Appendix_F_-_Active_Employee_and_Retiree_PPO_Plan_Census_(revised).xlsx

This file contains a census dataset of active employees and retirees enrolled in the County of Orange's self-insured Preferred Provider Organization (PPO) health plans, including Sharewell Choice PPO and Wellwise Choice PPO plans for active members, and corresponding retiree plans. The dataset includes demographic information such as date of birth, gender, home state, zip code, plan option, and coverage tier for approximately 1,400 active employees and 800 retirees spanning multiple states with concentrations in California, Nevada, Arizona, and other regions. The data supports the County of Orange's Request for Proposal for Claims Administration Services, which was released on February 15, 2024, with a proposal due date of March 15, 2024, at 4:00 PM Pacific Time. The contract scope encompasses claims processing, customer service, provider network management, utilization review, and disease management for the existing four self-insured PPO health plans with potential expansion to High Performance Network (HPN) plans, with an initial three-year contract term beginning January 1, 2025, and potential renewal for up to two additional consecutive one-year terms.

The census data reflects the County's membership base with varying enrollment tiers including individual, spouse/domestic partner, and family coverage options, with active employees averaging 45.3 years of age and retirees ranging from 60.6 to 78.3 years of age. The county's medical expenditures totaled approximately $52.7 million in 2022, and the current claims administrator is Blue Shield of California, with the county anticipating transition to a new vendor. Qualified contractors must demonstrate experience with public sector clients, maintain broad provider networks in California and nationally, possess robust cybersecurity protocols and healthcare regulatory compliance, and integrate with the existing OptumRx pharmacy benefits management system while potentially implementing plan design changes related to hearing aids, foot orthotics, fertility services, and abortion coverage. Performance standards and potential penalties apply for administrative and service metrics, with evaluation criteria encompassing administrative capability, cost, network capabilities, performance guarantees, plan design compatibility, and vendor qualifications and experience.