Medical and Pharmacy Request for Proposal

Effective: July 1, 2026

I. Introduction

Client Name The City of Hagerstown

Goals and Objectives

The City of Hagerstown (COH) is looking for the selected carrier to:

• Duplicate current benefits with minimal network disruption

• Provide superior service

• Achieve cost savings from discounts and reduced fixed costs

Business

Local Government

Client Information Address 1 East Franklin Street, Hagerstown, MD 21740

Covered Population Active employees and Retirees (new hires effective first day of employment)

Eligibility Full-time and Part-time employees working a minimum of 30 hours per week on a regular basis

Current Participation 347 of 437 eligible active employees currently participate in the health plan; 56 pre-65 retirees and 162 65+ retirees are also enrolled

Employee Contributions On average COH pays over 80% of health plan costs (varies by plan/tier)

Current Funding ASO

Proposed Funding ASO

PPACA Grandfather Status The plans are not grandfathered

Current Vendors Medical – United HealthCare Pharmacy – United HealthCare HSA – Wex (not part of this RFP) Stop Loss - United HealthCare (not part of this RFP)

Requested Services – You can quote either or both of the below scenarios:

1. Self-funded medical and pharmacy benefits

2. Self-funded medical only assuming pharmacy is carved out

Stop Loss: Do not include stop loss at this time. Stop loss quotes will be requested in the spring.

Commissions: No commissions included in administrative fees Effective Date: July 1, 2026 Proposal Due Date: January 8, 2026

II. Current and Proposed Benefits

COH currently offers three plans to active employees. The Level Plan, Select Plan and Plus Plan HDHP HSA (EE Plan and EE + 1 Family Plan). Please see the attached plan documents for detailed descriptions of the coverages.

Level Plan

In-Network* Out-of-Network*

Deductible $500 / indiv $1,250 / family

$750 / indiv $2,250 / family

Out-of-Pocket Max $2,000 / indiv $4,000 / family

$2,500 / indiv $5,000 / family

Preventive Care 100% 100%

Inpatient Hospital 10% after ded 30% after ded

Office Visits $25 PCP/SCP copay 30% after ded

Emergency Room $100 copay $100 copay

Prescription Drugs Retail - $6/$30/$45 Mail - $9/$45/$66

Select Plan

Deductible $250 / indiv $625 / family

$750 / indiv $2,250 / family

Out-of-Pocket Max $1,500 / indiv $3,000 / family

$2,500 / indiv $5,000 / family

Preventive Care 100% 100%

Inpatient Hospital 10% after ded 30% after ded

Office Visits 10% after ded 30% after ded

Emergency Room $100 copay $100 copay

Prescription Drugs Retail - $6/$30/$45 Mail - $9/$45/$66

Plus Plan HDHP HSA – EE Plan

Deductible $1,650 / indiv N/A / family

$1,650 / indiv N/A / family

Out-of-Pocket Max $1,650 / indiv N/A / family

$5,600 / indiv N/A / family

Preventive Care 100% 100%

Inpatient Hospital 0% after ded 30% after ded

Office Visits 0% after ded 30% after ded

Emergency Room 0% after ded 0% after ded

Prescription Drugs 0% after ded

*Reimbursements for in and out-of-network are based on the Allowed Amount

Plus Plan HDHP HSA – EE + 1/Family Plan

Deductible $3,300 / indiv + 1 $6,400 / family

$3,300 / indiv + 1 $6,400 / family

Out-of-Pocket Max $3,300 / indiv +1 $6,400 / family

$11,200 / indiv + 1 $11,200 / family

Preventive Care 100% 100%

Inpatient Hospital 0% after ded 30% after ded

Office Visits 0% after ded 30% after ded

Emergency Room 0% after ded 0% after ded

Prescription Drugs 0% after ded

Pre-65 Retiree Plan

Non-Differential PPO

In-Network* Out-of-Network*

Deductible $350 / indiv $875 / family

$350 / indiv $875 / family

Out-of-Pocket Max $2,250 / indiv $5,500 / family

$2,250 / indiv $5,500 / family

Preventive Care 100% 100%

Inpatient Hospital 20% after ded 20% after ded

Office Visits 20% after ded 20% after ded

Emergency Room 20% after ded 20% after ded

Prescription Drugs $200 deductible per person, then retail copays of $6/$30/$45 and mail copays of $9/$45/$66

Medicare-eligible Retirees (medical only, no Rx)

Non-Differential PPO

In-Network* Out-of-Network*

Deductible $150 / person $150 / person

Out-of-Pocket Max $2,500 / person $2,500 / person

Preventive Care 100% 100%

Inpatient Hospital 20% after ded 20% after ded

Office Visits 20% after ded 20% after ded

Emergency Room 20% after ded 20% after ded

Prescription Drugs Not covered

III. Proposal Specifications

Contract Situs The contracts are to be issued in the State of Maryland.

Plan Effective Date/Anniversary Date The proposed plan effective date is July 1, 2026. Future plan anniversary dates should be July 1.

Guaranteed Rates Proposals with multi-year rate and/or fee guarantees will receive the most favorable consideration.

Account Structure COH’s account structure for eligibility and claims will be comprised of eight subgroups to separate active employees, COBRA participants, Pre-65 retirees, Pre-65 surviving spouse. Pre-65 disabled retiree, Pre-65 disabled surviving spouse, Post-65 retiree, and Post 65 surviving spouse.

Rights to Records All claim records and eligibility data used by the carrier in its role as claim administrator shall remain the property of COH as Plan Sponsor and Plan Administrator.

Deadline Submit one electronic copy of your proposal to the CBIZ contacts below no later than January 8, 2026. If you elect to decline quotation, please advise prior to the due date.

Proposal Contacts Your proposal package should be provided to Beckie Lewis ((rlewis@cbiz.com) and Heather Knieriem (hknieriem@cbiz.com) at CBIZ.

RFP Timing It is the goal of COH to finalize all vendor decisions relative to this RFP by mid-March 2026

Questions All bid questions can be sent to Beckie Lewis (rlewis@cbiz.com) and Heather Knieriem (hknieriem@cbiz.com).

mailto:rlewis@cbiz.com mailto:hknieriem@cbiz.com

Renewal Notice After the initial fee guarantee period has expired, COH requires that any change to administrative fees and other pricing are effective on July 1st of each year and notice of any fee/pricing change must be provided at least six months in advance (by January 1st).

Cancellation Provisions After the first plan year, COH reserves the right to terminate its contract on any monthly administrative fee due date, provided such notification is given at least 30 days in advance. Upon termination of this contract, the selected vendor agrees to process runout claims for at least twelve months with no additional fee paid by COH. Any costs for future runout claim administration must be included in the initial fees paid by COH.

Hold Harmless The vendor shall be responsible for and agree to indemnify and hold harmless COH from damages to property or injuries (including death) to any person(s) and any other losses, damages, expenses, claims, demands, suits and actions by any party against COH in connection with the work performed by the vendor.

Confidentiality Agreement Information relative to this RFP may not be released to parties external to this process without the written consent of COH and CBIZ. In addition, CBIZ and COH agree to hold the information you provide in the strictest confidence and will not share your proposal responses with others outside of our respective organizations.

Vendors Errors/Omissions Neither COH nor CBIZ will be responsible for errors or omissions made in your proposal. You will be permitted to submit only one set of proposals. You may not revise or withdraw submitted proposals after the deadline date. After that, revisions to your original submission will not be allowed except as requested by CBIZ or COH.

Legal

Named Claims Fiduciary You shall be the “Named Claims Fiduciary” regarding review of claims and regarding first level appeals of Adverse Benefit Determinations (as the term is defined in ERISA). In discharging your responsibilities, you shall act in accordance with the documents and instruments governing the plan, and any applicable federal or state law, including, without limitation, the procedures described in Section 503 of ERISA and regulations promulgated thereunder. You shall be the “appropriate named fiduciary” for the purpose of providing a participant who has an Adverse Benefit Determination with a full and fair review of the decision denying the claim. Your decision on appeal of the Adverse Benefit Determination shall be the final review for the plan. In exercising your fiduciary responsibility, you shall have sole and complete discretionary authority to determine eligibility for benefits, to construe the terms of the COH plan, to make factual determinations, and to determine the validity of charges submitted for reimbursement under the plan. You shall be deemed to have properly exercised such authority unless you have abused your discretion hereunder by acting arbitrarily and capriciously.

Notwithstanding the foregoing, COH shall be the administrator of the plan, and shall have sole and complete discretionary authority to determine questions, relating to the eligibility of employees and dependents for participation in the plan, including determination of who a participant is. Nothing in the Contract shall limit the ability of COH to amend or terminate the plan.

Administrative

1. COH’s plans will run on a plan year basis.

2. You can administer the desired benefit design.

3. You are willing to coordinate (such as file feeds) with COH’s other vendors when necessary

(Pharmacy, COBRA, Claims Data Warehouse, stop loss, etc.).

Financial

1. Fees exclude commissions.

2. If awarded the COH business, your organization will be liable for run-out administration upon termination of your contract. There will be no additional charge for run-out claim processing for the first twelve months following termination.

3. Should you be awarded this business, you agree to assist with the transition of data (deductibles and out of pocket amounts; pharmacy files, etc.) in the future should COH select a new vendor at no additional cost.

IV. Attachments

Email rlewis@cbiz.com and hknieriem@cbiz.com with your intent to bid in order to receive the attachments.

• Census

• Summaries for three active medical plans and two retiree plans

• Medical/Rx Paid Claims and Enrollment

• Pharmacy Claims Detail (sent separately by whench@cbiz.com)

• Pharmacy RFP response workbook (sent separately by whench@cbiz.com)

• Medical RFP Vendor Response Workbook; use this to complete the following:

o Medical questionnaire o Geo access results o Provider disruption results

▪ Facility

▪ Professional o Discounts o Proposed performance guarantees o Plan design deviations o Financial questionnaire o ASO Fees

▪ Assuming Rx carved in

▪ Assuming Rx carved out o Other fees mailto:whench@cbiz.com mailto:whench@cbiz.com