Contract #2139 - 1-27-2026 Page 1 of 71 V01.06.2026

PLEASE DO NOT REMOVE ANY SHEETS FROM THIS DOCUMENT

TOWN OF VERNON

Request for Proposals (RFP) #2139 – 1-27-2026

Town of Vernon and Vernon Public Schools Medical Benefits Administrative Services, Pharmacy Benefit Manager, Dental Benefits, and Stop-Loss Insurance

Submittal Date: January 27, 2026, at 10:00 am

LATE SUBMITTALS WILL NOT BE ACCEPTED

Contract #2139 - 1-27-2026 Page 2 of 71 V01.06.2026

LEGAL NOTICE

REQUEST FOR PROPOSALS

Town of Vernon, CT

CONTRACT #2139 – 1-27-2026 - Town of Vernon and Vernon Public Schools Medical Benefits Administrative Services, Pharmacy Benefit Manager, Dental Benefits, and Stop-

Loss Insurance

The Town and Public Schools of Vernon (herein referred to as “VERNON”) has asked Acrisure, LLC (Acrisure) to solicit bid proposals for administrative services (ASO) for the Medical, Behavioral Health Care, Pharmacy Benefit Management (PBM), dental, and Stop-Loss Insurance components of the self-funded Vernon employee health plan. This RFP is requesting delivery of the comprehensive benefits plan through a traditional self-insured arrangement, mirroring the current funding arrangement. We are open to receiving a complete package of the requested services or carve-out options. VERNON reserves the right to choose one plan administrator for all products, or individual administrators for the different components of the benefit plans.

All questions should be directed to Nichole Greco, Project Coordinator, by email at ngreco@vernon-ct.gov, no later than January 13, 2026, at 3:30 pm. Answers to questions received will be posted by January 15, 2026, on the Town’s website at https://www.vernon-ct.gov/o/tov/page/bids-and-rfps and at the Connecticut State Department of Administrative Services (DAS) at https://portal.ct.gov/das by referencing Contract #2139-1-27-2026. It is the sole responsibility of the respondent to review any or all addendum or question responses related to this RFP.

Six (6) hard copies and one (1) electronic copy of the proposal must be submitted in a sealed envelope, clearly marked “BID DOCUMENT DO NOT OPEN - CONTRACT #2139-1-27-2026 - Town of Vernon and Vernon Public Schools Medical Benefits Administrative Services, Pharmacy Benefit Manager, Dental Benefits, and Stop-Loss Insurance” to John W. Kleinhans, Town Administrator, 14 Park Place Vernon CT 06066 no later than January 27, 2026 at 10:00 am, at which time proposals will be opened and read aloud publicly. Emailed, faxed or late proposals will not be accepted.

The selected firm must meet all municipal, state, and federal AA and EEO practices and requirements. MBE's, WBE's, SBE's are encouraged to apply. The Town reserves the right to reject any or all proposals in whole or part, to award any one service or group of services or all services, to negotiate with any or all companies submitting proposals, and to enter into an agreement with any contractor for any services mentioned in this RFP; if it is deemed to be in the best interest of the Town.

Confidentiality - If Respondent believes that any information in its proposal should be treated as confidential that material shall be clearly marked. The Town shall endeavor to protect confidential material from disclosure to non-Town employees to the extent permitted by State or Federal law.

In no event will the Town be responsible for the inadvertent disclosure of your response to this

RFP.

John W. Kleinhans, Town Administrator mailto:ngreco@vernon-ct.gov https://www.vernon-ct.gov/o/tov/page/bids-and-rfps https://portal.ct.gov/das

Contract #2139 - 1-27-2026 Page 3 of 71 V01.06.2026

Contents

TOWN OF VERNON

LATE SUBMITTALS WILL NOT BE ACCEPTED

LEGAL NOTICE

CONTRACT #XXXX - Town of Vernon and Vernon Public Schools Medical Benefits Administrative Services, Pharmacy Benefit Manager, Dental Benefits, and Stop-Loss Insurance John W. Kleinhans, Town Administrator

SECTION I: OVERVIEW

A. RFP OBJECTIVES

B. GENERAL TOWN & PUBLIC SCHOOL INFORMATION

C. GENERAL MEDICAL AND BEHAVIORAL HEALTH PLAN INFORMATION

D. BENEFIT PLAN DESIGN:

E. VENDOR SELECTION CRITERIA

F. MINIMUM REQUIREMENTS

SECTION II: BIDDING INSTRUCTIONS AND CONDITIONS

A. GENERAL PROPOSAL CONDITIONS

B. BID SPECIFICATIONS

C. TIMETABLE

D. BIDDING INSTRUCTIONS

E. NETWORK ACCESS

SECTION III: FINANCIAL SECTION

A. RATES AND FEES

SECTION IV: QUESTIONNAIRE – MEDICAL & MANAGED BEHAVIORAL HEALTH

A. CLAIMS MANAGEMENT

B. OPERATIONS

C. MISCELLANEOUS

D. FINANCIAL GUARANTEES

E. ASO BANKING/CLAIM REIMBURSEMENT ARRANGEMENTS

F. STOP-LOSS INSURANCE

SECTION V: QUESTIONNAIRE – PHARMACY BENEFIT MANAGER

General Information Eligibility

Member Services and Call Center Member Website and Mobile Apps Member ID Cards and Communication Materials

Contract #2139 - 1-27-2026 Page 4 of 71 V01.06.2026

Client Account Management Benefit Fair and Open Enrollment Participation Claim Processing and Adjudication System 340B Claim Processing Retail Network Mail Service Pharmacy Specialty Pharmacy Formulary Information Patient Assistance Programs/Copay Assistance Programs Clinical Programs Reviews & Appeals Clinical Safety and Fraud Waste and Abuse File Management and Data Rights Data Security and HIPAA Compliance Transition and Vendor Change Management Integration with other Vendors Auditing Client Invoicing Termination Rights Required Definitions Pricing and Performance Guarantees Allowances and Performance Guarantees

SECTION VI: PROPOSAL QUESTIONNAIRE - DENTAL BENEFITS PLAN

A. ADMINISTRATIVE FEES AND RETENTION

Contract #2139 - 1-27-2026 Page 5 of 71 V01.06.2026

SECTION I: OVERVIEW

A. RFP OBJECTIVES

The Town and Public Schools of Vernon (Vernon) has asked Acrisure, LLC (Acrisure) to solicit bid proposals for administrative services (ASO) for Medical, Behavioral Health Care, Pharmacy Benefit Management (PBM), Dental, and Stop-Loss Insurance components of the self-funded Vernon employee health plan. This RFP is requesting delivery of the comprehensive benefits plan through a traditional self-insured arrangement, mirroring the current funding arrangement. We are open to receiving a complete package of the requested services or carve-out options. Vernon reserves the right to choose one plan administrator for all products, or individual administrators for the different components of the benefit plans.

This is a formal RFP requesting proposals for an effective date of July 1, 2026. The employee health benefits plan has not been put out to bid recently. You are allowed to provide proposals for each requested coverage or provide a package proposal for all requested coverages, if that would provide advantages for you and Vernon. If there are favorable pricing terms for combining the medical, behavioral, PBM, dental services and stop-loss insurance, your proposal should indicate those advantages.

The purpose of this RFP is to select a vendor, or vendors, capable of administering the current Vernon employee benefit plan options in the most cost-effective manner and providing high-quality services to covered members through a broad network of providers. This RFP and collective bargaining agreements, require that vendors must be able to adjudicate Vernon’s current plan of benefits. There can be no deviations.

It is the intent of Vernon to understand the breadth of the provider network that may be available. If the network of providers and facilities falls below a 90% match your proposal may be disqualified.

Bidders may submit self-insured proposals for the following:

1. Medical benefits (including vision) administration;

2. Managed behavioral health administration;

3. Pharmacy Benefits Management (PBM);

4. Dental benefit administration;

5. Stop-loss insurance

ALTERNATE PLAN DESIGN OPTIONS

6. Any combination of the above.

Please provide your cost proposals as though each benefit can be chosen on its own as a stand-alone benefit. If you choose to provide a proposal that offers a multiple combination, please clearly identify any discount associated with the economies Vernon might receive by purchasing more than one product.

Contract #2139 - 1-27-2026 Page 6 of 71 V01.06.2026

With respect to the ASO contract, Vernon requires health care management services, behavioral healthcare management services including but not limited to: utilization management, case management, disease management, wellness and healthy lifestyles programs. With the overall objective of reducing health care costs, Vernon is interested in proposals for a strategic approach to promoting wellness and healthy lifestyles for covered members, using vendor programs and offerings in conjunction with its current in-house Wellness Program. It is expected that these programs will include robust reporting and data analytics to assist in continuous development of the overall health and wellness program.

Vernon is specifically looking for a tool that will track the aspects of Vernon’s health incentive program; tracking visits and reporting back to Vernon on a quarterly basis identifying those that are compliant with the plan requirements.

Vernon is seeking proposals for a July 1, 2026, effective date. This RFP is for a three-year period, but based upon performance of the Contractor, Vernon at its sole discretion, may renew for up to a total of two years of contract extensions.

For the ASO contracts, Vernon requires multi-year administrative fee guarantees and provider discount guarantees, as described elsewhere in this document. These will be considered minimum requirements for all successful bidders. These guarantees will be considered in tandem with your financial proposal as a complete proposal.

Submission of your proposal acknowledges acceptance of this requirement and is an agreement to duplicate current benefits exactly.

This RFP provides details of what is required to submit a proposal and what is required of the selected bidder in performing the scope of work. Bidders must follow the instructions in these bid specifications and complete all questions and tables.

This RFP gives estimated dates for the various events in the RFP and vendor evaluation processes. While these may be subject to change, bidders must be prepared to meet them as they currently stand. Any failure to meet a deadline in the RFP submission or evaluation phases may result in vendor disqualification.

Contract #2139 - 1-27-2026 Page 7 of 71 V01.06.2026

B. GENERAL TOWN & PUBLIC SCHOOL INFORMATION

Vernon, Connecticut (www.vernon-ct.gov)

Town Overview

Location & Size

• Vernon covers approximately 18.4 square miles and is located in Tolland County, in the Greater Hartford region of Connecticut.

• The town is bisected by Interstate 84 (with four interchanges), and has major state routes such as Routes 83, 74, 31 and 30, making it highly accessible.

• Population (as of the 2020 census) is about 30,215.

Community & Economic Context

• Vernon has a mix of residential neighborhoods and commercial/industrial heritage (including former mill buildings now repurposed).

• The town emphasizes its “town and community” feel: trails, parks (such as the Hop River Rail Trail), recreational opportunities, and a sense of community involvement.

• From a workforce/employer perspective: the strategic location (Mid-point between Boston and New York, easy access to major markets) may support commuting, regional labor-mobility and related benefits considerations.

Governance / Infrastructure

• The town is governed via a mayor-council form and has a full complement of municipal services including public safety, public works, parks, etc.

• Infrastructure investments are ongoing (for example sewer extensions and school improvements) indicating the municipality is maintaining/modernizing its built environment.

http://www.vernon-ct.gov/

Contract #2139 - 1-27-2026 Page 8 of 71 V01.06.2026

Public Schools: Vernon Public Schools

Structure & Scope

• The school district covers preschool through grade 12. The district offers a preschool program (half-day AM/PM; full-day Pre-K pilot) for 3- and 4-year-old children.

• Vernon has 7 Schools: Rockville High School, Vernon Center Middle School and 5 Neighborhood Elementary Schools. Approximate enrollment is 3,300 students.

Academic Performance & Growth

• The district has consistently outperformed state averages and ranked highly among alliance districts (those districts previously classified as lowest performing, now in improvement status).

• For example, in November 2024 the district earned 73.3 points vs. a state average of

70.8 in the “Next Generation Accountability System.”

• Two Vernon schools have been recognized as National Blue Ribbon Schools in the past five years: Skinner Road School and Northeast School. Several schools earned “Schools of Distinction” for high growth and achievement — e.g., Northeast School, Skinner Road School and Lake Street School.

• Lake Street School, part of the Vernon district, has been recognized by U.S. News & World Report as among the best in Connecticut elementary schools (ranked 54th of 545 in CT in 2024).

Facilities & Investments

• The district continues to invest in facility upgrades. For example, an Aquaponics Lab and new chemistry labs at the high school, upgrades to the unified arts programs at the middle school, and a new roof at an elementary school.

Early Childhood & Special Programs

• The preschool program is high-quality and expanding; the district is piloting a full-day Pre-K for 4-year-olds in 2025-26.

Contract #2139 - 1-27-2026 Page 9 of 71 V01.06.2026

C. GENERAL MEDICAL AND BEHAVIORAL HEALTH PLAN INFORMATION

Medical plans integrate behavioral health benefits into the Cigna plan offerings. Members are covered by common Behavioral Health benefits (currently administered by Cigna).

The health plan is self-funded and operates on the fiscal year, July through June. Members’ contributions vary by Union collective bargaining agreement. You can find the collective bargaining agreements on the Town’s website: https://www.vernon-ct.gov/o/tov/page/human-resources. The collective bargaining agreements will provide the employee contributions.

Theoretical premium rates are determined by Vernon in conjunction with its benefit plan consultant, The process beings in September and is finalized in April of each year. An annual Open Enrollment for plan participants is held in the month of May.

Vernon’s medical plan designs can be found in the plan design information attached herein.

D. BENEFIT PLAN DESIGN:

Detailed benefit plan summaries are included in the attached supporting data.

Prior to providing a bid response, bidders should carefully review the entire Medical Plan Document in detail, to ensure that they are capable of accurately administering all aspects of Vernon’s health plan.

E. VENDOR SELECTION CRITERIA

Below is a list of minimum requirements and performance expectations that Vernon uses for health plan management with an emphasis on continuous improvement. These are standards which vendors must presently meet to submit a proposal to Vernon in response to this RFP.

Each proposal shall be evaluated in accordance with Vernon’s selection criteria and other relevant factors, including:

Organizational Stability and Experience Total Cost - Administrative Fees, Rates & Other Guarantees Aggressive Multi-Year Rate and Discount Guarantees Competitive Hospital and Physician Negotiated Rates Proven health promotion and long-term chronic disease prevention programs Outcome-driven evaluation of disease prevention program effectiveness Network Access, including National Networks Minimal Membership Disruption Quality proven Utilization Management Programs State of the art administrative and claim paying services Ability to accurately administer Vernon’s plan options Demonstrated ability to manage costs.

https://www.vernon-ct.gov/o/tov/page/human-resources https://www.vernon-ct.gov/o/tov/page/human-resources

Contract #2139 - 1-27-2026 Page 10 of 71 V01.06.2026

Proven flexibility in reporting, including ability to customize management reports to meet Vernon specific requirements

Integrated on-line systems to facilitate online eligibility reporting and claim payments

Flexibility in administration and funding of behavioral health benefit Aggressive performance guarantees and performance penalties Demonstrated ability to implement Vernon’s benefit program in an accurate and timely manner.

Fully Transparent Pricing Models

Data Reporting, synchronization with Vernon’s enrollment process and Vernon’s ease of access to reporting data

Adherence to RFP conditions, requirements, criteria, methodologies and definitions Ability to perform all services requested in the RFP Bidder’s stability, size, experience and expertise Strength of financial guarantees and overall price offer Alignment with Vernon’s strategic goals, benefit philosophies, and objectives Strength of client account management – experience, responsiveness, compatibility Strength in analytics and reporting including standard and custom report capabilities Systems including claims adjudication and eligibility maintenance Customer service to members including call centers, member website and app capabilities

F. MINIMUM REQUIREMENTS

Vernon requires that bidders meet the following minimum requirements: (please confirm your agreement to each requirement)

1. Complete RFP Response – Bidders must include in proposals all information requested in this RFP. A bidder must respond to all components of the RFP related to the service upon which it is bidding. If a question or section does not apply to the service you are bidding on, please so state in your response.

2. Bundled Services – The Bidder must be able to provide all requested health plan services, including, but not limited to hospital, physician, mental health, and other ancillary benefits as a bundled service.

3. Behavioral Health Integration – Vernon’s medical plan designs include shared deductibles that apply to both medical and behavioral health expenses. The Bidder must have a proven ability to administer this integrated deductible across both benefits, particularly if the behavioral health benefit is with a vendor subcontractor or another vendor.

Contract #2139 - 1-27-2026 Page 11 of 71 V01.06.2026

4. Participants Immediately Covered - All current participants must be covered on July

1, 2026, and not subject to evidence of insurability. No pre-existing conditions exclusions are acceptable.

5. Qualifying Experience – The Bidder must have proven experience providing the requested services to groups similar in size to Vernon.

6. Medical and Prescription Drug Integration – The medical and PBM Bidder must have the ability to integrate medical and prescription drug claims and utilization data from Vernon’s vendors (currently Cigna and Express Scripts, Inc.).

7. Financial Stability – The Bidder must demonstrate its financial stability and meet Vernon’s submission requirement(s) by providing a) most recent financial report, and b) most recent independent auditor’s report.

8. Banking Arrangements: Vernon cannot accommodate banking arrangements where the vendor pays claims with Vernon checks or warrants or has the authority to draw funds from a Vernon member-held account. Vernon can transfer funds to a vendor-held claims payment account.

9. Brokers: Vernon will not entertain proposals from any agent or broker on behalf of a vendor. Vernon utilizes ACRISURE. ACRISURE will be working to assist Vernon through the RFP process. All proposals must be signed and submitted by the bidder.

10. Licensing: Must be licensed in the State of Connecticut at the time of the proposal submission to provide the plan services for which the proposal is being submitted.

SECTION II: BIDDING INSTRUCTIONS AND CONDITIONS

A. GENERAL PROPOSAL CONDITIONS

All bidders, by submitting a proposal, agree to the following terms and conditions unless expressly noted otherwise in your cover letter. These instructions are standard for all proposals issued by the Town of Vernon, Connecticut for the purchase of all supplies, materials, equipment, and the furnishing of certain services. The Town may delete, supersede or modify any of these standard instructions for a particular proposal by indicating such change in a section entitled "Special Instructions to Bidders".

1. Bidder Questions: All questions should be directed to Nichole Greco, Project Coordinator, by email at ngreco@vernon-ct.gov, no later than January 13, 2026, at 3:30 pm. Answers to questions received will be posted by January 15, 2026, on the Town’s website at https://www.vernon-ct.gov/o/tov/page/bids-and-rfps and at the Connecticut State Department of Administrative Services (DAS) at https://portal.ct.gov/das by referencing Contract #2139- 1-27-2026. It is the sole responsibility of the respondent to review any or all addendum or question responses related to this RFP.

mailto:ngreco@vernon-ct.gov https://portal.ct.gov/das

Contract #2139 - 1-27-2026 Page 12 of 71 V01.06.2026

2. Deviations: Any and all deletions, variations and exceptions to the specifications must be stated in writing at time of bidding and must be attached to the “Proposal” section of contract.

The Assistant Town Administrator will notify the contractor, in writing, of these changes. Terms and conditions of any additions or deletions will be subject to negotiation by both parties.

3. In the event it becomes necessary to revise any part of this RFP, an Addendum will be posted on the town’s website and on the State Department of Administrative Services (DAS) website, referencing the contract number.

4. The attached proposal is signed by the bidder with full knowledge of, and agreement with, the general specifications, conditions and requirements of this bid.

5. Not responsible for defects to electronically-mailed contracts.

6. Bids shall be submitted in sealed envelopes which shall be addressed to the Town

Administrator, 14 Park Place, Vernon, Connecticut 06066, and shall be clearly marked "BID DOCUMENT - DO NOT OPEN". The bid envelope shall indicate the contract number as shown on the "Request For Proposal". Emailed, faxed or late bids will not be accepted.

7. Bids received later than the time and date specified in the "Request For Proposal" will not be considered. Withdrawal of bids received later than the time and date set for the bid opening, will not be considered.

8. Bids received prior to the advertised hour of opening will be securely kept sealed. The officer whose duty it is to open them will decide when the specified time has arrived and no bid received thereafter will be considered.

Town of Vernon office hours:

Monday – 8:00 am – 4:30 pm Tuesday – 8:00 am – 7:00 pm Wednesday - 8:00 am – 5:00 pm Thursday – 8:00 am – 4:30 pm Friday - Closed

9. All deliveries of commodities hereunder shall comply in every respect with all applicable laws of the

Federal Government and the State of Connecticut. Unless otherwise stated herein, all deliveries made under this contract must consist of new merchandise.

10. The bidder shall insert the price per stated unit and extend a total price for each item. IN THE EVENT

THAT THERE IS A DISCREPANCY BETWEEN THE UNIT PRICE AND THE TOTAL PRICE EXTENSION, THE

UNIT PRICE WILL GOVERN.

11. In accordance with the provisions of Section 12-412 (a) of the Connecticut General Statutes, the Town of Vernon and Vernon Public Schools are exempt from the payment of Federal or State tax and such tax or taxes shall not be included in bid prices.

Contract #2139 - 1-27-2026 Page 13 of 71 V01.06.2026

12. The Town reserves the right to reject any and all bids, wholly or in part; to waive technical defects, and to make awards in the manner deemed to be in the best interests of the Town.

13. The Town will not accept any additional charges for freight or shipping.

14. Contractor shall agree to maintain in force at all times during the contract the following minimum coverages and shall name Town of Vernon as an Additional Insured on a primary and non-contributory basis to all policies, except Workers Compensation. All policies should also include a Waiver of Subrogation. The successful bidder must carry the following insurance coverages. Insurance shall be written with Carriers approved in the State of Connecticut and with a minimum AM Best’s Rating of “A-“ VIII. In addition, all Carriers are subject to approval by the Town of Vernon.

The Contractor must carry the following insurance coverages (Town of Vernon added as additional insured):

General Liability (Minimum Limits) Each Occurrence: $ 1,000,000 General Aggregate: $ 2,000,000 Product/Completed Operations Aggregate: $ 2,000,000 Fire Damage Legal Liability $ 100,000

Automobile Liability (Town of Vernon added as additional insured):

Combined Single Limit $ 1,000,000

Umbrella/Excess Liability (following form of general liability, auto liability and employer liability):

Each Occurrence: $ 5,000,000

Workers' Compensation/Employers Liability Workers' Compensation Statutory Requirement set forth by State of CT Employers Liability Each Accident $ 1,000,000 Disease-Policy Limit $ 1,000,000 Disease-Each employee $ 1,000,000

Professional Liability (where required) Each Claim: $ 2,000,000 Annual Aggregate $ 2,000,000

If any policy is written on a “Claims Made” basis, the policy must be continually renewed for a minimum of two (2) years from the completion date of this contract. If the policy is replaced and/or the retroactive date is changed, then the expiring policy must be endorsed to extend the reporting period for claims for the policy in effect during the contract for two (2) years from the completion date.

Original, completed Certificates of Insurance must be presented to the Town of Vernon prior to contract issuance. The Contractor agrees to provide replacement/renewal certificates at least 30 days prior to the expiration date of the policies. All insurance shall not be canceled, Contract #2139 - 1-27-2026 Page 14 of 71 V01.06.2026 limits reduced or coverage altered, 30 days written notice must be given to the Town of Vernon, Town Administrator, 14 Park Place, Vernon, CT 06066.

15. Intent to Bid: Any bidder wishing to bid must affirmatively indicate within the time period allotted in the timetable.

16. Bidder Questions: Any bidder wishing to ask questions must do so within the time period allotted in the timetable. All responses will be provided together at the same time and disseminated to all bidders that have indicated an intent to bid, regardless of issuing questions.

17. Costs for Proposal Preparation: Any cost incurred by bidders in preparing or submitting proposals is the bidders’ sole responsibility.

18. Oral Explanations: Vernon will not be bound by oral explanations or instructions given at any time during the competitive process or after the award of the contract.

19. Time of Acceptance: The bidder agrees to be bound by its proposal for a period of at least 120 days from the time of the submission of the proposal, during which time the plan and/or Acrisure, LLC may request additional information or clarification of the proposal for the purpose of evaluation.

20. Representations and Warrantees: Bidder warrants the accuracy of information submitted and acknowledges that Vernon will rely on the bidder’s information in making its selection and contracting with the successful organization. Responses to this RFP will be the primary source of information used in the evaluation process. Each bidder is requested and advised to be as complete as possible in its RFP response.

21. Written Consent: After award of the contract, vendor is prohibited from subletting, conveying, assigning, or otherwise disposing of any contract or contractual obligation resulting from this RFP, its rights, title or interest therein or its duties or obligations thereunder, or its power to execute such agreement to any other company, corporation or entity without the previous express written consent and written approval of Vernon.

22. Exceptions: Any exceptions to terms, conditions, or other requirements in any part of these specifications must be clearly pointed out in bold type in the appropriate section of the proposal. Otherwise, it will be considered that all items offered are in strict compliance with the specifications. The successful bidder will be responsible for compliance. Any exceptions will be part of the evaluation process and may constitute grounds for rejection of the proposal.

23. Bidder’s Representative: The proposal must be signed by a representative of your organization, who is authorized to bind the firm to a contract in the event of the award.

24. Rights to Claims Data: All claims data is the property of Vernon and must be made available upon request.

25. General Legal Compliance: All bidders and services must adhere to all relevant federal and state laws and regulations.

26. Right to Audit: All bidders agree to extend to Vernon the right to an independent audit.

Contract #2139 - 1-27-2026 Page 15 of 71 V01.06.2026

27. Conflict of Interest: Bidders shall certify in writing that no relationship exists between the bidder and Vernon, and no relationship exists between the bidder and another person or organization that constitutes a conflict of interest with respect to a contract resulting from this RFP.

28. Confidentiality: All proposals and other materials submitted will become the property of Vernon and may be returned only at Vernon’s option. The successful bidder’s response will become part of the contract file and may become a matter of public record, as will all other bid responses received. If the bid response contains material that is considered by the bidder to be proprietary and confidential, the bidder shall clearly designate the material as such, explaining why such material should be considered confidential. The bidder must identify each page or section of the response that it believes to be proprietary and confidential with sufficient grounds to justify each exemption from release, including the prospective harm to the competitive position of the bidder if the identified material were to be released. Under no circumstances can the entire response or price information be marked confidential. Responses so marked may not be considered.

29. Statement of Rights: Vernon reserves the right to obtain clarification or additional information necessary to properly evaluate a proposal. Vendors may be asked to give a verbal presentation of their proposal after submission. Failure of a vendor to respond to a request for additional information or clarification could result in rejection of that vendor’s proposal.

By submitting a proposal, the bidder acknowledges that it has read this RFP, understands it, and agrees to be bound by its requirements and conditions. Failure to meet any of these conditions may result in disqualification of bids. Please indicate clearly in your cover letter if you cannot adhere to any of these conditions.

B. BID SPECIFICATIONS

Proposal Response: Your proposal should be submitted assuming an effective date of July 1, 2026. The initial contract period should be for 36 months (July 1, 2026, through June 30, 2029) with the availability of up to two (2) subsequent years of renewals.

Proposal Format: Each proposal must include sufficient data to allow for verification of the total cost of vendor’s bid. Each proposal must respond to every request for information in this document. Bidders are asked to respond only to the specific questions in the RFP. Repeat the specific question and provide the response. All responses must be addressed concisely and clearly. All pricing must be provided as requested in the RFP Exhibits. Any additional costs must be clearly explained.

C. TIMETABLE

Action/Event Date Questions Due from Bidders January 13, 2026, by 3:30 p.m. EST

Bid Responses Due to Acrisure Revised: January 27, 2026 by 10:00 am

Contract #2139 - 1-27-2026 Page 16 of 71 V01.06.2026

Finalist Meetings with Bidders Week of February 23, 2026

Vendor Selected/Bid Awarded Week of March 9, 2026

Implementation/Transfer Phase February 20, 2026 – June 30, 2026

Contract Effective Date July 1, 2026

D. BIDDING INSTRUCTIONS

Six (6) hard copies and one (1) electronic copy of the proposal must be submitted in a sealed envelope, clearly marked “BID DOCUMENT DO NOT OPEN - CONTRACT #2139-1-27-2026 - Town of Vernon and Vernon Public Schools Medical Benefits Administrative Services, Pharmacy Benefit Manager, Dental Benefits, and Stop-Loss Insurance” to:

John W. Kleinhans Town Administrator 14 Park Place Vernon, CT 06066

No later than Tuesday, January 27, 2026 at 10:00 am at which time proposals will be opened and read aloud publicly. Emailed, faxed or late proposals will not be accepted.

Please designate the individual representing your company during the proposal process and confirm that this individual has the authority to bind your company to the provisions of your bid:

Representative Name: _________________________ Phone #: _____________

Title: _______________________________________

Contract #2139 - 1-27-2026 Page 17 of 71 V01.06.2026

The following services are requested:

VERNON Requests Bidder Quoting

Self-Funded Medical (ASO) Services ❑

Self-Funded Behavioral Health (ASO) Services ❑

Fully Capitated Behavioral Health Services ❑

Partially Capitated Behavioral Health Services ❑

Pharmacy Benefit Management Services ❑

Stop-Loss Insurance ❑

Dental Benefit Administration ❑

E. NETWORK ACCESS

Geographic Match

E1.1 Complete the geographic access analysis using driving distance as the measurement of distance, not “as the crow flies”. For each geographic setting, provide the number of providers within the area. For average travel distance and percent access, the geographic areas refer to employees residing in that particular county. For example, if an employee residing in Tolland County has access to 2 PCPs within 8 miles, but one of the PCPs is located in neighboring Hartford County, this employee is considered to have 100% access.

Each type of provider is mutually exclusive. Do not double count providers. An ob/gyn may serve as a pcp but only include this under the ob/gyn heading.

Responses are due both in the electronic Excel format provided and in hardcopy.

Notes: Standard for Definition of Access to Network Provider

PCPs:

OB/GYNs:

Pediatricians:

Specialists:

Hospitals:

2 physicians within 8 miles

2 physicians within 8 miles

1 hospital within 15 miles

E1.2 Indicate software used (i.e. GeoAccess):

E1.3 What geographic areas are not in your current service areas where Vernon’s participants reside? List by state and county.

http://providers.an/

Contract #2139 - 1-27-2026 Page 18 of 71 V01.06.2026

State County

E1.4 Indicate with a “Y” for Yes and “N” for No whether the Providers (physicians and hospitals) are in your POS and PPO networks (See Physician Disruption and Hospital Disruption).

E1.5 Is your POS network the same as your PPO Network? Are the same discounts negotiated?

E1.6 There is a provider utilization file that is provided in the shared materials. This is an excel file that provides a list of all utilized providers by school. Please indicate for each provider if they are a network or non-network provider. There is a column indicated for your response.

Contract #2139 - 1-27-2026 Page 19 of 71 V01.06.2026

SECTION III: FINANCIAL SECTION

A. RATES AND FEES

The Illustration of your ASO cost Proposal(s) will be illustrated in the attached Fee Proposal Exhibit.xls.

1. ASO Proposals: Provide multi-year administrative and network access fee guarantees for the policy years beginning July 1, 2026, through June 30, 2029.Vernonwill have the option to extend the contract annually for up to two additional one-year periods.

Therefore, Vernon requests that you provide fee proposals for 2 additional one- year time periods. If you are proposing fees, rates or maximum increases for the two optional one-year extension periods of July 1, 2029, July 1, 2030, please illustrate them accordingly.

2. You must confirm that all proposals are provided with fee and rate guarantees as requested herein.

3. Proposed cancellation clauses that include monetary penalties or liquidated damages clauses for termination prior to the end of the guarantee period are unacceptable.

Verification of Accuracy

Please designate the individual responsible for coordinating proposal responses and for binding the company to the responses to this RFP.

Name:________________________________________ Phone #: _____________

Title: ________________________________________

Please designate the chief actuary or independent actuary retained by the proposer who certifies the method used to determine and report requested discount information.

Name:________________________________________ Phone #: _____________

Title: ________________________________________

Please designate proposer’s Medical Director or Chief Medical Officer.

Name:________________________________________ Phone #: _____________

Title: ________________________________________

Contract #2139 1-27-2026 Page 20 of 71 V01.06.2026

Medical and Managed Behavioral Health

QUESTIONS

SECTION IV: QUESTIONNAIRE – MEDICAL & MANAGED BEHAVIORAL HEALTH

OVERALL REQUIREMENTS

For your proposal to be considered and accepted, your organization must provide answers to all questions presented in this section. When answering the questions, please repeat the question and provide your answer numbered to correspond to the RFP question. All questions must be answered. Reference should not be made to a prior response unless the question involved specifically provides such an option. Be sure to refer to the earlier sections of this RFP before responding to any of the questions, so that you have a complete understanding of all of Vernon’s requirements with respect to the proposal.

A. CLAIMS MANAGEMENT

Behavioral and Substance Use Questions

1. Are Behavioral and Substance Use claims paid from the same claims platform, which pays medical claims, or from a separate claims platform? Describe in detail how this works. Vernon requires one integrated set of data for behavioral health utilization reports, whether the behavioral health benefit is ASO, partially capitated or fully capitated. Describe any impediments to your data reporting capabilities in this area or confirm that you can meet this requirement.

2. Please confirm that if partial or full capitation is selected, you will provide VERNON, in addition to all other reporting, with actual claims experience.

3. Under Federal Mental Health Parity (FMHP), how will you manage behavioral health care?

4. Under FMHP, how will you manage out of network providers for medical necessity?

5. Indicate non-network equivalent R&C Percentile used for non-network reimbursement for the

POS & PPO Plans.

6. Indicate source of non-network R&C Allowances (Ingenix, Medicare, ADP, Other).

7. Explain any financial incentives (bonuses) or disincentives (withholds) in network provider contracts that are tied to utilization goals, specialty referrals, member survey results, quality of care outcomes or other performance results.

8. If applicable, please describe how you will work with the current administrator to insure a smooth and orderly transition for the participants.

Contract #2139 1-27-2026 Page 21 of 71 V01.06.2026

9. What percentage of professional providers in your network that will serve Vernon are at full capacity and are not accepting new patients? Provide number by specialty and by county area. What percentage are accepting new patients? Provide same information.

10. Describe your internal mechanisms for controlling inpatient costs. Are there incentives built in to move patients from inpatient to outpatient?

11. If you are proposing a sub-contracted arrangement with behavioral health and Substance

Use vendors, please describe how you coordinate with your affiliated organization, subcontractors, including addressing utilization/ care management and administrative issues and holding them accountable for performance.

a. Describe your integrated approach to utilization and case management for dual diagnoses.

b. Describe your approach to case management for persons with chronic diseases, end of life care or other situations where both medical and behavioral health care are beneficial.

12. If you are proposing integrated (not subcontracted) behavioral health and Substance Use management, is there a dedicated unit or dedicated personnel for behavioral health/Substance Use case management distinct from those who handle medical case management? If yes:

a. Describe your integrated approach to utilization and case management for dual diagnoses.

b. Describe your approach to case management for persons with chronic diseases, end of life care or other situations where both medical and behavioral health care are beneficial.

Disease Management

13. Describe your disease management programs. Include in the description the types of conditions managed, the target population for each program, the identification process, the process for stratifying the population, standard interventions for each population tier, the average amount of time an individual participates in the program, and any program hierarchy for assigning individuals with co-morbidities.

14. Confirm that the five major disease management programs are built into your base pricing proposals, both self-insured and fully-insured.

15. Describe your methodologies for calculating and reporting cost savings related to prospective, concurrent and retrospective review.

16. Confirm that your ROI data contains only members who are actively participating in a DM program. “Actively participating” excludes members who have been contacted by phone or mail but have not responded. Vernon requires information on the exact number of members actively engaged in a program. Return on Investment’s (ROI’s) that are not based on engaged and active participation of the member will be considered inaccurate and invalid.

Contract #2139 1-27-2026 Page 22 of 71 V01.06.2026

17. Are any covered individuals excluded from the programs? If so, provide a description of the persons excluded and criterion used to exclude them.

18. In the past 12 months, what portion of individuals identified with the target condition ultimately enrolled in your program(s)?

19. How will disease management coordinate with other health care management programs

(e.g., utilization management, pharmacy management, behavioral health, case management)?

20. Describe your methodologies for calculating and reporting cost savings related to disease management.

21. What ROI have you experienced with your disease management programs? Describe the specific programs and exactly how you calculated the ROI.

22. Provide any findings and outcome data you have that demonstrate the effectiveness of your disease management programs.

23. Provide a description of your standard disease management reports. Indicate the frequency, level of reporting specifically for VERNON, and define the data included. Provide a copy of the report template.

Case Management Questions

24. Provide a detailed description of your case management program, including any specialty programs that are included in your proposal.

25. Are you willing to offer a specific team of account managers for Vernon membership? If so, please provide a brief resume of the account managers that will service VERNON.

26. At what dollar level is a claim case managed?

27. Aside from cost, what specific criteria are used to identify cases for case management?

Describe the means used to screen the population for case management. When and how is case management initiated?

28. What is the process for assigning pre-certification, large case management cases and appeals to external providers for review? What percent of cases typically require external provider involvement? At what point is external provider involvement initiated?

29. Will your firm provide case management for the out-of-network cases? For what percentage of your clients do you routinely provide case management for the out-of-network cases?

30. Describe any additional programs available that are not included in the proposal and the fees associated with those programs.

31. Describe how you calculate case management savings. Include details on any classification schemes (e.g., hard and soft savings)?

Contract #2139 1-27-2026 Page 23 of 71 V01.06.2026

32. Provide a description of the standard case management reports provided. Indicate the frequency, level of reporting, and define the data included. Provide a copy of the report template.

Health Care Management

33. Explain any financial or other incentives established for providers to comply with utilization management protocols, treatment standards or other aspects related to health care

Quality Management

34. Are any of your health care management programs accredited? If so, list which programs

(e.g., utilization review, case management), by what organization (NCQA, Utilization Review Accreditation Commission (URAC)) and the current accreditation status.

35. What percentage of physicians, non-physician providers and facilities are credentialed prior to contracting (including physicians with leased health plans)?

36. Are there formal, written credentialing/re-credentialing standards for general medical and surgical hospitals? If "yes," provide a copy.

37. Submit copies of your Healthcare Effectiveness Data and Information Set (HEDlS) reports for the last reporting period.

Coordination of Benefits (COB)

38. When you are the secondary payer in a COB situation, do you use your usual, customary, and reasonable (UCR) profiles, reduced network fees, or those of the primary carrier in determining your level of reimbursement?

39. Please complete the following table:

Average COB savings as a percent of total plan cost

Will you guarantee COB Savings?

Active/Early Retiree Y/N Medicare Eligible Y/N

Health Promotion, Wellness and Prevention Programs

40. The Board of Education has implemented aspects of the State’s Healthy Employees’

Program. The Town is implementing the program July 1, 2026. They have and will be implementing the provision that requires adhering to a preventive services schedule. If the employee does not obtain the required preventive services, then contributions to be enrolled will be increased.

a. Describe the health promotion, wellness, prevention and similar kinds of programs, including health risk appraisals that are included in your proposal. Vernon is

Contract #2139 1-27-2026 Page 24 of 71 V01.06.2026 specifically interested in favorably influencing lifestyle diseases (e.g., coronary artery disease, diabetes, high blood pressure and obesity). Describe your ability to customize these Programs for Vernon. Describe the level of administrative access Vernon will have to both front and back ends. Describe your ability to offer these programs to employees not enrolled in the Health Plan. Describe the level of support you provide with your Wellness Programming (marketing, design, implementation, technical and administrative). Describe your incentive platform in detail including customization of design, assigning and tracking of points, ability to award incentives through portal.

41. Describe any optional health promotion/ wellness/ prevention programs you offer.

42. Provide the specific additional fees (i.e. administrative, technical support, customization, reporting, access by users/Vernon, etc.), if any, related to each of these programs.

43. Describe the value of these programs (i.e. cost-benefit analysis).

a. How do they integrate with other vendors/programs/tools, if separate (e.g., pharmacy, employee assistance program (EAP), tracking tools and websites)?

b. How do they integrate with other health care management programs (e.g., case management, disease management)?

c. How do you incorporate the results into your other health care management programs?

d. What type of consumer tools/services do you provide to enable people to make the best choices when they need health care? Describe in detail your web-based member tools and transparency capabilities?

e. What percentage of your administrative cost are you willing to commit back to

Vernon to support Wellness Programming or Incentives?

44. What ROI have you experienced with your health promotion, wellness and/ or prevention programs? Describe the specific programs and methods used to calculate the ROI.

45. Provide any other findings and outcomes you have experienced with your health promotion, wellness and/ or prevention programs.

46. Provide a description of the standard health promotion, wellness and/or prevention reports provided. Indicate the frequency, level of reporting (e.g., book of business, specific to Vernon) and define the data included. Describe your ability to customize reporting based on State-specific requests. Provide a copy of the report template.

47. Vernon is interested in implementing a health benefits employee savings incentive program.

If an employee chooses services through a more cost-effective provider or facility the employee will receive a share of the savings.

Contract #2139 1-27-2026 Page 25 of 71 V01.06.2026

a. Are you able to provide this service or would you require a third-party to implement and administer such a program?

b. How many savings incentive programs do you currently have operating?

c. What information is necessary for employees to make an informed decision?

d. How will your organization assist in providing this information; telephonic assistance, web based, phone applications?

e. How is the savings calculated and presented?

f. Which aspects of the health benefits plan would be included in a savings incentive program?

g. For your current clients, what is the standard percentage of savings shared with the employee?

h. How do you identify a “More cost-effective provider or facility”? Describe the criteria.

i. How do you communicate to plan members when such an identification has been made?

j. How do you satisfy members’ concerns about lower quality care using more cost-effective vendors?

48. After a year with your services, what impact do you believe your program(s) will have on

VERNON’s:

a. Inpatient utilization – frequency of admits and duration of stay.

b. Outpatient utilization – frequency and duration of treatment.

c. Out-of-network utilization – steerage to in-network usage.

d. Other.

B.…