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 attachment for Orange County, Florida's Request for Proposals (Y26-151) soliciting Medicare Supplemental Plans and Medicare Part D Employer Group Waiver Plans (EGWP) for county retirees and Medicare-eligible dependents across five Florida counties: Orange, Brevard, Osceola, Seminole, and Volusia. Proposers must submit sealed responses electronically via the OpenGov e-Procurement Platform by 4:00 PM EST on May 7, 2026, with a question submission deadline of April 9, 2026. The contract term commences January 1, 2027, for three years with two optional one-year renewal periods. Proposers must offer Medicare Supplement plan options (Plans F, G, and N) with monthly premium rates provided across five age ranges (65, 66-69, 70-74, 75-79, and 80+) for each county, and Medicare Part D EGWP plans at low and high coverage levels with reference plan proposed rates of $214.97 (Low Plan) and $377.00 (High Plan).
The Fee Schedule Worksheet requires detailed premium information including year-over-year percentage increases for 2024, 2025, and 2026; premium rating methodology (Community Rated, Issue Age Rated, or Attained Age Rated) for 2027 and beyond; premium submission dates; Medicare Part A and B requirements; guaranteed rates for the 2026 plan year; renewal timelines and grace periods; spousal discounts; confirmation that rates are net of agent or broker commissions; and any assumptions, limitations, or exclusions affecting proposed rates. Proposers must also provide performance guarantees with associated penalties for plan utilization standards and plan implementation. The current incumbent carriers are Cigna-HealthSpring for prescription drug plans and Medicare Surround Cigna for supplemental coverage, with approximately 400+ retirees currently enrolled. The worksheet requires officer certification that proposal information is accurate and binding on the company.
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_E_-_Fee_Schedule_Worksheet.docx | DOCX document | |
| 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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