AddendumFour~1.pdf

Addendum #4 PEBB RFP for Medical and Pharmacy Benefit Services

OregonBuys Bid No. S-44300-00014758

This is Addendum #4 to Public Employees’ Benefit Board’s (PEBB) Request for Proposals (RFP) for comprehensive medical and pharmacy benefit services. Part A of this Addendum includes answers to questions received by the RFP’s Single Point of Contact through 3:00 pm on October 17, 2025 and at the September 16, 2025, Pre-Proposal Conference. Part B of this Addendum includes all formal changes in language and specifications to the RFP, including any of its corresponding attachments and exhibits.

Part A. Questions and Answers

Item No. Question / Request for Clarification Answer / Clarification Answer /

Clarification Delivered by…

1 Hi. Please advise when Attachment "D" will be available. Thank you.

Attachment D is currently marked as "Reserved". At this time, PEBB does not plan on issuing an Attachment D but rather plans on keeping it marked as "Reserved". If this changes and PEBB does add an Attachment D to the RFP, it will be done via formal Addendum, which will be publicly posted.

Addendum #2

2 Can you tell me what lines of business this is for? Assuming Commercial. Any others? Also, how many lives? Go live date?

RFP due date?

All of the answers to these questions are located in the Main RFP document. The Main RFP documents include the key milestones and dates as well as the rules and processes governing this RFP. PEBB encourages Proposers to read and review the Main RFP document before reviewing the other RFP documents that have been posted.

Addendum #2

3 Could you please advise when Attachment I (Sample Group Benefits Contract) will be made available? This attachment is listed on page 4 of the Main RFP document, but I don't see it posted yet.

PEBB has posted Attachment I documents with Addendum #2. Addendum #2

4 What is the structure of the procurement/solicitation? Will the State/PEBB entertain carveout solutions for navigation and clinical care management solutions outside of the medical carrier?

Please see the Main RFP document for information about how this RFP is structured.

As described in the Main RFP document, this RFP may result in various types of benefit Contracts including combined medical and pharmacy, medical only, and pharmacy only benefit Contracts.

This RFP does not currently contemplate awarding Contracts for other types of services, including the point solutions and various carve out programs that are part of PEBB's current plan design.

Addendum #2

Item No. Question / Request for Clarification Answer / Clarification Answer / Clarification Delivered by…

5 Can you please describe how to respond to multiple proposal scenarios (i.e., medical only, pharmacy only, medical and pharmacy, regional, statewide)?

If you wish to submit multiple Proposals (based on the many toggles), please email Heather Hein at hhein@proposaltech.com. Please also provide the identifying name for each invitation variation you are requesting.

Please note that every invitation requires the completion of the entire RFP (based upon your toggle selections).

Addendum #2

6 Can you confirm all redaction will occur in a process outside of ProposalTech? At this time, ProposalTech displays an option for redaction.

Proposers should ignore the confidential answer button in Proposal Tech until it is removed or otherwise deactivated.

All Proposal and document redactions should follow the process that PEBB will outline in the near future. Please see Section 4.1 of the Main RFP document for a list of key dates and milestones, including the expected instructions for redacting Proposals and other submitted documents.

Addendum #2

7 In the RFP it states the coastal region is from the coast to the cascades. Can you please clarify whether it extends to the coastal range or the cascades?

The RFP's Oregon Coast region is located from the coast to the coastal range. Addendum #2

8 Are proposals accepted for partial regions or do they have to provide services to the entire region?

The RFP does not require that Proposers serve an entire region to be considered for that region.

Addendum #2

9 When was the last time that PEBB released an RFP for a carved out PBM separately from medical?

The last time this business went out to bid was in 2013 for contracts effective in 2015;

however, in that Procurement, the pharmacy only bid was reserved for the Oregon Prescription Drug Program (OPDP).

Addendum #2

10 The scoring seems complex, is the intent to choose the highest medical and the highest pharmacy proposals?

Please see subsections 4.14 and 5.1.1 of the Main RFP document for information on how different types of Proposals are matched up and compared against one another as well as how PEBB will select the ASPs.

Please note that subsection 5.1.1 describes the instances where the Board may select a lower scoring Proposal over a higher scoring Proposal that is in direct competition with it.

Addendum #2

11 From a networks perspective, can you confirm if it's a narrow network that removes any major chains at this time?

PEBB's current Benefit Plans maintain a broad network. In 2026, the Board is introducing mandatory mail order or retail 90-day fills; however, the network will remain largely the same.

Addendum #2

12 For the pharmacy analytics and pricing, should we only include the claims data for the plans we are bidding on or for all 3 plans?

Proposers should provide the most competitive pricing Proposal possible for the population they intend to win. For the pharmacy analytics and contractual terms, please respond using

Clarification Delivered by… all claims data in Attachment S, Pharmacy Data Tables, on the tab "Pricing Detail," including populations you do not intend to cover. When developing pricing for premiums, please only use claims data for the populations you are bidding on.

13 Will all addendums be available in ProposalTech and OregonBuys or just one or the other?

Addenda should be available in both places. Addenda are first posted on OregonBuys and then posted in Proposal Tech. Please note, however, that when Attachment A, Questionnaire, is updated, there will likely be a delay of two to three days between when the updated Attachment A document itself is posted with the Addendum to OregonBuys and Proposal Tech and when the online questionnaire on the Proposal Tech website will reflect those changes.

Addendum #2

14 Is it required to fill out the OregonBuys quote site before submitting in ProposalTech?

No submissions are required on OregonBuys. All proposal submissions must go through Proposal Tech.

Addendum #2

15 Will PEBB entertain protests that allow for a different plan structure?

Please see Section 4.6 of the Main RFP document for information related to protesting the RFP process, Specifications, Scope of Work, and the proposed Sample Group Benefits Contract.

Addendum #2

16 Is there a certain format that we wanted to submit questions in ProposalTech and do they need to be consolidated and sent all at once?

There is no specific required format. Questions can be submitted on an ongoing basis, as they arise, using the process described in Section 4.2 of the Main RFP document.

Addendum #2

17 With regards to the list of the point solutions, are they all subcontracts to the Medical plans or are some of them directly contracted by PEBB?

PEBB's current point solutions are provided through its current Medical Benefit Plans. At this time, PEBB has no direct contracts with the various point solution Vendors providing services to its Members.

Addendum #2

18 Based on the description in the main RFP document around goals and focus areas for PEBB, with the understanding that member experience and other areas are of key importance to PEBB, and also with the understanding that PEBB is planning to launch several solutions for the 2026 plan year that are being put in place without a procurement process, is there an opportunity to bid on those components as well (specifically Garner and Collective Health)?

Please see the response to Item. No. 4 above. Addendum #2

19 Looking at Attachment C, it looks like there aren't regional solutions for the plans. Based on the current plan and the regions of the document, it's unclear if PEBB prefers a regional or a statewide approach or if that is to be determined?

This RFP allows Proposers to submit Proposals for numerous types of Benefit Plans, including statewide and various regional Benefit Plans.

Clarification Delivered by…

Please see the fourth paragraph of subsection 1.1 of the Main RFP document for the RFP's expected outcomes.

20 In the RFP it states that we can't talk to the Board, Staff, or Mercer about this procurement. Is there anyone else in the State of Oregon government we cannot talk to? For example, (ex) Governor Kitzhaber?

Please do not divulge the contents of your Proposal or have any conversations related to this RFP with any current State of Oregon employee, public official, or contractor unless specifically authorized by this RFP.

Addendum #2

21 Can you please advise if we submit redactions before or after the proposal submission deadline?

Please see the response to Item No. 6 above. Redactions will be submitted after the Proposal submission deadline per the key milestones and dates described in Section 4.1 of the Main RFP document.

Addendum #2

22 Does the RFP allow for the submission of a separate executive summary document that would include supplementary information about our proposed programs and benefits for PEBB, or would such additional documentation fall under the restriction stated regarding unsolicited additional documents (1.1 Introduction)?

Additional attachments will not be accepted, reviewed, or scored unless specifically requested in a questionnaire item or otherwise requested by PEBB during this RFP process.

Addendum #2

23 Can we submit both a medical only and a combined medical/pharmacy proposal? If we can, how do we do it?

Please see response to Item No. 5 above. Addendum #2

24 Does PEBB require us to offer/contract with particular point solution vendors, or are you seeking integration capabilities with your current vendor ecosystem?

Proposers are required to propose a plan design that is consistent with one of the plan designs described in Attachment C, Plan Designs, including offering the various point solutions or comparable programs either directly or through a subcontractor.

Please note that Questionnaire Item 2.5.2 of the questionnaire allows for Proposers to confirm whether they can contract with PEBB's current point solutions or propose a different solution.

Addendum #2

25 Question 2.6.1.6 in the Questionnaire document (page 154) indicates that the following data is contained in Attachment M:

•The number of admits by DRG for the time period excluding facilities subject to SB 1067

•The number of admits by DRG for the time period for facilities subject to SB 1067

Questionnaire items 2.6.1.4, 2.6.1.6, and 2.6.1.7 incorrectly reference Attachment M. These questionnaire items should reference Attachment O, Provider Discount Data.

Clarification Delivered by…

•The total relative weights of the DRG admits by county using final version 42. DRGs without weights are not included.

•The total relative weights of the DRG admits by facility and county subject to SB 1067 using final version 42.

DRGs without weights are not included.

•Procedures by CPT code excluding all facilities subject to

SB 1067

•Allowed amount for all CPT codes by county •Procedures by CPT code for all facilities subject to SB

•Allowed amount for all CPT codes by facilities subject to

SB 1067

However, we do not see this data contained in Attachment M.

Can you please advise where we can find this data?

26 Are Medical vendors that submit a combined (Medical + Rx) proposal also required to submit a Medical only proposal? Is there any way for a very strong Pharmacy Only proposal to win the business if no medical vendors submit strong Medical only proposals? I would think there is not much of an incentive for a Medical vendor to submit a strong Medical only proposal if it would only increase chances of PEBB carving out the pharmacy benefit.

Proposers who submit a combined medical and pharmacy Proposal are not required to also submit a medical only Proposal. That said, PEBB highly encourages those Proposers to do so.

Please see Sections 4.14 and 5.1.1 of the Main RFP document for a description of how various types of Proposals will be matched up and then compared.

While it is not guaranteed that a pharmacy only Proposal will be awarded a Contract under this RFP, PEBB believes that it is a real enough possibility that submitting medical only Proposals would hopefully be a worthwhile endeavor for Proposers.

Addendum #2

27 We have identified a discrepancy in the data between “Attachment U Pharmacy Claims Data.xlsx” and the Data Summary in the first tab of file “Attachment S Pharmacy Data Tables.xlsx”. For example, the Number of Rxs in the Data Summary tab of Attachment S is 1,358,167; whereas the Number of Rxs in the Claim Data File (Attachment U) is 1,358,161. The

Proposers should use the data in Attachment U to complete the information requested in other tabs of Attachment S.

Clarification Delivered by…

Total Days' Supply in the Data Summary tab of Attachment S is 61,495,331; whereas the Total Days' Supply in the Claim Data File (Attachment U) is 61,495,325. Additionally, the Undiscounted AWP in Attachment U is $634,138,745.55;

whereas in Attachment S' Data Summary tab is $634,138,805.95.

Please confirm respondents should only use the data in "Attachment U Pharmacy Claims Data.xlsx" to complete the information requested in the other tabs of Attachment S. If not, please provided an updated version of Attachment S with data summaries matching the data in Attachment U.

28 In Attachment A-Questionnaire, question 2.1.1.2.18 indicates "Confirm no Health Advocacy team members are located offshore." Can you please define Health Advocacy team members?

Anyone that supports the Member-facing health advocacy function for the Benefit Plan, including customer service representatives, Member advocates, case managers, or specialty resources that interact with Members.

Addendum #3

29 In Attachment P-Pharmacy Plan Design Summary, can you please advise if there is there are any sections we need to complete?

Attachment P, Pharmacy Plan Design Summary, is an informational attachment. Proposers do not need to populate it or otherwise add information to the attachment.

Addendum #3

30 Please confirm that PEBB and its vendors will only use confidential or proprietary information provided by bidders for the sole purpose of administering the RFP process.

PEBB and its contracted Consultant, Mercer, will only use the information submitted by Proposers as part of this RFP process for purposes of administering this RFP, subsequent contract negotiations, and resulting implementation work. Please note, however, that if a Proposer is selected as an ASP under this RFP and successfully executes a Contract with PEBB, its Proposal information may be relevant to, and used for, future Contract negotiations with PEBB.

Please also note that the documents and information submitted by Proposers are subject to Oregon’s Public Records Law. This RFP includes a process by which Proposers may redact certain information from their Proposals if the information is exempt from disclosure under the law.

Please see the response to Item #6 above for additional information.

Addendum #3

Clarification Delivered by…

31 Question: If we are submitting a Regional, Coordinated Care plan, please confirm that, for Attachment O, we are only required to complete the following tabs?

• DRG - Coordinated Care SB1067

• DRG - Coordinated Care non-SB1067

• CPT - Regional SB1067

• CPT - Regional non-SB1067

Yes, that is correct. Addendum #3

32 Attachment A, Questionnaire, page 185, Section 3.5 Pharmacy Network Administration, question 3.5.2.

Question: Should we report on only those zip codes/participants that fall within the service areas we are bidding on, e.g., Portland Metro?

Yes, please only report on the zip codes you are bidding on. Addendum #3

33 In Attachment A - Questionnaire, question 2.6.1.1, can you please clarify what the behavioral health clinical audit and the care management assessment audit would entail?

Clinical and operational audits and assessments typically include, but are not limited to, the following:

• Review of policies and procedures governing clinical interactions with Members;

• Case reviews of selected Member experiences with your program, and associated call recordings or text conversations supporting Member needs;

• Process work-flows and escalation protocols;

• Detailed information on staffing credentials and ongoing training efforts;

• Quality assurance measures to support the integrity of your offering;

• Network development and management standards;

• Process to monitor Provider Network capacity;

• Review of utilization management activity within the UM documentation system;

and,

• Review of all UM/care management notes, assessments, care plans and other documentation for selected Member cases.

Addendum #3

34 Attachment A, Questionnaire, page 120, Section 2.3.1.3 Geo-access and Disruption, Question 2.3.1.3.1. Please provide a Geo- Access report using the Census data in Attachment L and upload as part of your response. Please use the Representative Placement method of assignment for employees when providing your response. Please use your proposed comprehensive network

Representative Placement Method is using a statistically credible, smaller subset of the population to run the Geo-access analysis. The subset needs to be similar to the demographics, locations, and other aspects to the overall population. If the Proposer does not have the methodology or programming to use the Representative Placement Method, please provide the Geo-access on the entire PEBB population.

Clarification Delivered by… for this analysis. Attach the detailed Geo-Access report as part of the proposal.

Please define Representative Placement Method.

35 Attachment A, Questionnaire, page 202, Section 3.13 Formulary Management, Question 3.13.19. Complete all fields in the “Formulary” tab in Attachment S (Pharmacy Data Tables). Once completed, the file MUST be attached to this question. Please add any relevant NDC's if they are not found within our list.

On Attachment S, the instructions for the Pricing Detail tab indicate to use the data provided on the claim level file extract.

The claim level data is separated by carrier. Should we be using all three carriers' claims sets or just our own if we are an incumbent? {Part 1}

Similarly, for the Projections tab on Attachment S, should we be using our own experience to project forward, or the combination of all three carriers, but with area filters applied? {Part 2}

Response to Part 1: This RFP requests Proposers to bid on all Claims from all carriers within their proposed service area.

Response to Part 2: Use the combination of all data that falls within your proposed service area.

Addendum #3

36 Attachment A, Questionnaire, page 246, Section 3.40 General Pricing Requirements, Question 3.40.3. [SELF-INSURED ONLY] PEBB will only agree to pay administrative expenses passed through the claim wire for services that have been disclosed in this RFP process and agreed-upon by PEBB. Please list out any, and all, categories of fees that may apply to PEBB and denote which may apply to each plan. Do not include any local/state assessments, as those pass-through charges are excluded from this provision. Any claim wire charges that are not disclosed in the pharmacy pricing terms (Attachment T) will not be paid.

Also, Attachment A, Questionnaire, page 275, Section: [SELF-

This is correct. Addendum #3

Clarification Delivered by…

INSURED ONLY] Pricing, Question 3.58.1. Complete the attached the Pharmacy Pricing Terms (Attachment T) and complete all fields applicable to your offer. Once completed the file MUST be attached to this question.

Please confirm if we are providing a fully insured quote only, we do not have to complete Attachment T.

37 Attachment A, Questionnaire, page 52, Section 2.1.1.10 Data and Reporting, Question 2.1.1.10.19. Could you provide a report of your internal quality review process? If so, please provide a sample report. If yes, a sample report MUST be attached.

Please clarify what area or program this question is referencing.

This question is within the Advocacy and Navigation section, so it is referencing your proposed Advocacy and Navigation program.

Addendum #3

38 When will Attachment I be available for review? Attachment I was published as part of Addendum #2 on October 3, 2025. Addendum #3 39 Regarding your customized unique identifiers, could you please clarify their format? Are they numeric, alphanumeric, or another type? Additionally, how many characters do they typically contain?

The unique identifier is P followed by 8 numbers. For example, P01234567. Addendum #3

40 Regarding the PEBB pool of 160,000 (62k subscribers, 98k covered dependents) individuals, could you please provide the current account structure associated with this population?

PEBB consists of state entities that can be made up of smaller agencies. The entities are:

• Oregon State Payroll System (OSPS) agencies

• Oregon Universities (OUS)

• Lottery

• Self-Pays

• Semi-Independents

• Local Governments (non-state entities allowed to participate in PEBB)

There are actives, retirees, and COBRA participants in each entity. Employees can be full-time or part-time. These entities also consist of smaller agencies, each of which would have their own agency number.

Addendum #3

41 Based on the list of PEBB point solutions provided, could you clarify the expected level and type of integration with the TPA?

Integration level with TPAs is generally negotiated with the ASP. Specific goals for PEBB members’ experience navigating the healthcare system, including accessing care from point

Clarification Delivered by…

Additionally, is this integration requirement consistent across all listed point solutions, or does it vary by solution?

solutions and their role in improving member health, are detailed in section 1.3 of the main RFP document.

42 Please provide the current fee and confirm what this fee includes (Base fee, Network Access fee, Vendor Interface fee, Shared Savings fee, Claims Fiduciary fee, fee for 12 month run-out, printing and mailing of ID cards for new members, any other costs such as ad hoc reporting).

PEBB negotiates premiums and administrative fees in public meetings. The finalization of the premiums and administrative fees typically occurs in May for the following Plan Year.

For the 2026 Plan Year, please reference the meeting materials posted here:

https://www.oregon.gov/oha/PEBB/MeetingDocuments/PEBB-Board-Agenda- Attachments-2-20250520.pdf

Addendum #3

43 Please define any programs/fees that are not included in the current administrative fee. For instance (fraud, waste, and abuse and hospital bill audits, etc.)?

The current fee arrangements are inclusive of all programs -- there are no additional fees not included in the contracts. The contracts do include services that are not part of the base administrative fees and are paid through the Claims invoices.

We expect that fees are inclusive of all programs and work expected under the Contract unless otherwise agreed upon.

Addendum #3

44 Can you please advise if there are specific access criteria and/or provider categories you would like us to use for the GeoAccess report?

We revised this question to State the following: 2.3.1.3.1 Please provide a GeoAccess report using the Census data in Attachment L and upload the attachment as your response to this question. Please use the Representative Placement method of assignment for employees when providing your response. Please use your proposed comprehensive network for this analysis. The standards and provider types for this specific analysis can be found here:

https://www.oregon.gov/oha/HSD/OHP/Pages/network.aspx

Attach the detailed GeoAccess report as part of the proposal. The file MUST be attached to this question.

45 In Attachment A - Questionnaire, question 2.3.1.2.12, can you please indicate which providers are key providers for PEBB?

Key Providers are the most highly utilized Providers, Provider groups, and hospitals within the Network you are proposing for PEBB.

Addendum #3

46 In Attachment A - Questionnaire, question 2.1.1.11.9 asks about SSO. Is this question referring to inbound SSO from PEBB's internal systems or outbound to PEBB's preferred vendors?

This question is within the Advocacy and Navigation section, so it is referencing SSO to your proposed Advocacy and Navigation program from your Member portal.

Addendum #3

47 Do you have specific requirements for the GeoAccess report regarding:

-Access criteria -Provider categories to include

Please see the response to Item #44 above. Addendum #3 https://www.oregon.gov/oha/PEBB/MeetingDocuments/PEBB-Board-Agenda-Attachments-2-20250520.pdf https://www.oregon.gov/oha/PEBB/MeetingDocuments/PEBB-Board-Agenda-Attachments-2-20250520.pdf https://www.oregon.gov/oha/HSD/OHP/Pages/network.aspx

Clarification Delivered by…

48 In Attachment A, question 2.3.1.2.12 references "key providers."

Could you please specify which providers PEBB considers as key providers?

Please see the response to Item #45 above. Addendum #3

49 3) In Attachment A, Question 2.1.1.11.9 asks about SSO capabilities. Are you asking about:

-Inbound SSO: Members accessing our platform using PEBB credentials, OR -Outbound SSO: Members accessing PEBB's preferred vendor systems through our platform

Please see the response to Item #46 above. Addendum #3

50 Are you willing to accept bids from non-insurers who can support components of this RFP (i.e., independent healthcare navigators)?

Please see the response to Item #4 above. Addendum #3

51 Hi. Can we get an update on Attachment I for this RFP which is the sample contract? We don't see it in the included attachments.

Will this be provided as it is referenced throughout the RFP.

Thanks.

Please see the response to Item #38 above. Addendum #3

52 Question:

Attachment A, question 2.6.1.6 (page 154) indicates that the following data is contained in Attachment M(O):

• The number of admits by DRG for the time period excluding facilities subject to SB 1067

• The number of admits by DRG for the time period for facilities subject to SB 1067

• The total relative weights of the DRG admits by county using final version 42. DRGs without weights are not included.

• County is referenced here but not broken out in Attachment O. Should it be?

• The total relative weights of the DRG admits by facility and county subject to SB 1067 using final version 42. DRGs without weights are not included.

• County and facility are referenced here but are not broken out in Attachment O. Should they be?

The data is not broken out by facility. These services form the market basket of services with the utilization by admit or procedure that is requested to be repriced. Please use the utilization for each facility or county you are proposing as part of the PEBB Network.

Repricing should be provided by each region that is being proposed.

Clarification Delivered by…

• Procedures by CPT code excluding all facilities subject to SB

• Allowed amount for all CPT codes by county

• County is not broken out in attachment O. Should it be?

• Procedures by CPT code for all facilities subject to SB 1067

• Allowed amount for all CPT codes by facilities subject to SB

• Facility is not broken out in attachment O. Should it be?

53 In Attachment A, question 2.6.1.6 and 2.6.1.7, regarding facilities included/excluded from SB 1067, we've seen varying lists for this. Can we get a final list from Mercer so there is consistency across what competing payers are using for this analysis?

PEBB monitors the payments regulated by Senate Bill 1067 and the meeting materials for this work, including the facilities impacted, are publicly posted. Please reference the presentation here for the list of facilities:

https://www.oregon.gov/oha/OPEBB/MeetingDocuments/IW%20Packet%2005.14.2025.pdf

54 In Attachment A, question 2.6.1.6, we would like clarification that the CPT list is hospital only (not ASC, not ambulance, not professional, etc).

The CPT list contains services for all locations. The SB 1067 CPT list includes outpatient services in SB 1067 hospitals while the non-SB 1067 list includes all other locations.

Addendum #3

55 In Attachment O, what is the distinction between the “Coordinated Care” and “Statewide” tabs? If we are proposing Statewide PPO plan, do we need to populate all the attachment O tabs?

Proposers only need to populate the tabs aligned to the Proposal type they are submitting. Addendum #3

56 In Attachment O, can we get a definition for “Regional”? Please see Section 4.14 of the Main RFP document for a description of the regions for this

RFP.

Addendum #3

57 In Attachment O, “Not Peer Reviewed” is shown in each tab. Is there a peer reviewed version or is this version okay to use?

This version is fine to use. Addendum #3

58 In Attachment A, question 2.6.1.7 and 2.6.1.6, is any facility level repricing being requested where we would provide results by facility?

Repricing should be done based on expected utilization in the facilities in the counties/regions that you are proposing. Use your book of business utilization to weight the contracted rates per DRG/CPT code.

Addendum #3

59 In Attachment A, question 2.6.1.7 describes a financial guarantee based on the estimates provided here. What allowances are there in this guarantee for elements outside of the proposer's control?

Differences between the PEBB population and our current membership would be hard to estimate with complete certainty.

The guarantee is tied to your proposed contracted rates in this RFP response versus the actual reimbursements seen by PEBB in 2027. The guarantee is for contracted SB 1067 facilities that are subject to the 200% of Medicare cap. Compliance will be determined on each procedure’s or admission’s actual 2027 allowed cost compared to the Medicare 2027 allowed cost and the variance from the proposed cost provided for SB 1067 facilities in this https://www.oregon.gov/oha/OPEBB/MeetingDocuments/IW%20Packet%2005.14.2025.pdf

Clarification Delivered by…

RFP. As PEBB is required to verify compliance with the 200% of Medicare cap, every Claim for facilities subject to SB 1067 will be repriced to Medicare for 2027.

Repricing on the market basket is requested by region using the book of business mix of utilized Providers for the Proposer. If Proposers wish to submit the SB 1067 DRG and CPT files by facilities, it will be weighted based on total PEBB allowed for each SB 1067 facility.

60 In Attachment A, question 2.6.1.7, does this sentence need to be re-worded? “In addition, please provide repricing on the based on non-contracted providers using the maximum allowable rate for out-of-network services using a second copy of Attachment M.”

Yes. Please provide repriced costs based on your non-network reimbursement rates to determine the estimated out-of-network costs of your Proposal.

Addendum #3

61 In Attachment O, for DRG codes or CPT codes where we do not have any book of business claims utilization, how should those records be represented?

Those records should be represented by the typical or average contracted rate for that procedure or admission in the region.

Addendum #3

62 In Attachment A, question 2.6.1.7, since provider mix will be a significant factor in the comparison of actual contract percentage to proposed contract percentage and a potential penalty, was there a reason to request analysis by a subset of DRG codes and subset of CPT codes instead of by the actual facilities?

A market basket of all PEBB Claims provides a more consistent base for comparing proposed contracted rates versus facility specific utilization that may be highly variable and not credible.

Addendum #3

63 For ease of evaluation and normalization of data provided by various respondents, please define any specific methodologies that should be used in conducting the repricing exercise in Attachment O. For example, should respondents assume all applicable provider types when calculating the average allowable amount for each DRG/CPT?

If pricing varies by Provider type, use your book of business Provider mix for that service (for example the most recent 12 months).

Addendum #3

64 Please confirm respondents should only complete the applicable tabs of Attachment O and Attachment N for the "region" they are proposing. For example, only the Statewide tabs should be completed for a Statewide submission and only the Regional CCM tabs should be completed for a Regional CCM submission.

That is correct. Addendum #3

Clarification Delivered by…

65 Please clarify that all additionally requested forms, such as Attachments E, F, G, and H should be uploaded to ProposalTech's "Manage Documents" section, as there do not appear to be individual questions in ProposalTech requesting attachment of those forms.

Attachment A has been updated to add specific items that request Attachment E, F, and G.

Attachment H, the Disclosure Exemption Form, is not required at this time. Attachment H, along with its corresponding instructions, will be discussed in a meeting in January 2026.

Addendum #3

66 Question 1.1.5.7 asks for the “anticipated # of meetings attended per year”. Please confirm how respondents should indicate a willingness to attend any and all meetings held by PEBB, as the current field only allows an integer.

The response option for this question is updated to all allow a response with 25 words instead of a number response.

Addendum #3

67 Please confirm that question 1.1.4.19 is requesting that if a group leaves PEBB we will extend the same arrangement to the remaining population within.

Yes, this is correct. The question text has been updated for clarification. Addendum #3

68 Attachment A, Questionnaire:

Section 3.63.1 General, page 296.

Section 3.63.2 Performance Guarantee Guidelines, page 296.

Section 3.63.3 Implementation Guarantees, page 297.

Section 3.63.4 Ongoing Performance Guarantees, page 299.

Question: For questions 3.63.1 through 3.63.4, is a response required if we are submitting a fully integrated medical and pharmacy proposal that includes eligibility and enrollment, call center services, ID cards, and system setup? Additionally, since our pharmacy program does not have a separate premium charge or administrative fee, can these questions be considered addressed within the medical performance guarantee section instead?

The responses to the pharmacy specific PGs will each be scored and you will need to identify which medical PG aligns with the specific pharmacy PG ask in order for the team to score your response appropriately. If you decline to provide a PG or point to a relevant medical PG in response to a specific PG request, you will receive the lowest points possible for that specific PG.

Addendum #3

69 Attachment A, Questionnaire, page 138, Section 2.4.1 Value-based Payment Reporting, Question 2.4.1.1: Confirm you will provide the following three transparency reports as detailed in Attachment I, Sample Group Benefits Contract (see Exhibit D, Reporting and Performance Guarantees).

Please see the response to Item #38 above. Addendum #3

Clarification Delivered by…

Question: Please let us know when you expect to release Attachment I, Sample Group Benefits Contract.

70 Sections 1.1.12 Contractual Obligations and 1.1.13 Data Sharing and Security indicate they are reserved for potential questions that may be added via an addendum. To ensure bidders are able to review and respond appropriately before the deadline, could you advise if additional questions are expected, and if so, provide an anticipated timeline for their release?

Section 1.1.12 was updated via Addendum #2. Section 1.1.13 does not currently require a response.

Addendum #3

71 Regarding Question 3.63.3.1: Please confirm assumption that this should be updated to reflect (dates updated below):

“Timeliness and accuracy:

Proposer guarantees adherence to the mutually agreed-upon implementation work plan for the initial implementation of the prescription drug program. By no later than July 1, 2026 Proposer will collaborate with the Client to identify and agree upon, in writing, implementation tasks, deliverables, and dates necessary to satisfactorily install all members as of 1/1/2027. the Client may assess a penalty for any of the four most important implementation tasks (as agreed to by the Client and Proposer, in writing, prior to the implementation date) which are not completed accurately by the agreed upon scheduled completion dates, provided the Client and any applicable third party fully comply with all related implementation requirements and scheduled completion dates.”

Yes, this should state July 1, 2026 and January 1, 2027. This question has been updated accordingly.

Addendum #3

72 Regarding Question 3.23.4: The Projections sheet on Attachment S is requesting projections for 2026, 2027 and 2028. Please confirm if this should be updated to 2027, 2028, and 2029 given the contract year starting in 2027.

Yes, this should be 2027, 2028, and 2029. Our apologies for the error. Attachment S has been updated and published with Addendum #3.

Addendum #3

73 Regarding Question 3.58.1: This workbook in Attachment T is requesting pricing terms for 2026, 2027 and 2028. Please confirm if this should be updated to 2027, 2028, and 2029 given the contract year starting in 2027.

Yes, this should be 2027, 2028, and 2029. Our apologies for the error. Attachment T has been updated and published with Addendum #3.

Clarification Delivered by…

74 If we are NOT planning to bid an HMO plan: (1) Do we include/exclude Kaiser data for combined medical/Rx bid? (2) Do we include/exclude Kaiser data for pharmacy only bid?

Proposers should provide the most competitive pricing Proposal possible for the population they intend to win. For the pharmacy analytics and contractual terms, please respond using all Claims data in Attachment S, Pharmacy Data Tables, on the tab "Pricing Detail," including populations you do not intend to cover. When developing pricing for premiums, please only use Claims data for the regions/populations you are bidding on but for all Members in those regions/populations.

Addendum #3

75 Attachment M includes data through 2024. The pharmacy claims data includes claims data through June 2025. Can attachment M be updated to include data through June 2025?

The medical Claims data will not be updated. Please use the file currently provided. Addendum #3

76 Regarding Addendum #2: Previous response noted that "Proposers should provide the most competitive pricing Proposal possible for the population they intend to win. For the pharmacy analytics and contractual terms, please respond using all claims data in Attachment S, Pharmacy Data Tables, on the tab "Pricing Detail," including populations you do not intend to cover. When developing pricing for premiums, please only use claims data for the populations you are bidding on."

Please clarify further - if we do NOT intend to bid an HMO plan (Kaiser) should we still include Kaiser data when populating:

Other relevant Attachment S tabs including rebate projections, Attachment T - network and rebate guarantees, Section 3.55 Trend Management Guarantee

For all responses, please populate the responses as if the entire PEBB population was to be included. You may include qualitative commentary on which data is not being bid upon.

Addendum #3

77 In Attachment A - Questionnaire, question 2.1.1.15.17 and 2.1.1.15.18, can you please clarify what you mean by searches?

This is referring to Member searches for resources (programs, providers, etc.) within your digital navigation solution/system.

Addendum #3

78 Regarding Attachment A, Question 2.2.1.16.2 about our medical pharmacy program carve-out option:

Are you asking if we would allow PEBB to:

a) Carve out all medical drugs to a third-party vendor?

b) Carve out select drugs to another vendor or PBM (if we don't win their pharmacy contract)?

c) Keep the medical pharmacy program available for

Question 2.2.1.16.2 is asking whether medical plans offer their medical pharmacy program as a standalone offering for clients or other medical plans to contract with in addition to the carved-in offering they are proposing as part of this RFP. We understand this is a relatively uncommon offering, and at this time, PEBB is not considering carving out this benefit, but we are interested in learning if this is a possibility or if the vendor has capability to offer their program on a standalone basis.

Clarification Delivered by… medical-only coverage with a carved-out PBM?

79 Attachment A_10032025, Section 1.1.10 Data and Reporting, Question 1.1.10. 2, page 16. Confirm you will provide PEBB's data warehouse vendor with pharmacy claims feeds in the output required (see Attachment J) and on a monthly basis. PEBB's consultant will specify format changes and penalties may apply for missed reporting per contractual requirements.

Question: This question references Attachment J for the pharmacy claims data feed. When looking at attachment J, it appears that this is specific to Medical rather than Pharmacy.

The ‘Detail Layout' tab is asking for many fields that would never exist on a Pharmacy claim. Is there another attachment that is specific to Pharmacy?

An additional attachment (Attachment W, Pharmacy Data Warehouse File Layout) has been added which illustrates the expected pharmacy Claims data layout. Question 1.1.10.2 has been updated to reference Attachment W.

Both Attachment J and Attachment W apply to Exhibit D of the Combined Medical and Pharmacy Group Benefits Contract (Attachment I). Only Attachment W applies to Exhibit D of the Pharmacy Only Group Benefits Contract (Attachment I).

80 Attachment A_10032025, Section 2.3.1 Overall network Strategy, Question 2.3.1.3.1, page 318. Please provide a Geo- Access report using the Census data in Attachment L and upload as part of your response. Please use the Representative Placement method of assignment for employees when providing your response. Please use your proposed comprehensive network for this analysis. Attach the detailed Geo-Access report as part of the proposal. The file MUST be attached to this question.

Question: Can PEBB provide clarification about what they would like us to report? We don't see reporting criteria in Attachment A.

Please see the response to Item #44 above. Addendum #3

81 Please confirm if we are to fill out Attachment P - Pharmacy Plan Summary or if this is for informational purposes only.

Please see response to Item #29 above. Addendum #3

82 Please Confirm if the [current] Kaiser population [for PEBB] is out to bid.

Yes. PEBB's full population is included in this RFP. Addendum #3

83 Please confirm if we should be using the full population while quoting on the Pharmacy piece or if we should use the Statewide

Please see response to Item #76 above. Addendum #3

Clarification Delivered by…

Data for the Statewide proposal and the Regional Data for the Regional proposal?

84 Clarification question re: Attachment S requested in 3.13.9 and 3.23.4:

Please confirm respondents can indicate in Columns D and F, which formularies apply to a specific comment provided in row 5 “vendor comments, if any”. For example, please confirm respondents can place an asterisk (*) after responses in Columns D and F that correspond to the comment in row 5.

That approach should work, but please make sure that the (*) does not deviate from what is being asked because in column D we are asking for applicable Copay Tier and in column E we are asking for alternatives for drugs that will be excluded or tier 3. Please be sure to clearly explain what the (*) means as it relates to tiering.

Addendum #4

85 Clarification question re: Attachment S requested in 3.13.1:

Please confirm respondents are only required to list the name and description of the two formulary quotes in 3.13.1. Please confirm that the request for a “quote” for the two formularies does not require respondents to complete a second version of Attachment S for the more aggressive formulary. If an alternate Attachment S for the more aggressive formulary is required, where should respondents attach it?

If the more aggressive formulary will have different responses to the most closest formulary, we suggest you provide the tabs that need to be updated in an alternate Attachment S.

Addendum #4

86 Clarification question re: Attachment S requested in 3.62:

In Question 3.62, under Formulary/Second Level Appeal Determinations/Please describe member impact, there is a “Yes/No” option for a response instead of an open text field, like all the other rows in the chart. Please confirm the “yes/no” selection for just that row was intended and that all other rows are intended to remain open text fields.

This row has been updated to allow 100 word responses like the other questions. Addendum #4

87 Can we get claims with formulary status? We will not be providing formulary tiering as part of the RFP process. Addendum #4 88 The Census data differs from the data provided in Attachment R-

Pharmacy GeoAccess Analysis Template, which data should be used to complete Attachment R?

Please use the data under the Zip Code tab. Addendum #4

89 Can provisions be added to the Contract? PEBB expects to both update various negotiable provisions as well as add new provisions as needed to the Contracts resulting from this RFP process. The specific Contract negotiations will be based on both PEBB’s business needs as well as the specific information included in

Clarification Delivered by… the ASPs’ Proposals. Please note, however, that provisions cannot be added to the RFP’s resulting Contracts if they conflict with the non-negotiable terms identified in this RFP.

90 In Attachment G- There is a request to sign Attachment E, can you please confirm where bidders should sign?

Attachment E does not need to be signed but only completed and submitted. Attachment G has been revised accordingly.

Addendum #4

91 In order to submit any deviations to the Non- Negotiable terms on the contract by 10/20 can you please allow attachments to the "Ask Question" Feature in Proposal Tech or provide an email address where we can send red-lined documents to.

You may send via the “Ask Question” feature your request that a term or provision deemed non-negotiable be opened up for negotiation, however, attachments will not be accepted.

You may also submit a protest under this RFP consistent with process set out in Section

4.6.3 of the Main RFP document, requesting that PEBB open up for negotiation a term deemed non-negotiable. .

Addendum #4

92 For Question 2.3.1.8.7 it asks for 2 separate numbers however the response area does not allow 2 different numbers to be entered. Please add an additional column to add a second number.

This question has been updated to include 2 columns. Addendum #4

93 Does 2.1.1.10.22 refer to other vendor carriers that a member is concurrently enrolled with or prior medical carriers a member was consecutively enrolled with?

This questionnaire item is within the Advocacy and Navigation section and is asking whether your Advocacy solution has the ability to track and report on data across multiple carriers.

Addendum #4

94 Does 2.1.1.10.25 refer to access to the vendor's member service system? Can you describe the types of ‘high-level' inquiries the question refers to?

This questionnaire item is asking if PEBB will have access to a self-service portal where it can check things like eligibility and the Benefit Plan a Member is enrolled in.

Addendum #4

95 Regarding 2.1.1.11.10, can you share the format for your unique identifier (e.g. number of characters, alpha/numeric)?

Please see response to Item No. 39 above. Addendum #4

96 Does 2.1.1.13.1 ‘access to 36 months of historic claims data' mean summary data, or line level detail data?

This questionnaire item is asking if PEBB will have access to self-service summary reports for 36 months of data.

Addendum #4

97 Does 2.6.1.5 refer to an annual reprice exercise for cost projections or is this for a different purpose?

This repricing exercise is completed annually to monitor carriers' compliance with Senate Bill 1067 as well as providing required reporting.

Addendum #4

98 Are the point solutions outlined in 2.5.2.3 all direct contracted by PEBB or are they subcontracts of your current medical vendors?

Currently all point solutions are subcontracted through the medical carriers and are listed in Section 1.2 of the Main RFP document.

99 Are you open to alternative point solutions that address the same conditions/topics available as a subcontractor to the health plan?

Questionnaire items 2.5.2.3, and 2.5.2.5-2.5.2.20 allow Proposers to provide alternate options if necessary or if they feel they would be a better fit for PEBB. Attachment K provides an overview of PEBB's desired attributes for point solutions.

Clarification Delivered by…

100 Please provide clarification for the following question:

2.1.1.11.3 Can you include providers in a customer-specific

network in your directory, search features and reporting?

What does PEBB consider a "customer-specific" network to be?

This questionnaire item is asking if Proposers are able to provide a directory that is specific to the Network that PEBB Members use so that Members do not have to sort through a list of Providers that may or may not be in their specific Network.

Addendum #4

101 When will Attachment W be available? Attachment W was published with Addendum #3 on October 15, 2025. Addendum #4 102 Is it possible to have the provider's tax ID number added to

Attachment N - Provider Disruption Data file? This will allow us to increase the accuracy of the provider disruption analysis.

Tax ID will not be provided as part of this RFP process. Addendum #4

103 Can you please provide a definition of what you mean by "advocacy"? We see it referenced in section 2.1.1 of the questionnaire and also in section 2.6.5 Advocacy Performance Guarantees.

Advocacy is a service where Members may receive support and…