Attachment I - Cost Proposal.xlsx

This is a Cost Proposal attachment for the State of South Dakota Bureau of Human Resources and Administration's RFP #25RFP17863 for Medical Network and Pharmacy Administration Services. The RFP seeks an Administrative Services Organization (ASO) to provide comprehensive claims administration, enrollment services, provider network management, medical management, and Pharmacy Benefit Manager (PBM) services for the State Employee Health Plan covering approximately 12,435 active employees across four medical plans and one pharmacy plan. Proposals are due by December 15, 2025, at 5:00 p.m. CDT, with a Letter of Intent required by November 7, 2025. The contract period spans five years from July 1, 2026, through June 30, 2031, with potential for two five-year renewals. Implementation must be completed 60 days prior to the FY27 Annual Enrollment period beginning April 15, 2026, with final vendor selection anticipated by January 16, 2026.

The cost proposal template requires bidders to complete all yellow-shaded areas detailing fee structures across five contract years (July 1, 2026 – June 30, 2031). Fee categories include implementation fees, pre- and post-implementation audit fees, administrative service fees for claims processing on an incurred basis (ALSO fees), PEPM (per employee per month) rates, network access fees, utilization review services, disease management, claims fiduciary services, eligibility reporting, standard and custom reporting, ID card services, communication materials in multiple languages, benefit fair preparation, open enrollment support, runout fees, internal and external audits, medical necessity determination fees, vendor integration fees, member portal customization, and other miscellaneous services. Bidders must not alter the worksheet structure or format, and failure to comply may result in proposal elimination. The State is self-insured for all medical plans without stop-loss coverage, placing no specific or aggregate stop-loss risk on the selected contractor. CVS Caremark currently administers pharmacy services but is not identified as the incumbent for comprehensive services being sought.