ESBD_521004_1780004498571_Exhibit B-1 - Medical ASO Pricing Sheet.pdf

This is a Medical ASO (Administrative Services Organization) Pricing Sheet for RFP 2604-002, which requests pricing for medical insurance administration services. The vendor selected for contract award must provide comprehensive coverages and services including medical plan administration, claim processing, pharmacy benefits management, and various supplementary programs such as utilization management, case management, disease management, nurse line services, diagnostic imaging, maternity management, and telehealth. Bidders are required to develop their quotes based on multiple supporting exhibits including the Medical Summary of Benefit Coverages (Exhibit A-1), Medical Plan and Claim Information (Exhibit A-4), Medical Large Claim Report (Exhibit A-7), Top 50 Drugs Report (Exhibit A-8), Medical Provider Utilization Report (Exhibit A-9), and Census Coverage information (Exhibit A-12).

The pricing sheet requires vendors to provide itemized quotes for all required coverages and services, including specific line items for medical claim administrative fees, pharmacy rebate credits, network access fees, shared savings arrangements, claim fiduciary fees for second-level appeals, stop loss carve-out fees and reporting fees, pharmacy carve-out fees, data integration and file fees, cost containment programs (facility charge review, subrogation, itemized bill review), and any other fees not addressed. Vendors must calculate a total monthly administrative fee based on the provided benefit structure and claim history data, with the total monthly cost to be reflected in the final row of the pricing schedule.