City of Jackson, Mississippi - Major Medical, Dental and Vision Insurance Plans RFP

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REQUEST FOR PROPOSAL

The City of Jackson is seeking bids from responsible firms to provide Third Party Administration for the City of Jackson Medical, Dental and Vision Benefit Plans.

Sealed bids will be received by the City Clerk of Jackson, Mississippi at 219 S.

President Street Jackson, MS 39201 or at Post Office Box 17, Jackson, Mississippi 39205 until 3:30 PM, local time (CT), Tuesday September 1, 2026 at which time they will be publicly opened and read aloud for:

To provide Third Party Administration for the City of Jackson Medical, Dental and Vision Benefit Plans. Anticipated date of change is January 1, 2027.

Electronic Proposals MUST be submitted at www.jacksonmsbids.com. For any questions related to the electronic bidding process, contact PH Bidding at admin@phbidding.com or call 662-407-0193.

Proposals are to be in a sealed envelope plainly marked on the outside. “Bid to Provide Third Party Administration of Jackson’s Health, Dental and Vision Benefit Plans.”

The City of Jackson is committed to the principle of non-discrimination in public contracting. It is the policy of the City of Jackson to promote full and equal business opportunity for all persons doing business with the City.

Bid preparation will be in accordance with the Instructions to Bidders.

A mandatory pre-bid conference will be held at 1:00 p.m., on Monday, August 17, 2026 at 633 North State Street, Jackson, Mississippi 39205, 3rd floor. Responders may participate in-person or remotely. All questions regarding the request for proposal, must be submitted in writing by August 14, 2026 by 12:00 noon. Questions must be emailed to Toya Martin, Director of Human Resources, at tmartin@jacksonms.gov. All questions and responses will be read and answered during the pre-bid conference.

The City reserves the right to reject any and all bids and to waive any and all irregularities in respect to any bid submitted or to accept any bid which is deemed most favorable to the City of Jackson.

Sincerely, Dates of Publication:

___________________________ The Mississippi Link Toya Martin, Director July 30, 2026 Department of Human Resources August 6, 2026

(601) 960-1327 http://www.jacksonmsbids.com/ mailto:admin@phbidding.com mailto:tmartin@jacksonms.gov

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REQUEST FOR PROPOSALS

Major Medical, Dental, and Vision Insurance Plans

For City of Jackson, MS Employees, Eligible Retirees, and Eligible Dependents

RFP# 94828-090126

Publication Dates: July30 & August 6, 2026

Responses Due: September 01, 2026

CONFIDENTIALITY STATEMENT

By accessing this RFP, you agree that the information contained herein shall be treated as confidential. The content may only be used for the purpose of responding to the RFP and must not be used for any other purpose beyond the approved scope of work.

Table of Contents

1. Public Notice / Advertisement

2. Request for Proposals

3. Scope of Coverage and Services

3.1. Medical and Prescription Drug Scope of Services (Medical & Pharmacy

Proposers Only)

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3.2. Dental Requirements

3.3 Vision Requirements

4.Cost Proposal Requirements

5. City Data Package and Proposer Due Diligence

6. Minimum Proposer Qualifications

7. Proposal Submission Instructions

8. Proposal Format and Required Content

9. Pricing Instructions

10. Evaluation and Award

11. Contract Term and Renewal

12. General Terms and Conditions

13. Compliance, Privacy, and Data Security1.

14. Attachments and Required Forms

Attachment A: Proposal Cover Sheet

Attachment A-1: Proposer General Information

Attachment B: Required Certifications

Attachment C: References

Attachment D: Exceptions and Deviations Form

Attachment E - Major Medical & Prescription Drug Proposal Questionnaire

Attachment E-1: Administrative Services

Attachment E- 2: Specific Inquiries Regarding Administrative Services

Attachment E- 3: Provider Disruption Questionnaire

Attachment E- 4: Provider Contracts

Attachment E- 5: Specific Provider Confirmation – Physicians

Attachment E- 6: Specific Provider Confirmation – Hospitals

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Attachment E- 7: Pharmacy Benefit Manager (PBM)

Attachment E- 8: High-Cost Claimant Questionnaire

Attachment F: Dental Plan

Attachment G: Vision Plan

Attachment H: Detailed Pricing Forms

H- 1 Medical Pricing for Self-Funded Plans

H- 2 Fully Insured Dental Pricing for Fully-Insured Plans

H- 3 Fully Insured Vison Pricing for Fully-Insured Plans

H- 4 Optional ASO / Stop-Loss Pricing

Attachment I: Network Disruption and Provider Access Form

Attachment J: Implementation Plan

Attachment K: Confidentiality and Non-Disclosure Agreement (Only required if requesting claims data)

15. Appendices / Reference Documents

Appendix 1: Current Summary Plan Description (SPD) / Benefit Summary

Appendix 2: Benefit Design Grids

2. Request for Proposals

2.1 Purpose

The City of Jackson, Mississippi (the "City") requests proposals from:

a) third-party administrators (TPAs) and administrative services organizations

(ASOs) to provide administration services for its self-funded medical and prescription drug plan through a TPA and/or ASO arrangement;

b) fully insured dental plan; and

c) fully insured vision plan.

Proposers may submit proposals for any single line of coverage or for multiple lines. The

City may award one or more lines to one or more vendors, and may reject any or all

| Page 5 proposals, if doing so is in the City’s best interest. The selected organization will provide self-funded major medical or fully-insured dental or vision insurance plans, or both or any combination thereof. Services will include related administrative services for eligible City employees, eligible retirees, and eligible dependents.

The City seeks proposals that provide high-value benefits, competitive and sustainable pricing, strong provider access, practical member service, transparent administration, and minimal disruption for employees and retirees.

This procurement represents a key component of the City’s ongoing efforts to provide cost-effective, high-quality healthcare benefits while ensuring responsible stewardship of public resources. The City looks forward to receiving proposals from qualified proposers capable of supporting these objectives.

2.2 Procurement Overview

This RFP is issued under applicable Mississippi law, City policy, and the procedures stated in this RFP. Proposals must be complete, responsive, signed, and submitted by the deadline.

The City will evaluate proposals using the published criteria in this RFP. Price/total projected cost is the highest-weighted factor.

No proposal, policy, rate, or administrative-services agreement is binding on the City until approved by the governing authority and executed by authorized representatives.

The City may request best and final offers, interviews, finalist presentations, clarifications, plan design alternatives, or revised pricing.

The City will not reimburse proposal preparation, travel, underwriting, actuarial, or legal costs.

2.3 Current Benefits Background

The City's current medical/Rx and dental plan information, eligibility categories, current rates and contributions, census data, and claims/utilization data will be provided through the RFP data package, a controlled data room, appendices, or written addenda. Because vision coverage has not been previously offered by the City, no historical vision claims or utilization data is available. Proposers must rely only on the RFP, the controlled data package, and written addenda when underwriting or pricing proposals.

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Access to Historical Claims and Underwriting Information

Historical claims experience, enrollment data, and other supporting underwriting information will be made available to qualified respondents upon request through a secure electronic file-sharing method. To obtain access to this data package, respondents must satisfy the following requirements:

Designated Point of Contact: All requests for historical data must be submitted in writing solely to the HR Director as the designated RFP contact.

Confidentiality Requirements: Access will be granted only upon receipt of a fully executed Non-Disclosure and Confidentiality Agreement (See Attachment K –

Non-Disclosure and Confidentiality Agreement).

Verification: Access will be authorized following verification of the respondent's participation in the procurement process and receipt of the required documentation

Eligible active employees. Regular full-time employees; regular part-time employees working an average of 30 or more hours per week; and any other eligible groups recognized by City policy or law.

Eligible retirees. Retirees under age 65 and dependents, subject to Medicare-related exclusions and City policy; City of Jackson police officers and firefighters and dependents retired under the 20-year plan who are not eligible for or entitled to Medicare benefits;

and any other eligible groups recognized by City policy or law.

Dependents. Spouses, children, and other dependents as defined by the applicable plan documents, City policy, federal law, and Mississippi law.

COBRA / continuation. Qualified beneficiaries and continuation participants to the extent required by applicable public-sector COBRA and other continuation laws.

2.4 Definitions

Term Meaning

ASO Administrative services only arrangement for a self-funded health plan.

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Term Meaning

BAA Business Associate Agreement required when an entity performs functions involving PHI as a business associate under HIPAA.

Carrier An insurer, PPO, dental carrier, vision carrier, TPA, ASO, or other proposer legally authorized to provide proposed services.

City The City of Jackson, Mississippi.

COBRA Continuation coverage requirements applicable to state and local government group health plans, as applicable.

Fully insured A policy under which the carrier assumes insurance risk in exchange for premium.

Self-funded A policy under which the employer pays employees’ medical claims directly and assumes the financial risk for those costs, subject to any stop-loss coverage the City may elect to purchase.

Major Medical Group health coverage including medical and related benefits;

prescription drug coverage should be included unless the City requests otherwise.

Plan Document

Hierarchy

The final executed contract, plan document, summary plan descriptions, insurance policy, and any addenda, in that order of precedence unless otherwise stated in the contract.

Plan Year January 1, 2027 – December 31, 2027

PBM (Pharmacy

Benefit Manager)

The entity responsible for administering prescription drug benefits, formulary management, pharmacy network contracting, and rebate administration.

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Term Meaning

Proposal The complete response submitted by a proposer, including pricing, forms, certifications, and exceptions.

Proposer Any qualified vendor, carrier, TPA, or entity submitting a formal proposal in response to this RFP.

PHI (Protected

Health

Information)

Individually identifiable health information created, received, or maintained by the Plan or its Business Associates, as defined under HIPAA regulations.

RFP

This Request for Proposals, including all attachments, appendices, exhibits, and written addenda issued by the City.

RFP Designated

Contact

The sole City contact designated in this RFP for procurement communications.

Stop-loss

Insurance

Insurance coverage purchased by the City to protect its self-funded plan against catastrophic individual claims (Specific Stop-

Loss) or higher-than-expected overall claims (Aggregate Stop-

Loss).

TPA (Third Party

Administrator)

The entity contracted to perform administrative services, claims processing, and operational functions for the City's self-funded health plan.

3. Scope of Coverage and Services

The City requests proposals for the following lines of coverage and services.

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Major Medical / Prescription Drug Coverage: Proposers should provide clearly labeled alternate self-funded, level-funded, ASO, or stop-loss proposals, with disclosure of all risks, fees, and assumptions.

Dental Coverage: Fully-insured dental proposals are required. Proposers may include passive PPO, PPO, indemnity, or other options, but must clearly identify network, reimbursement method, exclusions, waiting periods, and orthodontia availability and employee-paid scenarios.

Vision Coverage: Fully-insured vision proposals are required. Proposers may offer vision PPO, passive PPO, indemnity, or alternative plan designs.

The City may accept or reject any line separately.

All proposals must explicitly detail the local provider network (including a directory or disruption analysis for the Jackson Metropolitan area), out-of-network reimbursement methods, and all coverage exclusions or limitations.

Each proposer shall respond only to the line(s) of coverage for which it is qualified, and all responses must clearly identify which requirements are being addressed for each line.

Optional Alternatives: Alternative plan designs may be proposed to reduce cost, expand access, or improve overall value for the City. However, any alternative proposal must be submitted as a separate, clearly labeled option, and will only be considered if the proposer also submits a plan that substantially matches the City's current benefits, unless otherwise instructed.

3.1. Medical and Prescription Drug Scope of Services (Medical & Pharmacy

Proposers Only)

The medical proposal shall address only the self-funded medical and prescription drug plan, including claims administration, network access, pharmacy benefit administration, utilization management, case management, reporting, compliance support, implementation, and transition services. Requirements in this section do not apply to fully insured dental or vision coverage unless expressly stated. Proposers must provide a detailed response demonstrating their capacity to administer the City’s self-funded health and prescription drug plans. Responses must address each operational area below.

Mandatory Response Requirement:

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All Proposers submitting a bid for Medical / Prescription Drug Coverage must complete and submit all required questionnaires and exhibits in Attachment E (E-1 through E-7), Pricing Forms H-1 and H-4, Network Disruption Form Attachment I, and Implementation

Plan Attachment J. Failure to submit these mandatory attachments in their entirety may render the proposal non-responsive and subject to immediate rejection

3.1.1 Plan Design Administration and Matching

Core Plan Matching: Proposers must demonstrate the capability to administer a self-funded plan design that substantially matches the City's current medical and prescription drug benefit structures.

Deviation Disclosure: Proposers must explicitly identify and itemize every structural deviation from the City's current plan, including but not limited to: deductibles, coinsurance percentages, copays, out-of-pocket maximums, covered services, exclusions, utilization management protocols, formulary tiers, and specialty pharmacy rules.

Self-Funded Cost-Saving Alternatives: Proposers may provide alternative self-funded plan configurations that offer cost-containment opportunities for the City or enhanced choices for members. For each alternative proposed, the proposer must explain the projected impact on claims expenditures, administrative fees (PEPM), member disruption, network configurations, and utilization behavior.

3.1.2 Provider Network Capabilities (Preferred Provider Network) and Contract

Pricing Analysis

Network Infrastructure: Proposers must specify the precise commercial network options being offered, including the designated service area, hospital network access, primary/specialty care density, behavioral health access, and urgent care availability within the City of Jackson and surrounding regions.

Provider Disruption Analysis: Based on the City’s historical provider utilization file (if provided), the Proposer must submit a comprehensive geo-access and provider disruption analysis demonstrating the percentage of current match-rates for the City's active employee and dependent population.

Proposers must complete and submit Attachment H - Contract Pricing and

Attachment I – Network Disruption and Provider Access Forms located in the

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Appendix of this RFP. The City of Jackson will rely heavily on the negotiated hospital, physician, and prescription drug allowed amounts provided in Appendix

H to evaluate the financial feasibility and cost-effectiveness of each proposal.

Failure to complete these tables in their entirety may result in the disqualification of the proposal.

3.1.3 Prescription Drug (Pharmacy Benefit) Administration

Formulary and Clinical Management: Describe the proposed formulary management system, tier structures, prior authorization workflows, step therapy protocols, and specialty drug management.

Distribution and Accumulator Programs: Detail the availability of mail-order services, 90-day retail maintenance fill programs, copay accumulator/maximizer programs, and insulin/diabetes supply management.

Rebate Transparency: Proposers must explicitly define how pharmacy rebates, manufacturer credits, or discounts are tracked and passed through dollar-for-dollar to the City's self-funded claims fund.

3.1.4 Care and Utilization Management

Clinical Oversight: Describe the proposer’s integrated clinical programs, including standard utilization review, disease management, large-case management, maternity support, chronic condition tracking (e.g., diabetes, hypertension), and behavioral health integration.

High-Cost Claimant Support: Detail specific administrative strategies used to identify, monitor, and mitigate catastrophic or high-cost medical claims to protect the City's self-funded financial exposure. Proposers must complete Attachment E-8 (Questionnaire on

High Cost Claimant Support) in its entirety.

3.1.5 Administrative Documents and Compliance Support

Plan Documentation Support: The selected TPA must assist the City in drafting and updating its self-funded Summary Plan Descriptions (SPDs), Summaries of Benefits and Coverage (SBCs), plan booklets, and open enrollment materials.

Regulatory Compliance Framework: Identify the administrative support provided to ensure the City remains compliant with federal and state mandates, including but not

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Equity Act (MHPAEA) reporting, HIPAA privacy/security regulations, and Affordable Care

Act (ACA) reporting workflows.

3.2. Dental Requirements

The dental proposal shall address only fully insured dental coverage and related enrollment, claims, customer service, provider network, reporting, open enrollment support, and implementation services. Medical claims administration, pharmacy benefit administration, and medical utilization management requirements do not apply to the dental proposal unless expressly stated.

The City of Jackson currently offers a voluntary, fully insured dental plan that is 100% employee-paid via payroll deduction and intends to continue to offer the same. The City provides no direct financial contribution toward the premium, nor does the City assume any liability for benefit costs or claims. The City’s role is strictly limited to sponsoring the group plan and processing premium payments via payroll deduction.

Mandatory Response Requirement:

All Proposers submitting a bid for Dental Coverage must complete and submit the Dental

Questionnaire in Attachment F and Provider Disruption Analysis in Attachment I.

Failure to complete and submit these mandatory attachments in their entirety will render the proposal non-responsive and subject to immediate rejection.

3.3 Vision Requirements

The vision proposal shall address only fully insured vision coverage and related enrollment, claims, customer service, provider network, reporting, open enrollment support, and implementation services. Medical claims administration, pharmacy benefit administration, and medical utilization management requirements do not apply to the vision proposal unless expressly stated.

The City provides no direct financial contribution toward the premium, nor does the City assume any liability for benefit costs or claims. The City’s role is strictly limited to sponsoring the group plan and processing premium payments via payroll deduction.

The Vision Questionnaire is Attachment G of this RFP. Failure to complete and submit this mandatory attachment in its entirety will render the proposal non-responsive and subject to immediate rejection.

3.4 Required Objectives

a) Maintain or improve benefit value while controlling total City and employee cost.

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b) Minimize provider disruption, especially for high-utilization employees, retirees, dependents, hospitals, primary care, specialists, behavioral health, dental providers, and pharmacies in the Jackson/Hinds County service area.

c) Provide transparent underwriting assumptions and pricing methodology.

d) Provide responsive account management with named contacts and clear escalation channels.

e) Support open enrollment, onboarding, eligibility file exchange, ID card delivery, and member education.

f) Meet applicable federal and state laws for group health plans, dental and vision coverage, privacy, continuation, disclosure, and transparency.

g) Offer meaningful reporting, renewal strategy, utilization review, and cost-containment support.

3.5 Scope Overview

This RFP seeks proposals from qualified organizations capable of providing comprehensive Third-Party Administration services for the City’s self-funded medical plan, fully-insured dental or fully-insured vision plan, for an individual line of coverage or any combination thereof. The selected Proposer will be responsible for delivering a full suite of administrative and support functions, including but not limited to:

a) Claims administration and adjudication

b) Provider network access and management

c) Customer service and member support

d) Eligibility and enrollment management

e) Care management and wellness programs

f) Utilization management

g) Reporting and analytics

h) Compliance and regulatory support

i) Implementation and transition services

The Proposer must demonstrate the capacity to administer the plan with accuracy, timeliness, and operational integrity while supporting the City’s goals of cost containment, transparency, and high-quality member service.

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3.5.1. Detailed Scope of Work

The Proposer shall provide a complete suite of Third-Party Administration services and insurance management services necessary to support the City of Jackson’s self-funded medical plan, as well as its fully insured dental and vision plans. All services must be delivered in accordance with applicable federal, state, and local laws, industry best practices, and the performance standards outlined in this RFP. The Proposer must demonstrate the operational capacity, technical capability, and subject-matter expertise required to administer a complex municipal health and welfare plan serving employees, retirees, and dependents.

The Scope of Work includes, but is not limited to, the following service areas:

3.5.2 Claims Administration

The Proposer shall provide accurate, timely, and compliant claims processing services, including:

a) Adjudication of medical claims in accordance with plan documents

b) Coordination of benefits (COB) and subrogation

c) Application of deductibles, copays, coinsurance, and accumulators

d) Fraud, waste, and abuse detection

e) Claims payment accuracy reporting

f) Timely processing standards that meet or exceed industry norms

3.5.3 Preferred Provider Network Access & Management

The Proposer shall provide access to a robust provider network that ensures high-quality, geographically accessible care for members. Requirements include:

a) Comprehensive local, statewide, and national network coverage

b) Network adequacy and disruption analysis

c) Contracting strategies to address identified gaps

d) Provider directory maintenance and accuracy

e) Network performance reporting

3.5.4 Customer Service & Member Support

The Proposer shall operate a dedicated customer service function that includes:

a) A toll-free member services line

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b) Trained representatives familiar with City-specific benefits

c) Multilingual support

d) Call center performance metrics and reporting

e) Member education materials, ID cards, SBCs, and digital tools

3.5.5 Eligibility Enrollment Management

The Proposer shall support all aspects of eligibility administration, including:

a) Secure file exchange with the City

b) Eligibility file setup, mapping, and testing

c) Ongoing enrollment updates and error resolution

d) Retiree eligibility management

e) Reconciliation reporting

3.5.6 Case Management and Wellness

The Proposer shall provide integrated care management and wellness services, including:

a) Utilization management

b) Case management and disease management

c) Preventive care programs

d) Wellness initiatives tailored to municipal employees

e) Behavioral health integration

f) Reporting on engagement, outcomes, and cost savings

3.5.7 Reporting and Analytics

The Proposer shall deliver comprehensive reporting and analytics capabilities, including:

a) Monthly, quarterly, and annual reporting packages

b) Predictive analytics and cost-trend analysis

c) Benchmarking against public-sector norms

d) Real-time dashboards and data transparency

e) Custom reporting upon request

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3.5.8 Compliance and Regulatory Support

The Proposer shall ensure full compliance with all applicable federal, state, and local laws regulations, and administrative guidelines. The Proposer’s obligations shall include, but are not limited to, compliance with and administrative support for:

a) Federal Health Care Statutes: ACA, HIPAA, MHPAEA, CAA, and all applicable provisions of the internal Revenue Code (IRC) governing employer-sponsored health and wealth plans.

b) State Insurance Laws: All Mississippi Department of Insurance mandates, regulations, and statutory requirements as they apply specifically to the City’s fully insured lines of coverage (dental and vision) and self-funded administrative obligations.

c) Governmental Plan Standards: Industry best practices from the ERISA that no provision of this contract shall be construed to waive the City of Jackson’s status as an ERISA-exempt governmental plan under 29 USC § 1003 (b)(1)

d) Public Records Act Compliance: Timely cooperation, retrieval, and provision of plan documentation, claims data summaries, and administrative records necessary to satisfy the City’s obligations under the Mississippi Public Records

Act (Miss. Code Ann. § 25-61-1 et. seq.) and independent financial or regulatory audits.

e) Continuation of Coverage and Billing: Public sector COBRA administration, continuation of coverage requirements, and retiree billing administration

f) Data Privacy and Security: Execution and strict adherence to a Business

Associate Agreement (BAA) in compliance with HIPAA/HITECH privacy and security standards.

g) And any and all other applicable federal, state, or local laws or regulatory updates enacted during the term of the agreement that govern the administration of municipal health and welfare benefits.

3.5.9 Implementation & Transition Services

The Proposer shall provide a structured, timely implementation process, including:

a) Project management and kickoff

b) Eligibility and data migration

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c) System configuration and testing

d) Member communications and ID card distribution

e) Parallel claims testing

f) Go-live readiness review

3.5.10 Audit Rights, Record Retention & Data Access

The Proposer shall comply with all City audit requirements, including:

a) Full access to records, systems, and personnel

b) Support for scheduled and unannounced audits

c) Record retention for at least seven (7) years

d) Data ownership and return of all City data upon termination

3.5.11 Performance Guarantees

The Proposer shall propose measurable performance guarantees tied to:

a) Claims accuracy

b) Customer service responsiveness

c) Care management engagement

d) Network performance

e) Reporting timeliness

f) Implementation milestones

Penalties or fee-at-risk structures required.

3.5.12 Administrative Services

Proposers must complete and submit the Administrative Questionnaires located in

Attachments E2-3 in the Appendix of this RFP, certifying which services are included in their proposed base administrative fee. Detailed instructions and required response format are provided with the attachment.

4. Cost Proposal Requirements

Proposers shall submit a complete and transparent Cost Proposal that includes all fees, charges, and financial obligations associated with providing Third-Party Administration or administrative services for the City’s self-funded medical plan, self-insured dental and/or self-insured vision plan. All pricing must be presented in a clear, itemized format and must

| Page 18 reflect the total cost of services required under this RFP. The City will not be responsible for any costs not expressly identified in the Proposer’s Cost Proposal.

The Cost Proposal must include, at a minimum, the following components:

4.1. Administrative Fees

Proposers shall provide detailed pricing for all administrative services, applicable to their line of coverage, including, as applicable:

a) Per-employee-per-month (PEPM) fees for core TPA services

b) Eligibility management and enrollment processing

c) Customer service operations

d) Claims administration

e) Utilization management

f) Care management and disease management (medical only)

g) Reporting and analytics

h) Compliance support

All proposed fees and charges shall remain firm and fixed for the initial term of the contract. The City will not accept or honor any price fluctuations, surcharges, or automatic annual adjustments unless expressly negotiated and approved by the City’s governing authority in writing prior to contract execution.

Proposers must clearly specify whether all proposed fees are guaranteed, fixed, or subject to annual adjustment for the duration of the contract with the City of Jackson, MS.

4.1.1 Price Stability and Rate Adjustments

All proposed administrative fees must remain fixed and guaranteed for the initial term of the contract. The City will not accept automatic annual increases or inflation escalators.

After the initial term, any request for a rate adjustment must be submitted in writing to the

Human Resources Department at least sixty (60) days prior to the contract renewal date.

To be considered, the proposer must provide:

a) A detailed explanation of the external factors driving the request (e.g., changes in federal or state regulatory requirements).

b) Documentation showing the direct impact on the proposer's operational costs.

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c) No rate adjustment shall be effective until it is formally approved and executed via a written contract amendment by the City's governing authority.

4.2 Network Access Fees

If applicable, Proposers shall disclose:

a) Network access fees (PEPM or percentage-of-savings)

b) Pass-through vs. bundled pricing

c) Any surcharges for out-of-area or national network access

d) Subcontractor network fees and Transparency. The Proposer shall remain fully responsible for all fees, costs, and expenses associated with its subcontractor network. The Proposer must provide a complete, itemized breakdown of all subcontractor fees included in the proposal, including any administrative markups, network fees, or pass-through charges. The City reserves the right to review and reject any proposed subcontractor fees deemed exorbitant, unreasonable, or inconsistent with competitive market rates.

4.3 Limitations on Subcontractor Markups

All subcontractor services utilized under this agreement must be billed to the City at actual cost, or at the predetermined fixed rate established in the proposal. The primary proposer is strictly prohibited from applying exorbitant administrative fees, network access fees, or secondary markups to subcontractor charges. Any allowable subcontractor administrative fee must be disclosed and capped at a fixed percentage or a fixed flat rate for the duration of the agreement.

All network pricing must be fully transparent and clearly defined.

4.4 Care Management & Utilization Management Fees

Proposers are responsible for:

a) Utilization management

b) Case management

c) Disease management

d) Wellness programs

e) Behavioral health programs

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Proposers must indicate whether these services are included in the base administrative fee or priced separately.

4.5 Implementation & Transition Costs

Proposers shall identify all one-time or recurring costs associated with:

a) Implementation and project management

b) Eligibility file setup and testing

c) System configuration

d) Member communications and ID cards

e) Claims run-out support

f) Data migration and integration

No additional implementation fees will be permitted.

4.6 Minimum Mandatory Requirement

Minimum Mandatory Requirement: Proposers must provide a comprehensive, standard telehealth/virtual care program (including 24/7 access to board-certified physicians for primary care, urgent care, and behavioral health consultations). This standard virtual care capability must be included within the base administrative fee or core network access fee at no additional cost to the City or its members.

Evaluation Preference: During the evaluation process, the City will give distinct preference to Proposers who demonstrate that advanced or enhanced virtual care capabilities—such as specialized virtual chronic condition management (e.g., diabetes, hypertension), or digital dermatology—are integrated directly into their core benefit offering without separate, a la carte, or supplemental PEPM charges.

Disclosure of Surcharges: Any Proposer attempting to assess a separate fee, surcharge, or standalone subscription cost for baseline telehealth services must explicitly disclose such charges in the Cost Proposal.

4.5 Optional or Value-Added Services

Proposers shall list and price any optional services.

Enhanced analytics or predictive modeling: Identify all costs for advanced data scrubbing, predictive clinical forecasting, or custom reporting dashboards. Proposers

| Page 21 must explicitly state whether standard quarterly utilization and financial reporting are included in the base administrative fee or if they carry an additional charge.

Wellness incentives & Fund Allowance: Detail the administrative fees for managing, tracking, and validating employee wellness compliance or incentive distribution.

Proposers must distinguish between the cost to administer the platform and the actual funding mechanism for the rewards/incentives themselves.

Additionally, state whether the Proposer offers an annual client wellness budget or financial stipend to the City (e.g., dedicated wellness fund/allowance). If applicable, specify:

1. The total annual dollar amount provided to the City;

2. How and when funds are allocated or reimbursed; and

3. Any restrictions, eligible expense categories, or approval requirements for utilizing the funds.

Retiree billing or COBRA administration: Provide itemized pricing for complete compliance management, including sending required notifications, premium billing, collection, and coverage termination workflows. Specify fees on a per-notification or per-active-participant-monthly basis.

Pharmacy carve-out support: Specify all one-time technical implementation fees or ongoing data-syncing fees required to integrate and share real-time eligibility, claims, and deductible accumulators with a third-party Pharmacy Benefit Manager (PBM) selected by the City.

Prohibition on Unsolicited Direct Member Contact and Incentive Programs:

Proposers are strictly prohibited from initiating unsolicited direct telephonic, electronic, or mail outreach to covered City employees or dependents for care management, preventive care reminders, prescription adherence programs, or health coaching. Furthermore, Proposers must disclose and certify that no financial bonuses, commissions, volume rebates, or third-party financial incentives are received or paid to TPA staff or subcontractors based on the volume or frequency of direct member contacts or clinical interventions.

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No optional member outreach or care management programs may be introduced, implemented, or added to the scope of services after contract award without prior authorization and formal execution of a contract amendment by the City's governing authority.

Each optional service must be priced separately.

4.6 Performance Guarantees & Fees at Risk

a) Performance guarantees

b) Associated financial penalties or fees-at-risk

c) Methodology for calculating penalties

d) Annual reconciliation process

e) Core Performance Guarantees

4.6.1 Performance Guarantees and Fees at Risk

The selected Proposer must agree to the City’s mandatory Performance Guarantees

(PGs) outlined in this section.

Total Fees at Risk: The Proposer must place a minimum of 15% of their total annual administrative fees (Per Employee Per Month charges) at risk. This pool of funds will be allocated across the individual performance metrics detailed below: Claims Payment

Accuracy, Claims Processing Speed, Call Center Responsiveness, and Member Inquiry

Resolution.

Methodology and Penalties: Penalties will be calculated as a direct percentage of the monthly or annual administrative fee associated with that specific metric. Penalties are cumulative; however, the total penalty assessment across all categories shall not exceed the 15% annual cap.

Reporting and Annual Reconciliation Process: The Proposer shall submit quarterly performance tracking reports and a comprehensive performance monitoring report within

60 calendar days following the close of each plan year. All performance calculations must be backed by verifiable operational data.

Remittance of Penalties: If the Proposer fails to meet any established benchmark, the corresponding penalty amount must be issued to the City as a direct financial credit

| Page 23 against the next scheduled administrative invoice, or paid via check within 30 days of the final reconciliation if the agreement is terminated.

Audit Rights: The City reserves the right to audit the Proposer's self-reported performance data using an independent third-party auditor.

No "Gains Sharing": Outperforming a benchmark in one category (e.g., answering calls faster than required) cannot be used to offset or excuse a failure to meet a benchmark in another category (e.g., missing a claims accuracy target).

4.6.2. Claims Processing Accuracy and Timeliness

Financial Accuracy: * Benchmark: 98.0% or higher.

Definition: The total correct dollar amount paid divided by the total dollar amount processed.

Payment Accuracy: * Benchmark: 95% or higher.

Definition: The number of claims processed without an error divided by the total number of claims processed.

Claims Processing Timeliness: * Benchmark: 90% of all clean claims must be resolved within 14 calendar days; 95.0% within 30 calendar days.

4.6.3 Customer Service Performance

a) Average Speed of Answer (ASA): * Benchmark: 30 seconds or less.

b) Abandonment Rate: * Benchmark: Less than 3.0% of all incoming calls are dropped before being answered.

c) First-Call Resolution: * Benchmark: 95.0% or higher.

Definition: Member inquiries are fully resolved during the initial contact, with no repeat contact regarding the same underlying issue within thirty (30) calendar days.

4.6.4 Account Management and Reporting

Reliable data and responsive support to manage the City's budget.

Implementation Timeliness: * Benchmark: 100% of ID cards delivered to members, systems tested, and eligibility files fully live at least 15 days prior to the plan effective date.

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Standard Reporting Delivery: * Benchmark: Standard quarterly utilization and financial reports must be delivered within 30 calendar days following the end of each quarter.

Dedicated Account Support: The Proposer must assign a named primary Account

Executive and a designated backup representative to support the City. The account management team shall conduct quarterly strategic utilization and financial review meetings, unless an alternative schedule is expressly requested by the City.

Operational Escalation Protocols: The Proposer must establish an immediate escalation pathway for urgent member access-to-care issues. Urgent eligibility or coverage access issues must be acknowledged within one (1) business day and tracked continuously to full resolution.

4.6.5 Eligibility and Data Integration

ID Card Issuance: * Benchmark: New or replacement ID cards must be mailed within 5 business days of receiving a valid eligibility change file from the City.

Electronic Data Interchange (EDI) Success: * Benchmark: 100% load success rate of weekly enrollment files from the City's HR system within 48 hours of receipt.

Critical Error Correction: The Proposer must ensure the precise and accurate processing of weekly eligibility files. Any critical data errors or discrepancies causing urgent access-to-care issues for a member must be corrected and resolved within two (2) business days of notification by the City.

4.6.6 Pass-Through Costs and Transparency Requirements

Proposer must clearly identify:

A. Mandatory Disclosure:

a) Any pass-through charges

b) Subcontractor fees

c) Printing, mailing, or ID card costs

d) Data interface or file-transfer fees

Any other non-administrative charges

B. Transparency & Governance Rules

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The Proposer must provide absolute transparency regarding all non-administrative, subcontractor, and pass-through charges. To ensure the City is receiving competitive, uninflated pricing, the following requirements apply to all proposals

a) Actual Cost Mandate (No Markups): All permitted pass-through costs—including

Subcontractor fees, Printing, mailing, or ID card production, and Data interface/file transfer fees—must be billed to the City at actual, net cost. The Proposer is strictly prohibited from applying any administrative markups, handling fees, or profit margins to pass-through expenses. Any volume discounts or rebates received by the Proposer from third-party vendors must be passed directly along to the City.

b) Itemization and Documentation: The Proposer must list each anticipated pass-through charge as a separate, distinct line item. For all billing cycles during the contract term, the selected Proposer must attach copies of the original third-party vendor invoices to the City’s monthly billing statement to substantiate the exact costs incurred.

c) Prior Written Approval: The selected Proposer shall not incur or bill the City for any new, supplemental, or unlisted pass-through or non-administrative charge without obtaining express, prior written authorization from the City’s governing authority.

Unapproved pass-through charges will not be honored or paid.

d) Data Interface and File Caps: All standard data interface setup and routine weekly file transfers (including eligibility updates to the City's HR platforms) must be clearly defined as a fixed flat rate or included in the base administrative fee. Variable or hourly data management fees will be considered non-responsive.

Hidden or undisclosed fees discovered after award may constitute grounds for termination.

4.6.7 Cost Proposal Format

The Cost Proposal must be submitted:

a) In a separate sealed envelope or electronic file labeled “Cost Proposal”

b) Using the City’s required pricing template (if provided)

c) With all fees expressed on a PEPM basis, per-service basis, or unit cost basis, as applicable

d) With assumptions clearly stated

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Note: Incomplete or non-itemized pricing may result in disqualification.

Implementation and Open Enrollment

Implementation Manager: Assign a named implementation manager within five business days after notice of intent to award.

Implementation Timeline: Provide a detailed implementation timeline within ten business days after notice of intent to award.

Open Enrollment Support: Attend open-enrollment meetings, benefits fairs, webinars, and departmental meetings as requested by the City.

Member Communications: Provide customized employee communications, benefit summaries, rate sheets, SBCs, provider search instructions, Rx formulary links, dental network links, and transition-of-care instructions.

Data Integration and Card Issuance: Load eligibility accurately, issue ID cards on time, and provide weekly implementation status reports until coverage is live.

Stakeholder Coordination: Coordinate with the incumbent carrier(s), City payroll, HRIS, broker/consultant if any, COBRA administrator, and Section 125 administrator as requested.

5. City Data Package and Proposer Due Diligence

5.1 Data to Be Provided by the City

The City will make the following historical and administrative data information available to authorized proposers through a controlled data room, secure portal, protected appendices, or other approved process. All protected health information (PHI) and claims information should shall be de-identified in compliance with HIPAA privacy standards, unless a lawful basis and appropriate agreement permit disclosure:

a) Major Medical Plan Design Documents: Current medical plan documents, Summaries of Benefits and Coverage (SBCs), benefit summaries, administrative service contracts, and comprehensive renewal history.

b) Dental: Current dental plan documents, benefit summaries, utilization, and renewal history.

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c) Enrollment Census: Complete active Employee and dependent census with including de-identified ZIP codes, age or date of birth, gender if permitted, coverage tier, plan election, employment/retiree status, COBRA status, and eligibility categories.

d) Medical and Prescription Drug Claims Experience: Medical/Rx claims experience for at least 24 to 36 months, including paid claims by month, enrollment by month, high-cost claimant summary, (including large claim pooling), diagnosis/category summaries, if available, and historical Rx pharmacy metrics claims, (inclusive of specialty drugs, utilization, and trailing rebates/credits where applicable).

e) Dental Claims/Utilization Metrics: Comprehensive dental claims history for at least a minimum 24 to 36 months, including preventive, basic, major, orthodontic service usage categories, if available.

f) Provider Disruption Files: or claims De-identified historical provider list for medical, dental, hospitals, pharmacies, and high-utilization providers., de-identified as needed.

g) Administrative & Payroll Logistics: Current COBRA/retiree enrollment counts, retiree eligibility rules, collective bargaining or civil service considerations, and payroll deduction timing.

h) Ancillary and Interacting Programs: Current wellness, EAP, clinic, telehealth, disease-management, or carve-out programs that interact with medical or dental benefits.

5.2 Proposer Responsibility to Review Data

a) Mandatory Disclosure of Data Deficiencies: Each proposer is responsible for reviewing all RFP materials, addenda, data files, plan documents, and City answers before submitting a proposal. A proposer must identify any missing information that materially affects underwriting or pricing before the question deadline. All such inquiries must be submitted in writing prior to the formal question deadline. Failure to report data deficiencies constitutes a total waiver of the proposer’s right to request post-award pricing modifications

b) Prohibition on Post-Award Underwriting Changes: If a proposal relies on assumptions, the assumptions must be clearly stated. Hidden assumptions, undisclosed

| Page 28 contingencies, or post-award underwriting changes may be grounds for rejection or cancellation of award.

c) Rejection of Conditional Bids: The City reserves the right to reject any proposals with material caveats, incomplete rate exhibits, or underwriting contingencies that prevent apples-to-apples comparison.

6. Minimum Proposer Qualifications

At a minimum, each proposer must demonstrate the criteria below. A proposer that cannot meet a requirement must clearly identify the exception and explain the proposed alternative.

The minimum qualifications in this section apply only to the line or lines of coverage for which the proposer is submitting a proposal. At a minimum, each Proposer must demonstrate full compliance with the following mandatory qualifications. A proposer that cannot meet a requirement must clearly identify the exception and explain the proposed alternative. A proposal that fails to meet these baseline standards may be deemed non-responsive and subject to immediate disqualification.

a) Legal Authority and Mississippi Licensure: The Proposer must be fully licensed, admitted, certified, and registered with the Mississippi Department of

Insurance and the Mississippi Secretary of State to legally operate and provide

Third-Party Administration (TPA) and Administrative Services Only (ASO) functions within the State of Mississippi at the time of submission.

b) Financial Strength and Corporate Stability: Pure administrative TPAs must submit their most recent audited financial statements, organizational credit ratings, and regulatory status reports to prove long-term operational stability. For fully insured voluntary, employee paid dental and vision plans, proposing insurance carriers must provide current financial strength ratings from at least one recognized rating agency (A.M. Best, Standard & Poor's, Moody's, or Fitch). Proposers without a rating must submit an explicit statement explaining their financial solvency and regulatory standing.

c) Public Sector and Municipal Experience: The Proposer must possess a minimum of five (5) years of documented experience managing employee benefit plans (self-funded health plans or fully insured group dental/vision plans) for

| Page 29 governmental, municipal, county, public school district, or similarly complex public-sector employers. Distinct evaluation preference will be granted to proposers who demonstrate extensive experience administering municipal groups of a similar size, budgetary structure, and civil service eligibility complexity.

d) Local Network Density and Capacity: The Proposer must possess an established, mature commercial medical, vision and dental provider network with…