31786-00187_Digital_Submission_Instructions.pdf

This is a digital submission instructions document issued by the State of Tennessee, Department of Finance and Administration, Division of Benefits Administration, for RFP #31786-00187 seeking a third-party administrator (TPA) for The Tennessee Plan, a self-insured supplemental medical insurance program for Medicare-eligible state retirees. The RFP encompasses comprehensive administrative services including claims processing, member communications, call center services, HIPAA compliance, weekly claims payment processing, subrogation recovery, and enrollment management. Respondents must submit proposals by December 10, 2025, with a Notice of Award expected on February 26, 2026. Implementation activities will occur from April through December 2026, with the contract term running from January 1, 2027, through December 31, 2031, and a claims run-out period extending through December 31, 2033. All responses must be uploaded to the designated TNCloud file sharing link using the provided credentials and must comply with all file naming, format, and schedule requirements specified in RFP #31786-00187.

The compensation structure utilizes monthly per-member-per-month (PMPM) rates, with maximum contract liability determined by the best-evaluated cost proposal. The evaluation methodology allocates 10 points for general qualifications and experience, 40 points for technical qualifications and approach, and 50 points for cost proposals. The current incumbent, UMR, Inc., holds the existing contract which expires on June 30, 2028. The plan serves approximately 48,059 members as of July 2025, with consistent annual growth of 1,500 to 2,000 members. Historical claims data indicates annual plan costs increase by approximately 4%, with total paid amounts in the tens of millions of dollars annually, representing a substantial contract opportunity. The RFP does not specify explicit set-aside designations or restrictions on respondent types, and all submissions require strict adherence to HIPAA compliance standards as outlined in the associated HIPAA Business Associate Assessment requirements.