Exhibit_10_MAPD_Premium_Rate_and_LIS_Quote.docx
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- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
This document is Exhibit 10 for a Medicare Advantage Prescription Drug (MAPD) Premium Rate and Low Income Subsidy (LIS) Quote for Plan Year 2026, involving the OEIBA (Organizational Employee Insurance Benefits Association) Program. The exhibit outlines requirements for bidders to submit premium quotes for MAPD plans, with two submission options: a required "Quote with No Plan Changes" and an optional "Quote with Proposed Plan Changes" for current health contract holders. Bidders must submit estimated premium quotes with their bid, with final MAPD rates due by August 1, 2025, or two business days after CMS deadline calculations. The contract period covers January 1, 2026, through December 31, 2026, with provisions for future year renewals on May 1, 2026 (for Plan Year 2027) and May 3, 2027 (for Plan Year 2028).
The document specifies detailed pricing requirements, including a mandatory administrative cost rate of $4.477 Per Member Per Month (PMPM) for PY2026, which is subject to potential annual changes. Bidders must quote fixed dollar amounts divisible by two, with rates to be based on MAPD benefits specified in a referenced Exhibit 9. The quote includes tables for standard MAPD monthly premiums and a Low Income Subsidy (LIS) table with rates at different subsidy levels (100%, 75%, 50%, and 25%). The document requires signatures from the supplier's President, CEO, or authorized representative, emphasizing the formal nature of the rate submission process and the specific compliance expectations for MAPD plan offerings.
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Text version
Exhibit 10 MAPD Premium Rate and LIS Quote [Supplier Name] Plan Year 2026
What type of MAPD plan is Bidder offering for this bid?
☐ MAPD in combination with a non-Medicare HMO ☐ MAPD in combination with an MSP and a non-Medicare HMO ☐ Standalone national MAPD
Instructions:
1. Estimated premium quote(s) for an MAPD plan will be due with the bid submission.
2. The due date for the final MAPD rate(s) of Plan Year 2026 will be the later of:
a. August 1, 2025; or
b. Two business days following CMS deadlines for rebate allocation calculations based upon the release of the CMS national average monthly bid amounts.
3. The rate sheet shall include the plan name.
4. Administrative cost rate ($4.477 PMPM) for PY2026 should be included in the premium quote. This fee is determined annually by EGID and is subject to change either up or down in pricing. Refer to OEIBB Commercial Carrier Policy.
a. In the event of renewals, any change in the administrative assessment will be communicated to the Supplier no later than May 1st of the year preceding the following Plan Year.
5. Anything other than a fixed dollar amount will not be accepted and may cause the Bidder’s bid to be rejected. Any cents quoted in the Bidder’s rates shall be an even number and shall be divisible by two.
6. The MAPD benefits shall be those specified in Exhibit 9 for reference.
7. PY2026 Quote with No Plan Changes” for MAPD is required for all Bidders to complete. (Table 1)
a. “PY2026 Quote with Proposed Plan Changes” for MAPD is optional and only for Bidders with current health contracts with the OEIBA Program. (Table 2)
8. Low Income Subsidy Table 3 is due with the final MAPD rates in August.
Supplier agrees to provide annual renewal rates for each contracted option no later than the first business day in May preceding the Plan Year for which the rates apply:
1. May 1, 2026, for Plan Year 2027 (January 1, 2027, through December 31, 2027)
2. May 3, 2027, for Plan Year 2028 (January 1, 2028, through December 31, 2028)
TABLE 1 – MAPD Monthly Premium Quote with No Plan Changes PY2026 Quote (January 1, 2026, through December 31, 2026)
| Plan Name |
| Per Member Monthly Rate |
PY2026 Quote with No Plan Changes (Required)
TABLE 2 – MAPD Monthly Premium Quote with Plan Changes PY2026 Quote (January 1, 2026, through December 31, 2026)
| Plan Name |
| Per Member Monthly Rate |
PY2026 Quote with Plan Changes (Optional)
TABLE 3 – MAPD Plan Low Income Subsidy (LIS) (January 1, 2026, through December 31, 2026)
| LIS % |
| Rate for Medicare-eligible members after LIS is applied |
| 100% |
| $ |
| 75% |
| $ |
| 50% |
| $ |
| 25% |
| $ |
Signature Printed Name Date
Title Supplier Name (To be signed by the Supplier’s President, Chief Executive Officer or authorized representative.)
File details come from the government source that posted it. Updated .