Appendix_7_5_Enrollment_by_Plan.xlsx

This file is an enrollment spreadsheet prepared by the State of Tennessee for its Employee Assistance Program (EAP) and Behavioral Health Organization (BHO) procurement, detailing covered lives across three distinct self-funded insurance plans: State, Local Education, and Local Government. The spreadsheet presents detailed enrollment breakdowns by plan type, gender, age bracket, and dependent versus employee status across multiple insurance options including Limited PPO, CDHP, Premier PPO, and Standard PPO plans. The State Plan encompasses 146,281 covered lives, the Local Education Plan comprises 126,115 covered lives, and the Local Government Plan contains 26,670 covered lives, for a combined total of 299,066 covered lives requiring administrative and behavioral health services. The RFP was issued on October 8, 2025, with written questions due October 22 and November 19, 2025, and proposals due December 19, 2025. The state anticipates completing technical evaluations by January 29, 2026, with cost proposal scoring on January 30, 2026, and negotiations scheduled for February 9-11, 2026. The contract period spans 86 months, comprising eight months of implementation, 60 months of service delivery from January 1, 2027 through December 31, 2031, and an 18-month claims runout period.

The procurement utilizes a per-employee-per-month (PEPM) administrative fee model with no specific award value stated, though the state self-funds approximately $976 million in annual medical, pharmacy, and behavioral health claims across all three plans. The successful contractor must maintain NCQA accreditation as a Managed Behavioral Healthcare Organization and URAC accreditation for utilization management programs, with performance guarantees tied to liquidated damages ranging from $1,000 to $75,000 per incident. Qualified vendors must demonstrate financial stability, relevant experience managing employer populations exceeding 10,000 members, and claims adjudication experience exceeding $10 million annually for at least two clients. The state encourages responses from minority-owned, women-owned, service-disabled veteran-owned, and small business enterprises. Additional requirements include $5 million in cyber liability insurance and compliance with HIPAA, HITECH, and state security requirements, including annual SOC 2 Type 2 examinations and penetration testing. The incumbent contractor will be responsible for transitioning existing members and services at no additional cost to the state.