ARFQ INS2700000001 Specifications.pdf

ARFQ#: INS2700000001

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STATE OF WEST VIRGINIA

Offices of the Insurance Commissioner

REQUEST FOR QUOTATION

ARFQ INS2700000001

To Conduct Statutory Financial Examination Of:

Health Plan Group NAIC Group Code #1297

The Health Plan of West Virginia, Inc.

NAIC Code #95677

THP Insurance Company NAIC Code #60016

BID OPENING DATE: November 16, 2026 BID OPENING TIME: 2:00 p.m. (EST)

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ARFQ INS2700000001

TO CONDUCT STATUTORY FINANCIAL EXAMINATION OF:

THE HEALTH PLAN GROUP

The West Virginia Department of Tax and Revenue, Offices of the Insurance Commissioner (“OIC”), is soliciting bid quotations to perform a statutory financial examination of the Health Plan Group, consisting of The Health Plan of West Virginia, Inc. (“HPWV”) and THP Insurance Company (“THP”), collectively referred to as the “Companies” or “Health Plan Group”, in the State of West Virginia, in compliance with W. Va. Code §33-2-9 and in accordance with the procedures established by the National Association of Insurance Commissioners (“NAIC”) Financial Condition Examiners Handbook (“Handbook”).

The mission or purpose of the project is to contract a firm (“Vendor”) to draft a formal report of examination that contains findings, conclusions and recommendations for corrective or regulatory action, and a description of issues of non-compliance with West Virginia’s statutes, regulations, filing requirements and administrative procedures for:

Company Name The Health Plan of West Virginia, NAIC Code #95677 THP Insurance Company, NAIC Code #60016

Company Type HPWV – Health Maintenance Organization THP – Life and Accident & Sickness Insurer1

NAIC Company Group Code 1297 Exam Period January 1, 2023 – December 31, 2026 Principal Place of Business Wheeling, WV Expected Exam Start Date August 2, 2027 Expected Exam End Date June 30, 2028

“QUALIFIED VENDOR” DEFINED

Any Vendor submitting a quotation under this procurement must meet or exceed the minimum qualification set for in this ARFQ. Those quotations not meeting the mandatory specifications will be eliminated. Vendor qualifications and expectations are as follows:

GENERAL REQUIREMENTS

The following will be considered the minimum content of the Vendor’s quotation:

A. A statement of the objectives, goals and tasks to show or demonstrate the Vendor’s view of the nature of the agreement.

1 THP primarily writes POS and PPO health insurance plans and files on a Health blank.

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B. The Vendor shall provide a description of the deliverables and the time frame for delivery.

C. An outline of the Vendor’s background and experience with documentation outlining similar services provided for other regulatory jurisdictions during the past three years and provide the name, address and telephone number of three current references familiar with such services.

The Vendor must provide a list of personnel accompanied by a current resume who will conduct the project, detailing their education, professional designations, training and work experience with financial examinations. The Vendor must have the ability to provide a Certified Financial Examiner (“CFE”)2 to function in the capacity of Examiner-in-Charge (“EIC”). The OIC reserves the right to reject any proposed EIC. In this event, the Vendor will be required to provide another EIC who is acceptable to the OIC within five (5) working days.

The EIC must have a minimum of eight (8) years of insurance company financial examination experience. Staff examiners must have a minimum of two (2) years of insurance experience for all accounting and/or auditing functions. For the proposed EIC, the Vendor must furnish proof of certification (SOFE CFE designation) and documentation of recent experience using the Handbook and TeamMate audit software. The Vendor must have the ability to provide an IT specialist that holds a professional designation of Automated Examination Specialist (“AES”)3 or Certified Information Systems Auditor (“CISA”)4. The Vendor must have the ability to provide an Actuarial Specialist that holds at least one of the following credentials:

Fellow (or Associate) of the Casualty Actuarial Society (FCAS/ACAS) for property and casualty lines as well as Fellow (or Associate) of the Society of Actuaries (FSA/ASA) or Member of the American Academy of Actuaries (MAAA) for life and health lines. The OIC is currently utilizing the FedRamp environment/platform of Teammate+. Each contracted staff member must have a FedRamp license. No change in personnel assigned to the examination will be permitted without the written approval of the Chief Examiner, or designee.

D. A detailed work plan that will identify the major tasks to be accomplished and be used as a scheduling and managing tool, as well as the basis for invoicing.

E. During the term of this contract, the Vendor shall not solicit employees of the OIC for employment with the vendor, or to work as an independent contractor for the vendor, or to work as a consultant for the vendor by written, oral or any other means.

F. Vendor’s Cost Quotation on Pages 7 – 9: A schedule of fees for each level of prospective participant on an examination separated hours and fee for the following areas: Financial Examination work, Supervisory Review, Actuarial and IT reviews.

SCOPE OF WORK

The Vendor awarded the contract as a result of this ARFQ shall provide, at a minimum, the following services for completing a financial examination:

2 CFE is a registered trademark of and a designation bestowed by the Society of Financial Examiners.

3 AES is a registered trademark of and a designation bestowed by the Society of Financial Examiners.

4 CISA designation is sponsored by the Information Systems Audit and Control Association.

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A. Prepare and issue an examination planning memorandum for the companies examined in accordance with the NAIC Financial Condition Examiners Handbook (“Handbook”). The memorandum must be timely and must have the approval of the Chief Examiner or designee in order to continue with the examination process.

B. Prepare and issue a budget of the estimated time to complete identified examination procedures identified early in the planning process. The Vendor’s time budget must have the approval of the Chief Examiner in order to continue with the examination process. The Vendor must keep records of budget variances with explanations. Any budget or cost variance will require prior written approval from the Chief Examiner, after full written justification.

C. Coordinate work of examination team members in accordance with OIC policies and procedures, Handbook guidance, and NAIC Accreditation Program standards.

D. Perform any agreed upon examination procedures as outlined within the planning process and planning memorandum.

E. Document examination procedures performed and any findings within the examination work papers. Ascertain that procedures followed are those contained in the Handbook or approved by the Chief Examiner or designee.

F. Perform Supervisory Review of EIC examination procedures.

G. Draft a formal Report of Examination and if applicable, a Management Letter (“ML”) that contains the findings, conclusions, and recommendations of the examination team to be presented to the OIC no later than fourteen (14) calendar days following the completion of the field work.

H. Perform follow-up procedures identified by the Chief Examiner or designee.

I. Other tasks assigned or appropriate under the circumstances.

The EIC provided by the Vendor will have full responsibility for the examination, including planning, assignment and supervision of staff; execution of the examination; conducting status meetings with company management; conducting status meetings with OIC; preparing mandatory status reports on the progress of the examination; and the preparation of the final Report of Examination and ML.

The Vendor will provide the Chief Examiner with written status reports on a monthly basis. The Vendor will conduct two (2) recurring monthly status meetings; one with the companies being examined and one with the OIC. The frequency of status meetings will be monthly; unless waived by the Chief Examiner or its frequency adjusted (i.e. weekly, bi-weekly, etc.) by the Chief Examiner. The two meetings will be held separately and scheduled so that they are evenly spaced out over the monthly period (i.e. first meeting occurring at the start of the month, with the other meeting being held approximately two weeks later).

Upon completion of the examination field work and submission of the Report of Examination and ML for the companies, the Vendor will deliver to the Financial Conditions Division a complete

Health Plan Group Page 5 of 9 set of original electronic work papers prepared in the format required by the policies and standards of the Handbook and the State. Work papers are the property of the State and will be retained by the Financial Conditions Division.

No changes in scope are to occur, except with the written approval of the OIC.

BID AMOUNT

The amount of the bid submitted by each potential vendor shall be for all services rendered. The financial examination conducted for the aforementioned companies will require the use of a specialist in the areas of actuarial and information technology (“IT”) services. If during the conduct of the examination, the EIC determines, based on risk assessment, that additional specialists (tax, reinsurance, investment, or other) are required to fully address certain areas of focus, the EIC will identify and document the need for or use of other specialists and request approval from the Chief Examiner prior to the use of other specialists. This bid shall be the same regardless of which partner, member or outside contractor performs the services. It is anticipated that all examination work will be conducted remotely and will not require travel and related expenses.

INQUIRIES

Inquiries regarding specifications of this ARFQ must be submitted in writing to the contact named below with the exception of questions regarding the bid submission which may be oral. The deadline for written inquiries is October 26, 2026 @ 5:00 p.m. (ET). All inquiries must be addressed to:

Beverley A. Toney, Procurement Officer WV Offices of the Insurance Commissioner 900 Pennsylvania Avenue P.O. Box 50543 Charleston, WV 25305 Email: beverley.a.toney@wv.gov

After this ARFQ has been released, no contact between the Vendor and the Agency, other than the individual listed above, is permitted. Violation may result in rejection of the bid.

SCHEDULE OF EVENTS

Vendor’s Written Questions Submission Deadline ... October 26, 2026, 5:00 p.m.

Addendum Issued......................................................................... November 2, 2026 Bid Opening Date ..................................................... November 16, 2026, 2:00 p.m.

BID SUBMISSION

Vendors responding to this ARFQ may submit their electronic bids in wvOASIS or overnight in paper form with one (1) original and one (1) copy of their bids to:

mailto:beverley.a.toney@wv.gov

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Beverley A. Toney, Procurement Officer WV Offices of the Insurance Commissioner 900 Pennsylvania Avenue Charleston, WV 25302

The outside of the envelope or package(s) should be clearly marked:

ARFQ#: INS2700000001

Opening Date: November 16, 2026 Opening Time: 2:00 PM (EST)

GOVERNING LAW

The Vendor agrees that this agreement shall be governed by the laws of the State of West Virginia.

The Vendor further agrees to comply with the Civil Rights Act of 1964 and all other applicable Federal, State and Local Government regulations.

RECORD RETENTION (ACCESS & CONFIDENTIALITY)

Vendor shall comply with all applicable Federal and State of West Virginia rules and regulations, and requirements governing the maintenance of documentation to verify any cost of services or commodities rendered under this agreement by Vendor. The Vendor shall maintain such records for a minimum of five (5) years and make available all records to the State’s personnel at Vendor’s location during normal business hours upon written request by the State within ten (10) days after receipt of the request.

Vendor shall have access to private and confidential data maintained by the State to the extent required for Vendor to carry out the duties and responsibilities defined in this agreement. Vendor agrees to maintain confidentiality and security of the data made available and shall indemnify and hold harmless the State against any and all claims brought by any party attributed to actions of breach of confidentiality by the Vendor, subcontractors, or individuals permitted access by Vendor.

CONFLICT OF INTEREST

Vendor shall have no conflict of interest with the insurance company being examined. A conflict of interest for a vendor performing examinations of West Virginia domiciled insurance companies is defined as any financial, business, or personal relationship — whether actual, potential, or perceived — that could compromise the vendor's ability to provide objective, impartial, and unbiased analysis or examination work, or that could influence the vendor to act in a manner adverse to OIC’s best interests.

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REQUIRED INFORMATION

The OIC reserves the right to request any additional information at any time during the bid process prior to their recommendation of award notification. Responding Vendors shall include the following signed forms with their bid quotation submittal:

A. ARFQ (Agency Request for Quote Form ID: WV-PRC-ARFQ-002 2020/05) B. Addendum Acknowledgement Form (page 18 of Terms & Conditions) C. Vendor Hourly Rate Pages (Pages 8 – 9 of the Request for Quotation) D. DESIGNATED CONTACT AND CERTIFICATION & SIGNATURE PAGE (page

17 of Terms & Conditions)

A Vendor’s failure to provide complete and accurate information may be considered grounds for disqualification. Nothing may be added to alter the submitted bid.

To conduct the year ending December 31, 2026, financial examination of:

Health Plan Group

ARFQ #: INS2700000001

Date Submitted: _____________________________

Vendor Name: _____________________________

FEIN: _____________________________

Vendor Address: _____________________________

Contact: _____________________________

Email: _____________________________

State of West Virginia Business Registration Date (if applicable): _______________

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FINANCIAL EXAMINATION SERVICES

PART A

FINANCIAL

REVIEW

SUPERVISORY

REVIEW

EXAM BID

TOTAL

# of Anticipated Hours to Complete Assignment:

Cost per Hour: $ $ $

Vendor Fee Proposal: $ $ $

Part A – BID TOTAL: $ $ $

The OIC will be responsible for payment of Part A services.

EXAMINATION SPECIALIST SERVICES

PART B

IT

REVIEW

ACTUARIAL

REVIEW

SPECIALIST

BID TOTAL

# of Anticipated Hours to Complete Assignment:

Cost per Hour: $ $ $

Vendor Fee Proposal: $ $ $

Part B – BID TOTAL: $ $ $

The OIC will be responsible for payment of Part B services.

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TOTAL EXAMINATION SERVICES

PARTS A & B COMBINED

TOTAL

EXAM SERVICES

TOTAL # of Anticipated Hours to Complete Assignment:

Cost per Hour: $

TOTAL Vendor Fee Proposal: $

COMBINED – BID TOTAL: $

Upon completion of this formal bid, I hereby certify that the aforementioned company (“Vendor”) does meet all mandatory requirements specified in the established Request for Quotation.

(AUTHORIZED SIGNATURE) (DATE)