2026_Medical_RFP.xlsx

XLSX spreadsheet 28 KB Posted Oct 14, 2026

Attached to: Employee Benefits- Medical/Rx/EAP RFP
Solicitation number: 27-012CH-32RFP
Issued by: Maricopa County, Tucson City, Arizona

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Written by GovTribe AI · Oct 29, 2026

This is a Vendor Instructions and RFP Response Sheet for a Medical, Pharmacy, and Employee Assistance Program (EAP) benefits contract opportunity issued by the Tempe Union High School District in Arizona. The District seeks comprehensive proposals for medical and pharmacy claims administration, preferred provider networks (both broad and narrow/ACO networks), HSA administration, disease management, utilization review and case management, wellness services, and stop-loss insurance. Proposals must be submitted in Excel format through the Procurement Portal at https://procurement.opengov.com/portal/tuhsd no later than 2:00 pm on Thursday, November 19, 2026. The contract term is one year with options to renew for four additional one-year periods, effective July 1, 2027. Respondents must address all sections of the questionnaire, including general qualifications, minimum requirements, account management, administrative services, network medical and ACO services, pricing, banking and financial terms, reporting capabilities, medical management and disease management programs, wellness initiatives, and EAP services.

Vendors must provide detailed pricing without commission-based fees and maintain firm rates that will not be recalculated based on actual enrollment fluctuations. Respondents are required to propose a single bundled package encompassing all requested services and must commit to specific service levels including 24-hour customer service availability (8:00 AM to 6:00 PM MST minimum), multilingual support, secure eligibility management systems, and comprehensive reporting available through an internet portal within 15 days of month-close. The District reserves audit rights including 100 percent claims review access for up to three benefit plan years, with any identified overpayments or processing errors to be refunded within 30 days. Vendors must provide Maricopa County provider network data in Excel format, maintain networks at contracted sizes, accept fiduciary responsibility for claims processing at no additional cost, provide detailed geo-access reports demonstrating network adequacy, and agree to non-solicitation of district members and non-sale of member information without express written consent. All contract responses, interview materials, and clarification statements become binding contract terms upon award.

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Other files

File	Type	Posted
Employee_Benefits-_Medical_Rx_EAP_RFP_(Addendum_#1_Revision).pdf	PDF	Oct 29, 2026
Employee_Benefits-_Medical_Rx_EAP_RFP.pdf	PDF	Oct 20, 2026
00188_TUHSD_PBM_RFP_Proposal_Response_Document(6007643.3).xlsx	XLSX spreadsheet	Oct 14, 2026
Tempe_Union_School_District_-_Medical_RFP_-_2026(6005777.2).pdf	PDF	Oct 14, 2026

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Vendor Instructions RFP Response Sheet

Please read the directions below as our process has changed.

Please read, review and provide the information requested in this workbook. The cells will automatically expand as needed if your response is longer than the space shown in the cell, however, brevity is expected. Limitations do exist.

Beware that some questions request only a Yes or No response. Some questions contain limits on the length of your response.

The purpose for these limitations allows the Client to assess the responses as appropriate in a brief manner.

The worksheet is also locked so that you can only enter information in the Answers column or on the exhibits as requested.

Do NOT insert tabs or extra attachments unless instructed to do so.

Do NOT respond by "referring the Client to an attachment".

Do NOT delete sections of the questionnaire. If something does not apply to you leave it blank, or mark N/A. If you take something out, it will cause your responses to not line up correctly with the questions when we do the analysis.

Should you have any questions concerning the Questionnaire in this RFP, please reach out to the following contact(s) at Segal:

Response Documents Required for this Request for Proposal:

1) Questionnaire - Excel. Requires responses completed and returned in Excel format. DO NOT PDF

This Request For Proposal form is the sole property of Segal and is not intended to be reproduced for any purpose other than review by the Plan Sponsor contracted with Segal to prepare a procurement analysis. This file cannot be copied or reproduced in any method without the written consent by Segal.

Questions

ID	Questions	Answers
Section 1 - GENERAL QUESTIONS / QUALIFICATIONS & EXPERIENCE
1.1	What is your company name?
1.2	How many years has your firm offered the benefits outlined in the referenced Scope of Work ?
1.3	Would you match the benefits outlined in the Benefit Plan Summary to all participants included in the attached Census?
1.4	Are you able to administer the Benefit Plan Summary per the attached?
1.5	In the last 5 years, has your organization been involved in any Litigation that would prohibit your organization from delivering the Scope of Work outlined in the RFP?
1.6	If you have been involved in any litigation in the last 5 years, please explain.
1.7	Have you ever had any litigation specific to the District?
1.8	If you have had any litigation specific to the District, please explain.
1.9	Has your organization completed any mergers or acquisitions in the last 24 months?
1.10	If you have completed a merger or acquisition in the last 24 months, what impact will this have on the services provided?
1.11	Have you made any recent changes in your operational platform that will impact the success of delivering the services outlined in the Scope of Work?
1.12	Are you a broker or agency offering the products in this Scope of Work?
1.13	Please respond to the following:
1.13.a	Is your firm the sole responder to this RFP or are you partnering with other vendors to deliver the Scope of Work?
1.13.b	If you are partnering with other vendors, please explain who and why?
1.14	Do you anticipate any restructuring or reorganizing within the next two years? (this includes addition, reductions, relocations, or redesign of systems)
1.15	What are the most recent ratings, including the date of the rating for your company by the following (If not applicable, include a N/A)?
1.15.a	AM Best
1.15.b	Standard and Poor's (S&P)
1.15.c	Moody's
1.16	What is your firm's Net Promoter Score (NPS)?
1.17	Do you agree that any data and information regarding the District supplied to you for purposes of responding to this RFP will be destroyed immediately upon receiving notice that you were not the successful winner?
1.18	Recipient confirms and agrees that the data and information provided, which may include protected health information related to plan’s participants and beneficiaries, provided under the Agreement (“Plan Data”) is and shall remain the property of the plan. Recipient is not granted any right, title or interest in any Plan Data. Recipient may use and disclose Plan Data solely as necessary to effectuate the purpose and will not use, disclose, decompile, or reverse engineer, any Plan Data in support of Recipient’s other business activities. Specifically, Recipient will not de-identify any Plan Data or aggregate Plan Data (whether or not de-identified) with data received from Recipient’s other clients, customers or data sources.
1.19	Do you anticipate any transition issues with the following:
1.19.a	Eligibility
1.19.b	Benefit administration
1.19.c	Transition of care
1.19.d	Deductible and out of pocket transitions (if applicable)
1.20	Should your firm be awarded this RFP, how soon after notification (# of business days) of award would you be able to prepare the rough draft for the following:
1.20.a	Master Policy
1.20.b	Plan Booklet
1.20.c	Summary of Benefits or SBC
1.20.d	Contract Draft
1.21	Should your firm be awarded this RFP, identify any services performed outside the borders of the United States of America.
1.22	Does your firm have the capability to prepare communication pieces for the enrollees in Spanish?
Section 2 - MINIMUM REQUIREMENTS
2.1	Proposal Responses (Initial and Best and Final, if applicable) and Interviews (if applicable) will become part of the final contract. Do you agree that your written response to this RFP, written information provided as part of the interview or clarification questions will become part of the final contract for services outlined in the Scope of Services?
2.2	Have you proposed a single bundled package including, medical and pharmacy claims administration, medical and pharmacy preferred provider network, HSA administration, disease management, and utilization review/case management for medical and pharmacy, wellness services and stop-loss insurance?
2.3	Do you agree that the contract will not "auto" renew annually, and you will send a renewal confirmation each year, whether or not under a rate/fee guarantee, no later than 180 days from the effective date of coverage?
2.4	Confirm the rates and fees quoted in your proposal are firm and will not be recalculated based on actual enrollment.
2.5	Do you agree that the terms of the RFP responses are valid until a final contract is executed?
2.6	Confirm you understand that the Contract, if awarded, will be written for the length of one (1) year with the option to renew for four (4) additional one-year periods.
2.7	Confirm that your proposal is not contingent upon using another vendor for any other service (such as PBM, Wellness, Medical Management, Disease Management, Behavioral Health, etc.).
2.8	Do you agree that this bid response is NOT contingent on purchasing any services other than in the Scope of Work?
2.9	Do you agree that any provisions for restating premium rates due to changes in enrollment that exceed a 15% need to be confirmed as acceptable with the District?
2.10	Do you agree to provide no less than 30 day notice for any changes involving the sale, merger, data breaches, layoffs, participating provider terminations, consolidations, or outsourcing of services to foreign workers?
2.11	Do you agree that you will disclose all subcontractor arrangements, and any additional fees associated with the subcontractor arrangement at least 180 days prior to their effective date for services?
2.12	Do you agree to waive the "Actively-at-Work" clause upon the effective date of the policy, should you be awarded this RFP?
2.13	Confirm you agree to the specified eligibility rules established by the client and will communicate directly with the Client regarding any uncertain claimant eligibility situations before notifying the claimant of ineligibility?
2.14	Do you comply with all relevant Mental Health Parity and Addiction Equity Act (MHPAEA) regulatory requirements?
2.15	Confirm you will not solicit Client's members for any other products or services that your firm might offer, and confirm you will not sell any mailing or other list that includes Client member information without express written consent from the Client.
2.16	Right to Audit: Confirm Yes or No to the following audit right requirements.
2.16.a	Once each year, or more frequently as reasonably determined by the District, or within two (2) years following termination of this Agreement, District’s third party Auditor(s) (“Auditor”), as reasonably approved by Vendor (which approval shall not be unreasonably withheld), may inspect and verify claim data, eligibility, billing records, pricing discounts and terms, claims adjudication systems, healthcare benefits, clinical programs, subcontracted administrative services directly related to Client’s Member utilization and services, performance guarantees, and operational processes relating to the services provided to Client pursuant to this Agreement to ensure Vendor’s compliance with the terms and conditions of this Agreement, as the District deems appropriate.
2.16.b	Bidder agrees to grant the right of the District or its representative(s) to audit claims at any time during and up to two years following termination of the business relationship with prior written notification. The District will have access to 100% of all valid claim records to complete the audit at no cost to the plan sponsor. Bidder agrees to provide all necessary claims details, data definitions and reasonable support to complete an independent claim audit for each completed year under the contract in effect. The District will not be held responsible for time or miscellaneous costs incurred by the bidder in association with an audit including, but not limited to, the costs associated with providing audit reports, systems access, or onsite space.
2.16.c	Such audits may be based on either a 100% review of claims or a statistically representative sample thereof, or combination of methodologies. Auditor’s preliminary findings will be shared with Vendor. Any findings from a statistically representative sample of claims will be extrapolated to the total claims population for purposes of measuring overall financial dollar and incidence processing achievements; Vendor will produce financial impact reports for confirmed systemic errors. In the instance where Auditor has reviewed 100% of claims and identified suspect claims, Vendor may elect to review a mutually-agreed upon representative sample of the suspect claims.
2.16.d	The audit may include an onsite review of the sample claims by the Auditor at Vendor’s office. The Auditor will provide Vendor with the sample claims thirty (30) calendar days in advance of the onsite review. The onsite review will last up to five (5) business days.
2.16.e	The scope of such audits may include up to three (3) benefit plan years as determined by the District.
2.16.f	Any and all costs and expenses of each party associated with District’s audit shall be borne by the party incurring the cost. The parties agree that the scope of audits by the District or Auditor will not be duplicative of the SSAE-18 audit, but may include inspection and/or verification of certain information provided in the SSAE-18 audits to the extent necessary to give a more thorough understanding of and support for such information. Audit materials or documentation provided by Vendor will be confined to District-specific information.
2.16.g	If the audit discovers any validated overpayment of fees or claim payments by Vendor or other errors that result in economic losses to the client for failure to meet all vendor guarantees or performance standards, then Vendor shall pay the amount owed to the Client following completion of the audit, within 30 days of written confirmation from the client as to the agreed upon settlement terms and amounts.
2.17	Do you agree to maintain all required records for seven years, pertaining to the administration of the plans in force?
2.18	Do you agree to the transition of all records as requested by the District in the case of termination? This may include claim accumulators, plan experience, premiums (if applicable) and eligibility at no added fee to the District?
2.19	Do you agree to pay the run out claims for the District (including at a minimum 12 months of claim payments) following termination at no added fees to the District?
2.20	Do you agree to supply the necessary underwriting documentation for all renewals 180 days prior to the effective date?
2.21	Are you able to provide the services outlined in the Scope of Work?
2.22	Confirm that your pricing does not include commissions?
Section 3 - ACCOUNT MANAGEMENT
3.1	Confirm the Account Manager will respond to phone calls or emails within 24 hours of receipt.
3.2	Confirm you will attend the Open Enrollment meetings to review benefits and respond to questions.
3.3	Confirm your Account Manager will meet with the client to define the group, subgroup, and other reporting criteria necessary to support the District's decision making process.
3.4	Confirm that Account Manager will be present for monthly/quarterly meetings established by the District or as requested.
3.5	Confirm the Account Manager will present any legislative impacts to the employee/member benefits or any changes recommended for approval by the District.
3.6	Do you agree that all sample forms and communication materials will be provided to the District in advance of distribution for approval (ie, claim forms, enrollment forms, booklets, brochures, flyers, mailers, etc.)?
Section 4 - ADMINISTRATIVE SERVICES/CLAIM ADMINISTRATION
4.1	What is the minimum time for implementation needed to initiate the proposed benefits or scope of work?
4.2	Confirm your customer service team is available to serve the District's participants from 8:00AM - 6:00PM, MST.
4.3	Do you offer customer service representatives with multiple languages such as Spanish, French, etc.?
4.4	Confirm all customer service representatives are located in the continental United States of America.
4.5	Of the services listed below, indicate those services that are available on your member website and/or mobile app:
4.5.a	Check Claim Status
4.5.b	View Claim History
4.5.c	Contact Customer Service
4.5.d	Cost Treatment Calculators
4.5.e	Provider Locator
4.5.f	On-line Provider Directories
4.5.g	Plan Benefit Descriptions
4.5.h	Provider Price Comparison Tool (for common services such as office visits, etc.)
4.5.i	Provider Quality Ratings
4.5.j	Patient Satisfaction Information
4.5.k	Print ID Card
4.6	Do you have an automated method to identify and recover overpayments?
4.7	Does your firm retain any portion of the overpayment recoveries?
4.8	Do you have a secure website that the District can use to maintain eligibility enrollments, changes and addresses?
4.9	Do you agree that you will be able to implement and administer a High Deductible Health Plan (HDHP) in addition to the two current health plans the District offers effective July 1, 2027?
Section 5 - NETWORK MEDICAL
5.1	What is the marketing name of your broad network(s) being proposed?
5.2	Please complete the following:
5.2.a	Do you lease any portion of the network offered as part of this proposal?
5.2.b	If so, list who and for what services? Include wrap networks.
5.3	Does your network contract with Centers of Excellence for organ transplants or other diagnostic treatment plans?
5.4	Confirm you have provided an electronic copy of your proposed Maricopa County broad network providers in MS Excel format. Provide the following fields: Provider last name, provider first name, TIN, NPI, servicing street address, Servicing City, Servicing State, 5 digit zip code, Type of provider (MD, DO, PA, etc.),
5.5	Do you agree to maintain the size of your Maricopa County network for the duration of the contract to be no less than the size provided in your response to this RFP?
5.6	Do you anticipate a change in the size or location of your network in the next year that would affect the District's participants?
5.7	Do you anticipate any network changes over the next twelve months for:
5.7.a	Physicians?
5.7.b	Hospitals?
5.8	Confirm you have provided Geo Access reports for the network(s) proposed using as criteria 2 PCPs within 10 miles? Include family practice, general practice, internal medicine, pediatricians and OB/GYN. Provider to be based on MD or DO designations only. Also, 2 Specialists within 10 miles, and 1 Hospital within 20 miles? Results must be based on the census provided. Do not exclude any locations or employee groups. Very important - Geo results must include a report showing locations where the access criteria was not met, including the number of people impacted, name of the City, County, State and Zip Code.
5.9	Of the networks you are proposing, are they Open Access or Gatekeeper styles?
5.10	Do you provide Telehealth services? (24/7 access to medical, counseling, and psychiatry services)?
5.11	List the Telehealth services included in your proposal.
5.12	Do your providers offer Telemedicine services (virtual visits in lieu of physical office visits with a member's doctor)?
5.13	If you have gatekeeper, can women self refer to an OB/GYN for their annual well woman exams?
5.14	Are participants of our client able to self-refer to specialists?
5.15	Does your proposed network offer alternative medicine providers such as the following?
5.15.a	Homeopaths
5.15.b	Acupuncture
5.15.c	Massage Therapy
5.15.d	Naturopaths
5.15.e	Medicine Doctors
5.15.f	Other, list
5.16	What percent of local physician providers are at full capacity and will no longer accept new patients?
5.16.a	Primary care?
5.16.b	Specialists ?
5.17	For non-network claim negotiations, do you agree to cap your retained savings at the lesser of $5,000 per claim or the actual negotiated payment terms?
5.18	Identify all circumstances where the client will not receive the full discount according to your contract, (for example, list any fees or savings that are retained by your organization and not passed through to the client.
Section 6 - NETWORK - ACO
6.1	What is the marketing name of your narrow network(s) being proposed?
6.2	Of the networks you are proposing, are they Open Access or Gatekeeper styles?
6.3	Provide the net estimated claim savings on the total medical spend relative to your broad network for the current year.
6.4	If you offer Narrow Network or Value Based Contract options, what is the cost or fees associated with participation in your Narrow Network or Value Based Contract arrangements.
6.5	In your Narrow Network or Value Based contracts, how are out of area or out of state claims covered?
6.6	Confirm you have provided an electronic copy of your proposed Maricopa County narrow network providers in MS Excel format. Provide the following fields: Provider last name, provider first name, TIN, NPI, servicing street address, Servicing City, Servicing State, 5 digit zip code, Type of provider (MD, DO, PA, etc.).
6.7	Identify the amount and timing of any and all provider fees which will be passed through to the Client other than Claims (e.g. care coordination fees, performance incentive fees, etc.), and the basis for determining payment.
6.8	Are all providers eligible for Pay for Performance? If not, identify the criteria by which they are selected and the key hospital and physician groups that are included in your Pay for Performance arrangement.
Section 7 - PRICING
7.1	List all fees not specifically requested in the Pricing Fee Sheet attached. (List all non-Claim expenses, such as, include all fees added to claims not directly related to a service, ie., retained savings, pay for performance bonuses, out of network retained expenses, etc.)
7.2	If you are offering a savings guarantee, provide details of the minimum guaranteed savings, any shared risk corridors, the definition of and treatment of large claims in your savings guarantee and the amounts at risk.
7.3	If you are offering a discount guarantee, provide details of the minimum guaranteed discount, any shared risk corridors, the definition of and treatment of large claims or outlier claims in your discount guarantee and the amounts at risk.
Section 8 - BANKING/FINANCIAL
8.1	Do you require a binder check or any type of deposit should you be awarded coverage for the Scope of Work outlined for the District?
8.2	What is the grace period for payment of administrative fees?
8.3	How often are claims released for payment?
8.4	Confirm that you will accept fiduciary responsibility for claims processing at no additional fee to the District.
8.5	If you will not accept fiduciary responsibility for claims processing at no additional fee to the District, please explain.
8.6	What is the timeframe allowed for retroactive terminations?
Section 9 - REPORTING
9.1	Confirm you agree to establish reporting for eligibility, paid and incurred claims, and encounters or utilization (visits or services) by the subgroups and categories determined by the District.
9.2	Confirm you agree to supply monthly or quarterly reporting packages no later than 15 days from the close of a month as defined by the District (for example, by type of service, Active/COBRA, Hourly vs. Salaried, by locations, etc.)
9.3	Confirm you will supply electronic files for eligibility, claim details and utilization experience on a Monthly basis.
9.4	Have you shared a template for the routine claim and utilization reporting available to a client of our size? Attach and label as Report 1, Report 2, etc.
9.5	Are the reports prepared for the District available through an internet portal?
Section 10 - MEDICAL MANAGEMENT/DISEASE MANAGEMENT/CASE MANAGEMENT
10.1	Indicate your UM program accreditation:
10.1.a	URAC
10.1.b	NCQA
10.1.c	JCHO
10.1.d	Other
10.2	Name the procedures that require a pre-certification requirement - Please provide your categories for Precertification review.
10.3	Describe Medical Director interaction on clinical review, peer to peer, denials, and appeals.
10.4	Does your firm have a case management program? If so, please summarize the highlights of your program. Note if this is outsourced or handled internally.
10.5	Please describe your organization's philosophy of case management and the model under which it currently operates. Describe how the case management program integrates with other care management programs such as utilization review and quality management. In addition, describe your face-to-face member support and counseling offered to members receiving your case management services.
10.6	How do you coordinate case management activities between the claim administration vendor and the stop loss vendor?
10.7	Describe the process for identification and referral to case management including any predictive modeling, integration criteria, algorithms, self-assessments, and automations. Detail what quality checks are in place to be sure referrals are completed by the UM team as well.
10.8	How can the District's participants or Administrators access and identify your network's hospital quality and cost-efficiency ratings?
10.9	Do you employ a transparency model whereby members can research pricing and quality outcomes for procedures performed at network providers?
10.10	Do you agree to provide prior authorization /precertification services to the services/benefits which are outlined in the District's plan document under Precertification Review?
10.11	Do you agree to attempt to redirect pre-cert callers to an appropriate in-network provider where possible?
10.12	Who is responsible for obtaining a pre-service certification, the member or provider?
10.13	If the provider is responsible to obtain a pre-certification approval and doesn't, does the responsibility fall to the member?
10.14	Do you agree to provide the stop loss carrier with case manager notes, course of treatment, pre-certification of hospital stays, surgeries or transplants when requested during the contract periods without additional cost to the client?
10.15	How are the following individuals notified of an approved pre-certification?
10.15.a	Physician
10.15.b	Patient
10.15.c	Hospital/Ancillary vendor
10.16	Is your DM program developed internally or provided through an outsourced vendor?
10.17	If your DM program is outsourced, to whom?
10.18	How do you identify candidates for your DM program?
10.19	How do you communicate with candidates the value and benefits of participating in your DM programs?
10.20	How many outreaches will you perform to viable candidates?
10.21	Should a candidate chose not to participate, how do you guarantee they will not be contacted again.
10.22	What standard diagnoses/chronic conditions are covered by your DM programs?
10.23	List additional optional DM services available not currently included in your proposed fees on the Financial exhibits included.
Section 11 - WELLNESS
11.1	Provide a description of your proposed wellness program included in this RFP response.
11.2	Confirm you have provided a wellness allowance as requested on the appropriate fee sheet. If not, please explain.
Section 12 - EAP
12.1	How many face to face/virtual sessions per employee or dependent per issue are you proposing?
12.2	How many years has your organization been providing EAP services?
12.3	What is the average tenure of your behavioral health counseling staff?
12.4	Is any aspect of your services outsourced?
12.5	What key attributes distinguish your organization from the competition?
12.6	How does your program support the overall health and wellness of the workforce?
12.7	Describe the type of background checks your organization conducts on potential new employees?
12.8	Indicate your staff counseling services available for Pediatric, Adolescent, Adult and Geriatric?
12.9	Define your approach to connecting a plan participant with an appropriate counselor.
12.10	How do you approach connecting participants in need of continuing counseling to in-network providers.
12.11	What resources are available through the program in addition to counseling (crisis lines, live web chat, wellness resources, newsletters, etc.) and how are these resources made available?
12.12	What are the available hours of operation?
12.13	What is the average response time for all customer service portal or calls?
12.14	Will you provide 24-hour access to an EAP counselor qualified to assess and triage cases?
12.15	Will you maintain 24-hour access, seven days a week including telephonic crisis counseling?
12.16	Do you anticipate any transition issues with respect to moving EAP services from the existing vendor to your EAP program?
12.17	How do you handle participants who are approved visits or a course of treatment through EAP services when the District terminates your contract? Note the contract will state: The incumbent Vendor shall be responsible for payments of claims and continuation of coverage for the authorized services for the period authorized by the incumbent EAP/BHO or ninety (90) days, whichever is less should the client terminate your policy.
12.18	Confirm you are able to offer self-administration billing and there will not be a reconciliation done following payment?

File details come from the government source that posted it. Updated Oct 29, 2026.