7-Attachment A - Info and Scope of Work.docx

USHE Consolidated Health & Welfare Benefits | RFQ Information & Scope of Work Utah System of Higher Education Request for Statement of Qualifications Broker and Consulting Services for a Consolidated Health and Welfare Benefits Program Attachment A: RFQ Information & Scope of Work Solicitation Number: 07072026 Issued: 7/7/2026 Issuing Office: Utah Department of Government Operations, Division of Purchasing and General Services Procurement conducted under Utah Code Title 63G, Chapter 6a, Part 15

1. Purpose The Utah Board of Higher Education (Board), through the Utah Department of Government Operations, Division of Purchasing and General Services, is soliciting Statements of Qualifications from qualified broker and consulting firms to design, procure, implement, and provide ongoing support for a consolidated employee health and welfare benefits program covering all Utah System of Higher Education (USHE) member institutions. The selected firm will serve as the Board’s broker and consultant of record for the consolidated program and is expected to support a target effective date of July 1, 2027.

This solicitation is being conducted as a Request for Statement of Qualifications under Utah Code Title 63G, Chapter 6a, Part 15. Consistent with the Part 15 process, this solicitation does not request or evaluate fees or pricing. The selected firm will be ranked based on qualifications, and fees will be negotiated with the highest-ranked firm following the ranking determination. If a fee agreement cannot be reached with the highest-ranked firm, the Board may negotiate with the next-highest-ranked firm, and so on, consistent with the Part 15 process.

2. Background

2.1 The Utah System of Higher Education

USHE comprises sixteen member institutions, including eight degree-granting institutions and eight technical colleges, collectively spanning approximately 76,000 medically covered lives and an estimated $600 million in annual health and welfare benefit spend (2025). Member institutions currently maintain individual health benefit programs across multiple carriers and third-party administrators (TPAs), with significant variation in plan designs, networks, ancillary benefit offerings, and administrative arrangements. As of 2025, the majority of institutions were fully insured - primarily through the Public Employees’ Health Program (PEHP) – with other institutions self-insured.

2.2 How USHE Benefits Have Been Administered

Historically, each USHE member institution has procured and administered its own health and welfare benefits program independently. Member institutions individually select carriers or TPAs, design plan offerings, manage open enrollment, administer eligibility, and engage their own brokers or consultants. The Board and Office of the Commissioner of Higher Education (OCHE) have not historically played a consolidating role in benefit procurement or design. When last measured, USHE institutions operated under thirty-nine plan designs (twenty-three unique), with materially different cost structures, member experiences, and administrative burdens.

2.3 Recent Work Leading to This Solicitation

In 2025, the Board engaged an independent actuarial firm to perform a feasibility study evaluating a range of consolidation scenarios, from coordinated vendor selection through full risk pooling under various rating methodologies. The study quantified expected savings, identified statutory considerations under Utah Code § 49-20-202, and documented concerns raised by member institutions through a stakeholder survey. The study’s recommended approach was the establishment of a USHE-wide risk pool with rates that vary by institution, accompanied by structured input from member institutions on plan design, networks, and governance.

In early 2026, the Board issued a Request for Information (RFI) that sought best practices, strategies, and solutions to support a continuum of potential health and welfare consolidation models, with particular focus on delivering cost savings/avoidance, improving efficiency, and preserving or enhancing the competitiveness of employee benefit packages. The Board reviewed the RFI responses and has elected to proceed with this solicitation.

3. Objectives The objectives for the consolidated benefits program, and for the engagement of the selected firm, are as follows:

1. Reduce aggregate system-wide benefit program costs across all USHE member institutions while preserving overall benefit value.

1. Establish a unified governance and administrative structure that retains meaningful input from member institutions on plan design, network selection, and program direction.

1. Preserve network adequacy and member access for institutions both inside and outside of major metropolitan areas, including those in rural and regional service areas.

1. Minimize disruption to members and to member-institution human resource and benefits staff during transition to the consolidated program.

1. Position USHE to manage benefit cost trend effectively over time through improved data, vendor accountability, and program design.

1. Preserve optionality for the Board to proceed with the fully consolidated benefit program or with a partially consolidated benefit program (maintaining a subset of institution-led benefit options), based on the firm’s analytical work and recommendations. Options for a phased implementation should also be considered.

4. Contract Term The Board anticipates an initial contract term of three years under a full consolidation scenario, with possible options to renew at the Board’s sole discretion. The selected firm’s engagement is expected to support a consolidated program effective date of July 1, 2027. Project planning, claims data preparation, plan design work, downstream vendor procurement, communications, and transition activities shall be scheduled to support that date.

5. Budget The Board has not established a fixed budget for this engagement. Consistent with the Part 15 process under Utah Code Title 63G, Chapter 6a, fees will be negotiated with the highest-ranked firm following the qualifications evaluation. Firms are not requested to submit fees, costs, hourly rates, or other pricing information as part of their response to this solicitation.

6. Scope of Work The selected firm will provide broker and consulting services across the full consolidated USHE health and welfare benefits program, including all benefits outlined in 6.1. While the Board expects the firm to organize its work in a logical and sequenced manner, this Scope of Work describes objectives and deliverables rather than prescribing a particular methodology or approach. Firms are encouraged to describe their proposed approach in their response to the Questions for Potential Vendors.

6.1 Scope of Benefits

The consolidated program is anticipated to include any combination of medical, prescription drug, dental, vision, life, accidental death and dismemberment (AD&D), short-term disability (STD), and long-term disability (LTD) benefits. Wellness programs, employee assistance programs, and other ancillary or supplemental benefits may be included as determined by the Board.

6.2 Full Benefit Consolidation

The selected firm will target July 1, 2027, for implementation of consolidation recommendations. It is expected that the firm will analyze consolidation of the scope of benefits outlined in 6.1. The selected firm will assemble and analyze member-institution claims, eligibility, enrollment, premium, and plan design data; perform network adequacy and member-impact analyses; recommend a rationalized portfolio of plan offerings; recommend a rating methodology (including treatment of the statutory considerations under Utah Code § 49-20-202); and recommend a governance and oversight structure for the consolidated program. For this full benefit consolidation option, the firm shall provide estimated financial impact, implementation effort, statutory considerations, member disruption profile, and any dependencies between benefits.

USHE will provide a normalized analytical dataset to the selected contractor under a Data Use Agreement; firms are not expected to extract or assemble raw claims data directly from incumbent carriers or TPAs at the stage of the RFP.

6.3 Partial Benefit Consolidation

In parallel with designing the fully integrated consolidated program, the selected firm will produce a view of each benefit type that allows for the Board, OCHE, and USHE leadership to evaluate the program by each separate benefit outlined in 6.1. At a minimum, the firm shall model and report on pharmacy benefit consolidation independent of medical consolidation, consolidated stop-loss, consolidated ancillary benefits (life, AD&D, LTD, vision, and dental), and medical risk pooling under alternative configurations. For each benefit, the firm shall provide estimated financial impact, implementation effort, statutory considerations, member disruption profile, and dependencies on other benefits.

6.4 Downstream Vendor Procurement

The selected firm will design, issue, evaluate, and support contract negotiation for competitive procurements of downstream vendors required to support the consolidated program (full or partial consolidation). These may include one or more TPAs, medical networks, a pharmacy benefit manager, a stop-loss or reinsurance carrier, dental and vision carriers, life, AD&D, and LTD carriers, wellness and care management vendors, and other service providers identified during strategic design.

The procurement strategy shall be structured so that the Board, OCHE, and USHE leadership can evaluate downstream vendors both as benefits of the full consolidated program and as stand-alone, separate benefits. The firm will negotiate contracts with selected downstream vendors on behalf of USHE, including performance guarantees, service-level agreements, financial terms, data and reporting rights, and termination provisions. The firm shall ensure full transparency on all benefit contracts. Particularly for the Pharmacy Benefit Manager, there should be transparency regarding pass-through pricing, rebate retention, spread pricing disclosure, and audit rights.

6.5 Implementation Support

The selected firm will provide implementation project management for a July 1, 2027, effective date, including a detailed work plan with milestones, dependencies, and accountable parties. The firm will coordinate enrollment, eligibility, and ID card issuance across all member institutions; develop a member communication strategy and supporting materials; manage transition for members in active care episodes and for members enrolled in chronic condition management arrangements at incumbent vendors; and coordinate with member institution human resources and benefits staff throughout transition. The selected firm will be expected to develop and implement a work plan to educate and train institutional human resource professionals at member institutions in order to facilitate effective change management and implementation of the selected firm’s deliverables.

6.6 Ongoing Account Management and Renewal Support

The selected firm will serve as broker and consultant of record for the consolidated program throughout the contract term. Ongoing services may include annual renewal management, financial and operational reporting to the Board and USHE governance, large claimant reporting on a de-identified basis, trend analysis and emerging risk identification, vendor management and performance monitoring, member advocacy and escalated case support, annual strategic review with the Board and USHE governance, and triennial benchmarking of all downstream vendor contracts to market, with recommendations on re-procurement timing.

6.7 Coordination with Board-Retained Advisors

The Board may engage one or more independent advisors, including without limitation actuarial, legal, and procurement advisors, to support USHE in its oversight of the engagement and the consolidated program. The selected firm shall coordinate cooperatively with any such advisors, provide reasonable access to work products, models, and downstream vendor materials, and participate in joint working sessions as requested. The presence or absence of Board-retained advisors shall not relieve the selected firm of any responsibility under the resulting contract.

6.8 Compensation Transparency and Conflicts of Interest

The selected firm shall fully disclose all sources of compensation related to USHE business, including any compensation received from downstream vendors, on an ongoing basis throughout the contract term. The firm shall annually certify all compensation received from USHE and from any downstream vendor in connection with USHE business.

Firms are not disqualified from responding to this solicitation by reason of ownership, affiliation, or material business relationships with carriers, TPAs, pharmacy benefit managers, networks, or other potential downstream vendors. The Board recognizes that such relationships can in some cases yield favorable unit cost arrangements, integrated service models, or other member benefits. Firms with such relationships are expected to disclose them in detail in their response, describe how the relationship may benefit USHE, describe how the firm will manage the potential conflict in any downstream procurement, and propose procedural safeguards (for example, independent fairness review or recusal protocols) the firm would commit to in connection with downstream vendor selection.

6.9 Data Use and Work Product Ownership

All analytical work products, derivative datasets, models, dashboards, and reports produced by the selected firm in connection with USHE business shall be the property of USHE and shall be delivered to the Board in machine-readable form on request and at termination of the contract. The selected firm shall not use USHE data for any purpose other than serving USHE. The selected firm shall execute a Business Associate Agreement and a Data Use Agreement prior to receiving any USHE data containing protected health information.

6.10 Key Deliverables and Timeline

Firms should provide a detailed timeline including deliverables, key check-in dates, implementation dates, and other important milestone dates. While this RFQ has been outlined with a July 1, 2027, target effective date, if the vendor proposes an adjustment to that date a description of the need for an adjustment shall be provided and the timeline provided should be based on the revised effective data. The Board is targeting a vendor selection date of no later than August 31, 2026.

7. Evaluation and Selection Process Statements of Qualifications will be evaluated by an evaluation committee comprising at least three individuals designated by the Board, in accordance with Utah Code Title 63G, Chapter 6a, Part 15. The evaluation committee may, at its discretion, conduct discussions or interviews with one or more vendors to clarify or supplement the information provided in the written submissions.

The evaluation committee will score responses against the evaluation criteria identified in the solicitation and will rank the three highest-scoring firms for the purposes of fee negotiation. The Board will negotiate fees and final scope of work with the highest-ranked firm. If the Board and the highest-ranked firm are unable to reach agreement on fees and scope, the Board will conclude negotiations with that firm and commence negotiations with the next-highest-ranked firm, and so on. No fee, cost, or pricing information will be requested or evaluated as part of the qualifications evaluation.

8. Instructions to Vendors Vendors shall submit a Statement of Qualifications that responds to each question contained in Attachment B - Questions for Potential Vendors. Responses should be organized using the question numbering in Attachment B. Responses should be concise, specific to the Board’s engagement as described in this document, and supported by relevant examples and documentation. Vendors shall not include any fee, cost, hourly rate, or other pricing information in their response. Inclusion of pricing information may result in the submission being deemed non-responsive.

Vendors are encouraged to review the USHE Feasibility Study for Consolidation of Benefits dated June 10, 2025, which is provided for reference and context, as well as the Background section of this document.

9. Terms and Conditions This solicitation and the resulting contract are subject to the State of Utah’s standard terms and conditions, which are provided as a separate attachment to this solicitation. Any exception to the terms and conditions that a vendor wishes to propose shall be clearly identified in response to the applicable question in Attachment B.