable), and COBRA beneficiaries?*
3.20. What is the enrollment threshold for underwriting repricing?*
3.21. Please confirm minimum and maximum policy lengths (6, 9, 15 months, etc)? Do you have any multi-year programs available for stop loss? Please provide details.*
3.22. Do you offer participating contracts or premium refund agreement based on target loss ratios?*
3.23. Please provide details and outline any case level requirements (size, annual premiums, etc).*
3.24. Other than medical and RX, what other costs can be included in aggregate reimbursement? (ex. Dental, vison, etc) Is there additional cost for this? Please detail.*
3.25. Do you apply claims run in limits to new contracts?*
3.26. If so, please provide additional details*
3.27. Do you agree to provide plan mirroring language or an applicable endorsement to ensure expenses covered by the underlying Plan are covered by the applicable stop loss policy (standardly for all Avant business)?*
3.28. Please identify any states in which your policy would be written on different paper and which carriers would be applicable in such instances.*
3.29. If you cannot provide your traditional policy for certain states (NY for example), please confirm you will notify us of this during the RFP process.*
3.30. If your policy is being refiled, please confirm you will provide us with the changes PRIOR to filing for the year with the states for our review and feedback.*
3.31. At minimum, if your policy is refiled, we need to be notified and provided a copy of the new policy BEFORE placing coverage and NO LATER than 60 days following approval of the new police or any substantive changes to policy language or provisions. Please confirm.*
Claims Practices

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File details come from the government source that posted it. Updated Feb 24, 2026.