Exhibit_5_HMO_Premium_Quote.docx
DOCX document 40 KB Posted
- 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 an Exhibit 5 HMO Premium Quote for the State of Oklahoma's Employee Group Insurance Division (EGID) for Plan Year 2026, covering health insurance premium rates for current and non-Medicare retiree employees. The solicitation requires bidders to provide fixed-dollar monthly premium rates for four specific coverage tiers: primary member, spouse, one child, and two or more children, with rates to be quoted independently and without cents unless the amount is an even number divisible by two.
The premium quote includes an administrative cost rate of $4.477 per member per month, which is subject to annual adjustments. Bidders must submit a "PY2026 Quote with No Plan Changes" as a mandatory requirement, with an optional "PY2026 Quote with Proposed Plan Changes" available only for current health contract holders. The document stipulates that monthly premiums for current employees must be equal to premiums for retirees under 65 years old, and the quote must be signed by the supplier's president, CEO, or authorized representative. Suppliers are required to provide annual renewal rates by May 1st for the subsequent plan year, covering the periods from January 1, 2026, through December 31, 2026, and January 1, 2027, through December 31, 2027.
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Text version
Exhibit 5 HMO Premium Quote [Supplier Name] Plan Year 2026
1. The State of Oklahoma offers four coverage tiers for both eligible current and eligible former employees and their eligible dependents.
2. Bidder must provide rates for each classification independently of the other classifications; for example, the rate quoted for the spouse should not include the rate quoted for the primary member. Rate quotes for coverage levels other than the four levels specified below will not be considered.
3. 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 must be an even number and shall be divisible by two.
4. The rate sheet shall include the plan name.
5. Administrative cost rate ($4.477 PMPM) for PY2026 should be included in the premium quote for each plan. This fee is determined annually by EGID and is subject to change either up or down in pricing. Refer to the OEIBB Commercial Carrier Policy.
a. In event of renewals, any change in the administrative assessment will be communicated to the Supplier no later than May 1st (or the first business day in May) preceding the Plan Year to which the assessment applies.
6. The HMO benefits shall be those specified in Exhibit 4 (Current and Non-Medicare Retiree). The monthly premium for current employees is to be equal to the premium for retirees under sixty-five (65) years of age.
7. “PY2026 Quote with No Plan Changes” for current and non-Medicare retirees is required to be completed for all Bidders. (Table 1)
a. “PY2026 Quote with Proposed Plan Changes” for current and non-Medicare retirees is optional and only for Bidders with current health contracts with the OEIBA Program. (Table 2)
8. PY2026 HMO Premium Quote must be signed by the Supplier’s President, Chief Executive Officer or authorized representative.
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 2025 (January 1, 2028, through December 31, 2028)
Current and Non-Medicare Retiree Quotes (Tables 1 and 2)
TABLE 1 – HMO Monthly Premium Quote Current and Non-Medicare Retiree Blended Rate No Plan Changes (January 1, 2026, through December 31, 2026)
| Plan Name |
| Primary Member |
| Spouse |
| One Child |
| Two or More Children |
PY2026 Quote with No Plan Changes (Required)
| $ |
| $ |
| $ |
| $ |
TABLE 2 – HMO Monthly Premium Quote for current OEIBA Program Suppliers (Optional) Current and Non-Medicare Retiree Blended Rate With Plan Changes (January 1, 2026, through December 31, 2026)
| Plan Name |
| Primary Member |
| Spouse |
| One Child |
| Two or More Children |
PY2026 Quote with Plan Changes (Optional)
| $ |
| $ |
| $ |
| $ |
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 .