Michigan.gov/MiProcurement proposal instructions Department of Technology, Management and Budget - Procurement HMO Services for MPSERS Request for Proposal No. 230000003226 Solicitation Manager Name: Mary Ostrowski Direct Phone: (517) 249-0438 Email: ostrowskim@michigan.gov Main Phone: 1-855-MI-PURCH 1-855-647-8724 This is a Request for Proposal (RFP) for:

This is a Request for Proposal (RFP) for Health Maintenance Organization (HMO) services, including claim processing and administration of the health care plan, for the Michigan Public School Employees’ Retirement System (MPSERS) as described in Schedule A (the “Contract Activities”).

RFP Timeline

Anticipated date the State will post answers to bidder questions on www.michigan.gov/SIGMAVSS

11/01/2023

*A bidder’s proposal received at 1:00:01 p.m. Eastern is late and subject to disqualification.

This RFP is subject to change. Check www.michigan.gov/SIGMAVSS for current information.

1. PROPOSAL PREPARATION. The State recommends reading all RFP materials prior to preparing a proposal, particularly these Proposal Instructions and the Vendor Questions Worksheet. Bidders must follow these Proposal Instructions and provide a complete response to the items indicated in the RFP Structure and Documentation table below. References and links to websites or external sources may not be used in lieu of providing the information requested in the RFP within the proposal. Include the bidder’s company name in the header of all documents submitted with your proposal. Note that all documents and information submitted as part of a proposal will become public record immediately upon receipt by the State. Proposals received by the State may be posted on the State’s publicly available website after bidders are notified of the award recommendation.

RFP Structure and Documentation

2. CONTACT INFORMATION FOR THE STATE. The sole point of contact for the State concerning this RFP is listed on the Cover Page. Contacting any other State personnel, agent, consultant, or representative about this RFP may result in bidder disqualification.

3. MODIFICATIONS. The State may modify this RFP at any time. Modifications will be posted on www.michigan.gov/SIGMAVSS. This is the only method by which the RFP may be modified.

4. QUESTIONS. Bidder questions about this RFP must be emailed to the Solicitation Manager no later than the time and date specified on the Cover Page. In the interest of transparency, only written questions are accepted. Answers to questions will be posted on www.michigan.gov/SIGMAVSS. Submit questions using the format below; a Microsoft Excel format or similar is suggested.

5. DELIVERY OF PROPOSAL.

Electronic – The bidder must submit its proposal, all attachments, and any modifications or withdrawals electronically through www.michigan.gov/SIGMAVSS. The price proposal should be saved separately from all other proposal documents. The bidder should submit all documents in a modifiable (native) format (examples include but are not limited to Microsoft Word or Excel and Google Docs or Sheets). In addition to submitting documents in a modifiable format, the bidder may also submit copies of documents in PDF. Attachment file size is limited to 6 MB per document. Bidder’s failure to submit a proposal as required may result in disqualification. The proposal and attachments must be fully uploaded and submitted prior to the proposal deadline. Do not wait until the last minute to submit a proposal, as the SIGMA VSS system requires the creation of an account and entry of certain information, in addition to uploading and submitting the materials. The SIGMA VSS system will not allow a proposal to be submitted after the proposal deadline identified in the solicitation Closing On/Closing Date fields (Summary view/Detail view), even if a portion of the proposal has been uploaded.

Questions on how to submit information or how to navigate in the SIGMA VSS system can be answered by calling (517) 284-0540 or (888) 734-9749. The Solicitation Manager will not provide assistance related to the submittal of the proposal and all attachments on the day of the proposal deadline. Responsibility for a complete submission lies with the bidder. Note that all documents and information submitted in any manner as part of a proposal will become public record immediately upon receipt by the State. Proposals received may be posted by the State on the State’s publicly available website after bidders are notified of the award recommendation.

6. MANDATORY MINIMUM REQUIREMENTS. The term “Contractor” in this document refers to a bidder responding to this RFP, as well as the Contractor who is awarded the contract. The term “Bidder” is used throughout, to identify where specific responses to the RFP are required. To avoid disqualification, the Bidder must provide documentation to support the following:

6.1 Mandatory Minimum: In-network coverage must be Actuarially Equivalent to or exceed the coverage offered under the Michigan Public School Employees’ Retirement System’s self-funded Plan, a description of which is included as Schedule I1 PPO Non Medicare Summary of Benefits, I2 PPO Medicare Summary of Benefits, I3 Non Medicare Prescription Drug Summary of Benefits, and I4 Medicare Prescription Drug Summary of Benefits. See Schedule A, Section 1.2.1 to provide Bidder response to this requirement.

6.2 All service categories covered by the self-funded Plan must be covered by the HMO Contract. Refer to Summary of Benefits in Schedule I1, I2, I3, and I4. See Schedule A, Section 1.2.4 to provide Bidder response to this requirement.

6.3 The Contractor must be an HMO licensed in the State of Michigan and accredited by the National Council for Quality Assurance (NCQA), a national organization that evaluates HMO quality. The coverage offered to Members must be authorized under the Contractor’s HMO license. See Schedule A, Section 1.1.1 to provide Bidder response to this requirement.

6.4 The Contractor must provide services in all locations that they are currently approved by the Michigan Department of Insurance and Financial Services (DIFS) to service. See Schedule A, Section 1.1.2 to provide Bidder response to this requirement.

6.5 The Contractor must provide comprehensive benefits to Members when they temporarily reside outside of the service area. See Schedule A, Section 1.8.2 to provide Bidder response to this requirement.

6.6 The Contractor must provide all services at or below the premium rates as provided by the State. Illustrative premiums and benefit designs are provided for 2024 (See Schedule B and Schedules I1-I4. See Schedule A, Section 6.1.1 to provide Bidder response to this requirement.

6.7 The Contractor must have a contract in place with CMS at time of bid submission and is approved to provide a Medicare Advantage plan. See Schedule A, Section 1.1.5 to provide Bidder response to this requirement.

Only proposals meeting the mandatory minimum requirements will be considered for evaluation.

7. EVALUATION PROCESS. The State will evaluate each proposal based on the following factors:

The State will evaluate Bidder’s response to Criteria items on a Pass/Fail basis. The following criteria must be met for a Bidder’s proposal to be considered for award:

And

· Yes, we will comply as specified: PASS

· No, we cannot comply: FAIL

· Yes, we will comply but with written exceptions in accordance with Section 7. Evaluation Process provided with Bidder’s proposal:

PASS if the exception(s), at the sole discretion of the State, is evaluated as acceptable.

FAIL if it is not.

No, we cannot comply: FAIL Yes, we will comply but with written exceptions in accordance with Section 7. Evaluation Process must be provided with Bidder’s proposal:

PASS if the exception(s), at the sole discretion of the State, is evaluated as acceptable.

FAIL if it is not.

PROPOSALS THAT HAVE A FAIL DETERMINATION FOR ANY SECTION WILL NOT BE CONSIDERED FOR AWARD.

If applicable, the State’s evaluation will include consideration of a bidder’s qualified disabled veterans/service-disabled veteran owned business(QDV/SDVOB) status under MCL 18.1261(8). Additional information on the SDVOB preference is available at: Michigan.gov/SDVOB.

The State strongly encourages strict adherence to the Contract Terms. The State reserves the right to deem a bid non-responsive for failure to accept the Contract Terms. Nevertheless, the bidder may submit proposed changes to the Contract Terms in track changes (i.e., visible edits) with an explanation of the bidder’s need for each proposed change. Failure to include track changes with an explanation of the bidder’s need for the proposed change constitutes the bidder’s acceptance of the Contract Terms. General statements, such as that the bidder reserves the right to negotiate the terms and conditions, may be considered non-responsive. Failure to respond timely to requests for proposed changes to Contract Terms during ongoing negotiations may be cause for disqualification.

The State may but is not required to conduct an on-site visit to tour and inspect the bidder’s facilities; require an oral presentation of the bidder's proposal; conduct interviews, research, reference checks, and background checks at any point during the evaluation process.

8. NOTICE OF DEFICIENCY. The State reserves the right to issue a Notice of Deficiency to bidders if the State determines after the proposal deadline that a portion of the RFP was deficient, unclear, or ambiguous. Failure to respond to a Notice of Deficiency timely may be cause for disqualification.

9. CLARIFICATION REQUEST. The State reserves the right to issue a Clarification Request to a bidder to clarify its proposal if the State determines the proposal is not clear. Failure to respond to a Clarification Request timely may be cause for disqualification.

10. RESERVATIONS. The State reserves the right to:

a. Disqualify a bidder for failure to follow these instructions.

b. Discontinue the RFP process at any time for any or no reason. The issuance of an RFP, your preparation and submission of a proposal, and the State’s subsequent receipt and evaluation of your proposal does not commit the State to award a contract to you or anyone, even if all the requirements in the RFP are met.

c. Consider late proposals if: (i) no other proposals are received; (ii) no complete proposals are received; (iii) the State received complete proposals, but the proposals did not meet mandatory minimum requirements or technical criteria; or (iv) the award process fails to result in an award.

d. Consider an otherwise disqualified proposal if no other proposals are received.

e. Disqualify a proposal based on: (i) information provided by the bidder in response to this RFP; (2) the bidder’s failure to complete registration on www.michigan.gov/SIGMAVSS ; or (3) if it is determined that a bidder purposely or willfully submitted false or misleading information in response to the RFP.

f. Consider prior performance with the State in making its award decision.

g. Consider overall economic impact to the State when evaluating proposal pricing and in the final award recommendation. This includes but is not limited to: considering principal place of performance, number of Michigan citizens employed or potentially employed, dollars paid to Michigan residents, Michigan capital investments, job creation, tax revenue implications, and economically disadvantaged businesses.

h. Consider total-cost-of-ownership factors (e.g., transition and training costs) when evaluating proposal pricing and in the final award recommendation.

i. Refuse to award a contract to any bidder that has failed to pay State taxes or has outstanding debt with the State.

j. Enter into negotiations with one or more bidders on price, terms, technical requirements, or other deliverables.

k. Award multiple, optional-use contracts, or award by Contract Activity.

l. Evaluate the proposal outside the scope identified in the Evaluation Process section of this document if the State receives only one proposal.

11. AWARD RECOMMENDATION. The contract will be awarded to the responsive and responsible bidder who offers the best value to the State, as determined by the State. Best value will be determined by the bidder meeting the minimum point threshold and offering the best combination of the factors stated in the Evaluation Process section of this document, and price, as demonstrated by the proposal. The State will post an Award Recommendation and Evaluation Synopsis on www.michigan.gov/SIGMAVSS or in the manner it was originally published.

12. DEBRIEF MEETING AND BID PROTEST. The State will publish an Award Recommendation and Evaluation Synopsis which will provide instructions on how to request a debrief meeting.

If you wish to initiate a protest of the award, you must submit your written protest electronically at BidProtest-DTMB@michigan.gov no later than 5:00 PM., 10 business days after posting the Award Recommendation and Evaluation Synopsis on SIGMA VSS. The State reserves the right to adjust this timing and will publish any change.

Additional information about the protest process is available at .

13. STATE ADMINISTRATIVE BOARD. Contracts equal to $250,000 or greater than require approval by the State Administrative Board. The State Administrative Board’s decision is final; however, its approval does not constitute a contract. The award process is not complete until the awarded contractor receives a contract fully executed by all parties.

14. GENERAL CONDITIONS. The State will not be liable for any costs, expenses, or damages incurred by a bidder participating in this solicitation. The bidder agrees that its proposal will be considered an offer to do business with the State in accordance with its proposal, including the Contract Terms, and that its proposal will be irrevocable and binding for a period of 180 calendar days from date of submission. If a contract is awarded to the bidder, the State may, at its option, incorporate any part of the bidder’s proposal into a contract. This RFP is not an offer to enter into a contract. This RFP may not provide a complete statement of the State’s environment or contain all matters upon which agreement must be reached. The bidder understands that their proposal will become public record immediately upon receipt by the State. Other than verified trade secrets, proposals submitted via www.michigan.gov/SIGMAVSS are the State’s property.

15. CONFIDENTIAL TREATMENT FORM AND THE FREEDOM OF INFORMATION ACT. As a public record, all portions of the bidder’s proposal and resulting contract are subject to disclosure as required under Michigan’s Freedom of Information Act (FOIA), MCL 15.231, et seq. However, the State may exempt some information from disclosure as permitted by law. Under MCL 18.1261(13)(b), records containing “a trade secret as defined under section 2 of the uniform trade secrets act, 1998 PA 448, MCL 445.1902,” are exempt from disclosure under FOIA. In addition, “financial or proprietary information” submitted with a bidder’s proposal is exempt from disclosure under FOIA. A bidder’s failure to comply with this Section is grounds for rejecting a bidder’s proposal as non-responsive. As a part of its proposal, each bidder must follow the procedure below.

SUBMIT A COMPLETED “CONFIDENTIAL TREATMENT FORM” (CT FORM) WITH YOUR BID. Completion and submission of the CT Form is required regardless of whether the bidder seeks confidential treatment of information. Failure to submit a completed CT Form may be cause for disqualification from the solicitation process. If a bidder fails to properly complete and submit the CT Form or otherwise fails to follow CT Form instructions, the proposal may be publicly disclosed in its entirety without redaction after an award recommendation.

Complete and sign Section 1 of the CT Form if the bidder does NOT request confidential treatment of information contained in its proposal; or

i. Complete and sign Section 2 of the CT Form if the bidder requests confidential treatment of certain information. Bidder must also submit a “Public Copy” of the proposal with the trade secret, financial, and proprietary information redacted and clearly labeled as the “Public Copy.”

ii. Failure to complete and sign a CT Form may result in disqualification of the bidder. If a bidder fails to properly complete and submit the CT Form or otherwise fails to follow the CT Form instructions, the proposal, in its entirety, will be treated as a “Public Copy” and may be publicly disclosed by the State without redaction after bidders have been notified of an award recommendation.

FOIA REQUESTS. If a FOIA request is made for a bidder’s proposal, the Public Copy may be distributed to the public along with the bidder’s CT Form. The CT Form is a public document and serves as an explanation for the redactions to the Public Copy. Do not put any trade secret, financial, or proprietary information in the CT Form. Do not redact the CT Form itself.

b. NO ADVICE. The State will not advise a bidder as to the nature or content of documents entitled to protection from disclosure under FOIA or other laws, as to the interpretation of such laws, or as to the definition of trade secret or financial or proprietary information. Nothing contained in this provision will modify or amend requirements and obligations imposed on the State by FOIA or other applicable law.

c. FAILURE TO REQUEST CONFIDENTIAL TREATMENT. Failure to request material be treated as confidential as specified herein relieves the State, its agencies, and personnel from any responsibility for maintaining material in confidence.

d. Bids containing a request to maintain an entire proposal as confidential may be rejected as non-responsive. Bidders may not request confidential treatment with respect to resumes, pricing, and marketing materials. The State reserves the right to determine whether material designated as exempt by a bidder falls under MCL 18.1261 or other applicable FOIA exemptions. If a FOIA request is made for materials that the bidder has identified as trade secret, financial, or proprietary information, the State has the final authority to determine whether the materials are exempt from disclosure under FOIA.

e. Bidder forever releases the State, its departments, subdivisions, officers, and employees from all claims, rights, actions, demands, damages, liabilities, expenses and fees, which arise out of or relate to the disclosure of all or a portion of bidder’s proposal submitted under this RFP. Bidder must defend, indemnify and hold the State, its departments, subdivisions, officers, and employees harmless, without limitation, from and against all actions, claims, losses, liabilities, damages, costs, attorney fees, and expenses (including those required to establish the right to indemnification), arising out of or relating to any FOIA request, including potential litigation and appeals, related to the portion of bidder’s proposal submitted under this RFP that bidder has identified as a trade secret, or financial or proprietary information. The State will notify bidder in writing if indemnification is sought. The State is entitled to: (i) regular updates on proceeding status; (ii) participate in the defense of the proceeding; (iii) employ its own counsel; and to (iv) retain control of the defense, or any portion thereof, if the State deems necessary. Bidder will not, without the State’s written consent (not to be unreasonably withheld), settle, compromise, or consent to the entry of any judgment in or otherwise seek to terminate any claim, action, or proceeding. If a State employee, official, or law is involved or challenged, the State may control the defense of that portion of the claim. Any litigation activity on behalf of the State, or any of its subdivisions under this Section, must be coordinated with the Department of Attorney General. An attorney designated to represent the State may not do so until approved by the Michigan Attorney General and appointed as a Special Assistant Attorney General.

confidential treatment form INSTRUCTIONS. Bidder must complete either Section 1 or Section 2 of this CT Form and sign where indicated. Do not complete both sections. This CT Form must be signed by the individual who signed the bidder’s proposal. A completed CT Form must be submitted with your proposal, regardless of whether your proposal contains confidential information.

Failure to submit a completed CT Form with your bid is grounds for rejecting the proposal as non-responsive. If a bidder fails to properly complete and submit the CT Form or otherwise fails to follow CT Form Instructions, the proposal, in its entirety, will be treated as a “Public Copy” and may be publicly disclosed by the State without redaction after bidders have been notified of an award recommendation. See the Confidential Treatment Form and The Freedom of Information Act (FOIA) sections of the Proposal Instructions for additional information.

Section 1. CONFIDENTIAL TREATMENT IS NOT REQUESTED This section must be completed, signed, and submitted with the proposal if the bidder does not request confidential treatment of any material contained in the proposal. If this section is completed, do not complete Section 2. CONFIDENTIAL TREATMENT IS REQUESTED.

By signing below, the bidder affirms that confidential treatment of material contained in their proposal is not requested.

RFP Number

RFP Title

Signature

Date

Printed Name, Title, Company

Section 2. CONFIDENTIAL TREATMENT IS REQUESTED This section must be completed, signed, and submitted with the proposal if bidder requests confidential treatment of any material contained in the proposal. Submission of a completed CT Form is required to request confidential treatment. If this section is completed, do not complete Section 1. CONFIDENTIAL TREATMENT IS NOT REQUESTED.

Provide the information in the table below. Bidder may add rows or additional pages using the same format shown in the table. Bidder must specifically identify the information to be protected as confidential and state the reasons why protection is necessary.

The CT Form will not be considered fully complete unless, for each confidentiality request, the bidder: (1) identifies the Proposal Page #, Section #, and Paragraph #, (2) identifies whether the material is a Trade Secret (TS), Proprietary Financial Information (FI), or Proprietary Information (PI), and (3) explains the specific legal grounds that support treatment of the material as TS, FI, or PI. Bidders must provide a complete justification as to how the material falls within the scope of an applicable FOIA exemption or relevant case law. Bidders must not simply cite to an applicable exemption or case name. Bidders must also provide the contact information for the person at their organization authorized to respond to inquiries by the State concerning the material.

Bidder must also submit a “Public Copy” of the proposal with the trade secret, financial, and proprietary information redacted and clearly labeled as the “Public Copy”.

(1) Proposal Page #, Section #, Paragraph # (2) Material is Trade Secret (TS), Proprietary Financial Information (FI), Proprietary Information (PI) (3) Applicable FOIA Exemption with Written Justification (4) Bidder Contact Information

By signing below, the bidder affirms that confidential treatment of material contained in their proposal is requested and has attached to this form a redacted “Public Copy” of the bidder’s proposal.

RFP Number

RFP Title

Signature

Date

Printed Name, Title, Company vendor questions worksheet Provide a detailed response to each question. “You” and “company” refers to the bidder.

1. Contact Information

Bidder’s sole contact person during the RFP process. Include name, title, address, email, and phone number.

Person authorized to receive and sign a resulting contract. Include name, title, address, email, phone number and vendor customer code in SIGMA VSS.

2. Company Background Information

Legal business name and address. Include business entity designation, e.g., sole proprietor, Inc., LLC, or LLP.

What state was the company formed in?

Phone number.

Website address.

Number of years in business.

Number of employees.

Legal business name and address of parent company, if any.

Has there been a recent change in organizational structure (e.g., management team) or control (e.g., merger or acquisition) of your company? If the answer is yes: (a) explain why the change occurred and (b) how this change has affected your company.

Discuss your company’s history. Has growth been organic, through mergers and acquisitions, or both?

Has bidder ever been debarred, suspended, or disqualified from bidding or contracting with any entity, including the State of Michigan? If yes, provide the date, the entity, and details about the situation.

Has your company been a party to litigation against the State of Michigan? If the answer is yes, then state the date of initial filing, case name and court number, and jurisdiction.

Within the last 5 years, has your company or any of its related business entities defaulted on a contract or had a contract terminated for cause? If yes, provide the date, contracting entity, type of contract, and details about the termination or default.

State your gross annual sales for each of the last 5 years.

If receiving a contract under this RFP will increase your gross revenue by more than 25% from last year’s sales, explain how the company will scale-up to manage this increase.

State of Michigan Experience: Does your company have experience working with the State of Michigan? If so, please provide a list (including the contract number) of the contracts you hold or have held with the State for the last 10 years.

Describe partnerships and strategic relationships you think will bring significant value to the State.

State the physical address of the place of business that would have primary responsibility for this account if bidder is awarded a contract under this RFP.

To demonstrate qualification as a qualified disabled veteran, you must provide:

(a) Proof of service and conditions of discharge (DD214 or equivalent);

(b) Proof of service-connected disability (DD214 if the disability was documented at discharge or Veterans Administration Rating Decision Letter or equivalent if the disability was documented after discharge); and

(c) Legal documents setting forth the ownership of the business entity.

In lieu of the documentation identified above, you may provide proof of certification by the National Veterans Business Development Council.

Enter the names of documents submitted with your proposal to demonstrate status as a qualified disabled veteran.

4. Participation in RFP Development or Evaluation

If you enter “YES”, you are not eligible for contract award or to work as a subcontractor for the awarded vendor.

If you enter “YES,” you are not eligible for contract award. An awarded vendor may not partner or subcontract with anyone to provide goods and services required under a resulting contract if that subcontractor or partner assisted in the development of this solicitation.

If you enter “YES”, you are not eligible for contract award or to work as a subcontractor for the awarded vendor.

5. Prior Experience

Describe at least 3 relevant experiences from the last 5 years supporting your ability to successfully manage a contract of similar size and scope for the work described in this RFP.

Experience 1

Company name.

Contact name.

Contact role at time of project.

Contact phone.

Contact email.

City.

State.

Zip.

1. Project name and description of the scope of the project.

2. What role did your company play?

3. How is this project experience relevant to the subject of this RFP?

Dollar value.

Start and end date (mm/yy – mm/yy)

Status (completed, live, other – specify phase)

Results obtained.

Experience 2

Company name.

Contact role at time of project.

City.

1. Project name and description of the scope of the project.

Dollar value.

Start and end date (mm/yy – mm/yy)

Status (completed, live, other – specify phase)

Results obtained.

Experience 3

Company name.

Contact role at time of project.

City.

1. Project name and description of the scope of the project.

Dollar value.

Start and end date (mm/yy – mm/yy)

Status (completed, live, other – specify phase)

Results obtained.

6. Standard Contract Terms

Bidder must affirm agreement with the attached Contract Terms. If not in agreement, written exceptions in accordance with the Evaluation Process section of the Proposal Instructions must be provided with Bidder’s proposal.

7. Insurance Requirements

8. Michigan Economic Impact

Number of employees currently employed at locations within the State of Michigan.

Number of additional employees to be employed at locations within the State of Michigan if awarded this Contract (if any)

Minimum wage paid to employees employed at locations within the State of Michigan.

Average wage paid to employees employed at locations within the State of Michigan.

Percentage of employees employed at locations within the State of Michigan that are covered by employer-provided health insurance.

9. Labor, Antidiscrimination and Environmental Laws Compliance

Bidder must disclose any violations of state or federal labor, antidiscrimination and employment laws and regulations received within the past five years.

Bidder must disclose any violations of state or federal environmental laws and regulations received within the past five years.

10. Supplier Diversity

11. Other

12. Response to State Requests

SCHEDULE A - STATEMENT OF WORK CONTRACT ACTIVITIES

Request for Proposal No.230000003226 HMO Services for MPSERS This schedule identifies the anticipated requirements of any Contract resulting from this RFP. The term “Contractor” in this document refers to a bidder responding to this RFP, as well as the Contractor who is awarded the contract. The term “Bidder” is used to identify where specific responses to the RFP are required.

The Contractor must respond to each requirement or question and explain how it will fulfill each requirement. Attach any supplemental information and appropriately reference within your response.

IMPORTANT NOTE TO CONTRACTORS/BIDDERS: There are specific requirements for which acceptance must be simply acknowledged through a checkbox(es), and others that require further explanation. Click the appropriate checkbox and complete the entries as appropriate.

BACKGROUND

The Office of Retirement Services (ORS) administers the Michigan Public School Employees’ Retirement System’s (MPSERS) Plans, which provide post-employment health coverage to non-Medicare eligible and Medicare eligible Members, including Retirees, beneficiaries and their Dependents enrolled in the health plans. Health coverage is provided to retired employees of local school districts, intermediate school districts, tax-supported community or junior colleges, and certain universities. Financing for MPSERS is provided through public school employer contributions and Contract Holder premiums. ORS currently manages health coverage for approximately 234,700 Members in the MPSERS health plans. This includes approximately 199,200 members in the self-funded plan and approximately 35,500 participants in the HMOs. Approximately 15% of the Members in the self-funded plan are not Medicare eligible and 85% are Medicare eligible. Approximately 21% percent of HMO members are not Medicare eligible and approximately 79% are Medicare eligible.

MPSERS is a governmental entity and therefore not subject to the federal Employee Retiree Income Security Act (ERISA). MPSERS obligations are statutory, and the Contractor’s obligations will be pursuant to this Contract.

All words capitalized in this document indicate a defined word. Please refer to Schedule F Definitions for all definitions.

SCOPE

This is an RFP to solicit proposals from Contractors for HMO health coverage (medical and prescription drug services) for the Medicare-Eligible Members and non-Medicare Eligible Members, including Retirees, beneficiaries, COBRA participants, and Dependents, of the Michigan Public School Employees’ Retirement System (MPSERS), administered by the Michigan Office of Retirement Services (ORS). All current HMO offerings are fully insured. Bidder proposals must reflect fully-insured offerings only.

The Contractor must be able to provide and administer both a non-Medicare and a Medicare product inclusive of prescription drug coverage to Eligible Members who elected enrollment in an HMO and pursuant to the requirements listed herein.

The Contract resulting from this RFP will have a term of one (1) year, with four (4) one-year options.

No payment will be made to the Contractor during the Implementation Period. The Implementation Period means the period of time between the Contract begins or Effective Date anticipated June 1, 2024, and when Services are commenced on January 1, 2025. Contractor must commence performance of all Services to all Members, without interruption, on January 1, 2025.

1. Requirements Contractor must provide all Deliverables/Services and staff, and must do all things necessary for or incidental to the performance of the work set forth below.

1.1 General Requirements

1.1.1 Mandatory Minimum Requirement: The Contractor must be an HMO licensed in the State of Michigan and accredited by the National Council for Quality Assurance (NCQA), a national organization that evaluates HMO quality. The coverage offered to Members must be authorized under the Contractor’s HMO license. See also Proposal Instructions, Section 6.

List all exception(s):

Bidder must provide proof of licensure in the State of Michigan.

1.1.2. Mandatory Minimum Requirement: The Contractor must provide services in all locations that they are currently approved by the Michigan Department of Insurance and Financial Services (DIFS) to service. See also Proposal Instructions, Section 6.

List all exception(s):

Bidder must provide proof of service area approved by DIFS.

1.1.3 Provide a fully functional medical and prescription drug Plan for Members which encompasses and manages the needs of an older, retired population.

List all exception(s):

Bidder must describe how they comply with the above requirement(s):

1.1.4 The Contractor must be able to provide and administer both a non-Medicare and a Medicare product inclusive of prescription drug coverage to Eligible Members who elected enrollment in an HMO and pursuant to the requirements listed herein.

1.1.5 MANDATORY MINIMUM: The Contractor confirms that it has a contract in place with CMS at time of bid submission and is approved to provide a Medicare Advantage plan. See also Proposal Instructions, Section 6.

List all exception(s):

Bidder must provide proof of contract with CMS.

List all exception(s):

List all exception(s):

Bidder must describe its process for notifying the Plan Sponsor and Members of administrative changes:

1.1.6 The Contractor’s system, processes, subcontractors, and partners must comply with all applicable requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Contractor must provide Plan Sponsor with a signed attestation that it meets this requirement and may be required to recertify annually.

List all exception(s):

1.2 Plan Design

1.2.1 Mandatory Minimum: In-network coverage must be Actuarially Equivalent to or exceed the coverage offered under the Michigan Public School Employees’ Retirement System’s self-funded Plan, a description of which is included as Schedule I1 PPO Non Medicare Summary of Benefits, I2 PPO Medicare Summary of Benefits, I3 Non Medicare Prescription Drug Summary of Benefits, and I4 Medicare Prescription Drug Summary of Benefits.

List all exception(s):

The Bidder must provide an accurate and complete comparison of its benefits with those of the Retirement System’s Master Health Care Plan in Schedule L Benefit Comparison and Actuarial Attestation to demonstrate compliance with this requirement. This response is critical for the State’s understanding of the Bidder’s benefits and the response to this should be thorough and easy to understand. Bidder’s completed Schedule L must be accompanied with an Attestation of Actuarial Equivalence to the Retirement System’s Master Health Care Plan.

1.2.2 The Contractor must provide an accurate and complete comparison of its benefits with those of the Retirement System annually, within 30 days of rate notice being provided by the Plan Sponsor.

List all exception(s):

1.2.3 Plan Sponsor requires annually a signed Actuarial Equivalence Attestation from a certified actuary or a demonstration of actuarial equivalence from an underwriter. This deliverable is due annually, with Contractor’s Comparison of Benefits referenced above.

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1.2.4 Mandatory Minimum: All service categories covered by the self-funded Plan must be covered by the HMO Contract. Refer to Summary of Benefits in Schedules I1, I2, I3, I4. See also Proposal Instructions, Section 6.

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1.2.5 Contractor must provide an accurate listing of its service area, separated by zip code annually.

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1.2.6 If changes are made to the plan design or rules for Contractor’s plan, Contractor must:

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Bidder must describe how they comply with the above requirement(s):

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1.3.2 The Contractor must notify the Plan Sponsor of any known or suspected system issues that may impact operations or service to Members.

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Bidder must describe how they comply with the above requirement(s):

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Bidder must provide their plan for meeting this requirement, including but not limited to, whether this will be managed in house or subcontracted, specific locations, average staffing, and how Contractor will scale up if needed throughout the contract term while maintaining the requirement. See also Section 4.9 Disclosure of Subcontractors. Information must correlate with the information in Section 4.9 if third party subcontractors are utilized.

Bidder must provide detail on Bidder’s process for assisting prospective members who have not yet enrolled in the Plan but will be eligible to do so in the future: