Attachment_E_-_Fee_Schedule_Worksheet.docx
DOCX document 41 KB Posted
- Solicitation number
- Y26-151
- Issued by
- Orange County, Orlando City, Florida
About this file
This is a Fee Schedule Worksheet for a Medicare Supplemental Plans and Medicare Part D Employer Group Waiver Plans procurement issued by Orange County, Florida, with responses due by 4:00 pm EST on Thursday, May 7, 2026. The worksheet requires respondents to provide Medicare Supplement coverage and Medicare Part D Employer Group Waiver Plan (EGWP) options across five Florida counties: Orange, Brevard, Osceola, Seminole, and Volusia. Bidders must submit monthly premium rates for individual retirees across multiple age ranges (65, 66-69, 70-74, 75-79, and 80+) for both Medicare Supplement plans (N, F, and G) and Part D plans. The procurement also requires detailed information regarding premium rating methodologies, renewal timelines, Medicare Part A and B requirements, and whether premiums are fully insured and guaranteed for the 2026 Plan Year.
The worksheet mandates submission of specific Medicare Part D plan options, including a Low Plan with a $0 deductible and a High Plan with a $3,000 out-of-pocket maximum, with current proposed premiums listed at $214.97 and $377.00 respectively for the reference plans. Respondents must provide historical premium increase data for 2024, 2025, and 2026, disclose whether premiums include agent or broker commissions, and describe any applicable assumptions, limitations, or exclusions affecting the quoted rates. Additionally, bidders are required to outline performance guarantees related to plan utilization standards and plan implementation, along with associated penalties for non-compliance. All responses must be submitted electronically via the OpenGov e-Procurement Platform, with hand-delivered, mailed, faxed, or emailed submissions rejected as non-responsive.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Medicare_Supplemental_Plans_and_Medicare_Part_D_Employer_Group_Waiver_Plans_(Addendum_#1_Revision).pdf | ||
| Medicare_Supplemental_Plans_and_Medicare_Part_D_Employer_Group_Waiver_Plans.pdf | ||
| RFP_Y26-151-KK.pdf | ||
| Attachment_F_-_Census.xlsx | XLSX spreadsheet | |
| Attachment_D_-_Pharmacy_Directory_.xlsx | XLSX spreadsheet | |
| Attachment_C_-_Pharmacy_Drug_Plan_Formulary.xlsx | XLSX spreadsheet | |
| Attachment_B_-_Proposal_Worksheet.docx | DOCX document | |
| Attachment_A_-_Mandatory_Features_Checklist.docx | DOCX document |
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Text version
ATTACHMENT E
FEE SCHEDULE WORKSHEET
Fee Schedule
| A. | Provide the following information about your Company: |
| Company Name |
B. List your Company’s average Plan premium increases from the previous year for the Orlando Area in the following calendar years.
% Increase
| Medicare Supplement Response |
| EGWP Response |
2026 (Actual or Anticipated)
C. Premium issues regarding your Company’s Proposal
| Medicare Supplement Response |
| EGWP Response |
1. Describe what premium rating your Company will use for 2027 annual premiums and beyond.
(Community Rated, Issue Age Rated, or Attained Age Rated)
2. If Age rated, when will age be determined and when will premium increases take effect?
3. On what date will your Company submit written premium increases to the County for the upcoming Calendar Year?
4. Will retirees be required to have Medicare Part A and Part B as a condition for your Company’s coverage?
5. Are the premiums your Company quoted fully insured and guaranteed for the 2026 Plan Year?
6. Confirm you Company shall disclose the applicable timeline for annual renewal premium increases, along with the grace period in which premiums will remain in effect until the revised premiums will be charged.
7. Will your Company discount the premiums if both retiree and spouse select your plan? If so, indicate the discount.
8.Confirm rates are net of any agent or broker commissions.
Medicare Supplement Monthly Premiums.
Monthly Premiums
1. List the monthly premium rates for an individual retiree.
If the 2027 premiums are not currently approved, proposals will be accepted for 2026 approved plans and premiums.
Orange County
| Age Range |
| N |
| F |
| G |
66-69
70-74
75-79
80+
Brevard County
| Age Range |
| N |
| F |
| G |
66-69
70-74
75-79
80+
Osceola County
| Age Range |
| N |
| F |
| G |
66-69
70-74
75-79
80+
Seminole County
| Age Range |
| N |
| F |
| G |
66-69
70-74
75-79
80+
Volusia County
| Age Range |
| N |
| F |
| G |
66-69
70-74
75-79
80+
1. Are the rates provided above for the 2026 or 2027 calendar year?
2. List any assumptions, limitations, or exclusions that are conditions of the premium rates your Company is proposing. Indicate any impact to your proposed rates if any of these conditions are not met.
Medicare Part D Employer Group Waiver Plan (EGWP) Monthly Premiums.
1. Below are the requested plans. Proposals must either meet or exceed the plans listed.
If the 2027 premiums are not currently approved, proposals will be accepted for 2026 approved plans and premiums.
Low Plan
| Low Plan |
| Deviations |
| Deductible |
| $0 |
| Out of Pocket Maximum |
| N/A |
Initial Coverage Period 30 day supply
| Generic |
| $5 |
| Brand Preferred |
| $45 |
| Brand Non-preferred |
| $75 |
| Specialty |
| 33% |
Catastrophic
| Standard Part D Out of Pocket Max |
| $2,100 |
| Generic |
| $0 |
| Brand |
| $0 |
90 day supply
| Tiers 1-4 |
| 3X |
High Plan
| High Plan |
| Deviations |
| Deductible |
| $0 |
| Out of Pocket Maximum |
| $3,000 |
Initial Coverage Period 30 day supply
| Generic |
| $10 |
| Brand Preferred |
| $30 |
| Brand Non-preferred |
| $50 |
| Specialty |
| $50 |
Catastrophic
| Standard Part D Out of Pocket Max |
| $2,100 |
| Generic |
| $0 |
| Brand |
| $0 |
90 day supply
| Tiers 1-4 |
| 3X |
4. Rates. List proposed monthly premium below.
| Current |
| Proposed Monthly Premium |
| Low Plan |
| $214.97 |
| High Plan |
| $377.00 |
1. Are the rates provided above for the 2026 or 2027 calendar year?
2. List any assumptions, limitations, or exclusions that are conditions of the premium rates your Company is proposing. Indicate any impact to your proposed rates if any of these conditions are not met.
Performance Guarantees
F. List the Performance Guarantees your Company has included in your premiums.
| Issue/Service |
| Guarantee |
| Penalty |
1. Please indicate the performance guarantees you are proposing for Plan utilization standards
2. Indicate the performance guarantees for Plan implementation.
As an officer of the Company, I certify that the information contained in our proposal worksheet is accurate, and our Company will be bound by the contents of our proposal.
Signature: _____________________________ Date: ___________________
Name: ________________________________ Title: _____________________
Company:
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