Exhibit_A,_Attachment_A.1_-_Scope_of_Services_Worksheet.docx
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- Solicitation number
- 26-P-67TF
- Issued by
- Volusia County, Florida
About this file
This is a Scope of Services Worksheet for Volusia County, Florida's Medicare Supplement and Part D Pharmacy Insurance procurement (Contract 26-P-67TF). The County seeks a fully insured medical and pharmacy plan provider for Medicare-eligible retirees and their spouses across Volusia, Flagler, Seminole, Lake, Orange, and Osceola Counties. The contractor must provide Medicare Supplement coverage, Medicare Part D Employer Group Waiver Plans (EGWP) pharmacy benefits, and maintain separate eligibility reporting by agency. Plans are effective January 1, 2027, and the County's Third Party Administrator (WEX) will manage eligibility, enrollment, and billing functions. The contractor must assign a dedicated account manager and client service manager with retiree health plan experience, provide telephonic and web-based customer service during business hours, coordinate directly with retirees regarding enrollment and benefits, and conduct training and support for at least three on-site enrollment meetings annually.
Contractors must provide fully insured group or individual plans through group billing with 2026 CMS and Florida Office of Insurance Regulation approval, with anticipated 2027 rate approvals. Combined Medicare Supplement Plan N and Part D Pharmacy premiums for Volusia County must be lower than the current $971 monthly single coverage rate. One carrier will be selected for Medicare Supplement coverage and one for Part D Pharmacy; both plans must include comprehensive drug coverage with generic drugs at reduced co-pay, full coverage gap benefits, and prescription drug step therapy and prior authorization capabilities. Contractors must disclose all commissions, administrative fees, and broker involvement; accept monthly premium payments via group billing; verify Medicare eligibility for all members; provide annual plan experience reports within 90 days of plan year end; and impose no conditions beyond the County's FRS Health Insurance Subsidy contribution of up to $225 monthly for retirees with 30 years of public sector employment. All premiums must allow 30-day grace periods for payment without penalty.
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26-P-67TF Attachment A.1 - Scope of Services Worksheet
COUNTY OF VOLUSIA – MEDICAL AND PHARMACY PLAN FOR MEDICARE ELIGIBLE RETIREES
A. Provide the following information about your Company:
Company Name
Service Center Location
Primary Contact for Plan
Primary Contact E-mail Address
Primary Contact Telephone
B. Complete the charts below with the information on the fully insured plans that the Contractor shall provide.
1. Include the number of current retirees covered by your Company in the chart below. The “Volusia County Area” includes Volusia, Flagler, Seminole, Lake, Orange and Osceola Counties.
| Retirees Currently Enrolled |
| Medicare Supplement |
| EGWP Part D |
Volusia County Area
Number of Covered Retirees in Florida
Number of Covered Retirees in US
2. Indicate approval status dates by the Centers for Medicare & Medicaid Services (CMS) and/or the Florida Department of Insurance for the Plans.
| Medicare Supplement |
| Response |
2026 CMS Approval
Florida OIR 2026 Rate Approval
Date of Anticipated CMS Approval for 2027 Rates
Date of Anticipated FL OIR Approval for 2027 Rates
3. References (Public Groups Preferred)
| Current Clients |
| Plans Offered |
| Contact Name |
| Contact Title |
| E-mail Address |
| Contact Telephone |
| Years as Client |
1.
2.
3.
4.
4. List the Account Manager your Company will assign to help administer the Program for each component below.
| Plan Option |
| Name |
| Location |
| Yrs. With Company |
| Yrs. Retiree Experience |
| No. of Clients |
Medicare Supplement
Part D Pharmacy
C. Acknowledge (use “Yes” or "Acknowledged" in the column below) the following as it pertains to your response. Note applicable Clarification/Limitation in the column title the same below.
| Issue |
| Acknowledgement |
| Clarification/Limitation |
1. The Contractor shall provide fully insured group plans or fully insured individual plans through group billing.
2. The plans and premiums being provided by the Contractor will be for 2026 and currently approved by the Centers for Medicare & Medicaid Services (CMS) and the Florida Office of Insurance Regulation, as applicable.
3. One Medicare Supplement carrier will be selected overall.
4. The Medicare Part D Pharmacy Plan will be a comprehensive plan with one carrier selected overall.
5. A client service manager or Project Manager, with experience in retiree health and pharmacy plans, will be assigned to work with the County or the County’s Third Party Administration (TPA)
6. A telephonic customer service component for specific questions on the Contractor’s plans will be provided and will be accessible to Members and the County during regular business hours.
7. The Contractor shall answer specific benefit questions, be responsible for their specific plan enrollment, and interface with the County for enrollment, eligibility, and premium functions.
8. The Contractor shall send all annual and new Retiree enrollment materials, approved by the Centers for Medicare & Medicaid Services (CMS), where applicable, and reviewed by the County, directly to the Retiree’s residence. The Contractor shall be responsible for the enrollment of retirees.
9. The Contractor shall coordinate claim submittals with Medicare where applicable.
10. Eligibility information will be updated monthly and accessible on-line. Eligibility discrepancy reports will be provided to the County or the County’s TPA on a monthly basis.
11. The Contractor shall assign a contact person to work with the County or the County’s TPA during the implementation process and annual enrollment.
12. The Contractor shall assign a single contract person to work with the County or the County’s TPA on eligibility and billing issues, including collection rules for FRS deductions.
13. On-line web-based and telephonic customer service and education tools will be made available to Plan Members.
14. The Contractor shall have the ability to accept monthly premium payments from the County or the County’s TPA on a group billing basis.
15. The Plans have no pre-existing condition limitations and are guaranteed issue for current and future Members covered under the County’s health Plan.
16. The Contractor shall assist the County with annual enrollment by 1) training the staff on retiree plans; 2) assisting with annual enrollment, eligibility, and premium billing and collection; and 3) attending at least three (3) half-day on-site enrollment meetings.
17. The Contractor shall verify Medicare eligibility and enrollment for each Member electing its medical and pharmacy plans.
18. The Contractor shall provide an annual Plan experience report to the County within ninety (90) days after the end of the Plan year.
19. Medicare Supplement premiums for Florida will be established on the Age and Issue of the Policy.
20. If commissions or administrative fees are included in the premiums, the Contractor shall disclose the applicable commissions or administrative fees that are included in the premiums.
a. If agents/brokers are included, the name/names shall be disclosed by the Contractor, along with the services that will be provided.
21. The Contractor’s Medicare Part D Pharmacy Plan will closely match the Plan design and co-pays included in the Exhibit B.2 - Medicare Part D Pharmacy Pricing Plan.
22. The Contractor’s Medicare Part D Pharmacy Plan will include a comprehensive Network of pharmacies and have a comprehensive Network on a state and national basis.
23. The Contactor shall provide comprehensive coverage for generic and brand drugs and include full benefits through the Coverage Gap in the comprehensive Medicare Part D Pharmacy Plan.
24. All generic drugs, including select generic drugs at reduced co-pay, will be included in tier 1.
25. The Contractor’s Medicare Pharmacy Part D Plan medication coverage will include one hundred percent (100%) Part D coverage plus a bonus list of medications for the coverage option.
26. The Contractor shall assist in administrating Medicare Part D Pharmacy low-income subsidy payments, low-income cost sharing, and catastrophic reinsurance.
27. The Contractor is permitted to include pharmacy step therapy and prior authorization programs.
28. Premiums for Volusia County for the Medicare Supplement Plan N and the Part D Pharmacy Plan, when added together, will be lower than the current medical and pharmacy premium charged by the County for single coverage ($971).
29. All premiums and fees can be paid within a 30-day grace period without penalty.
30. The Contractor shall not impose conditions as to employer contributions in addition to the County’s contribution to the FRS Health Insurance Subsidy that results in a subsidy of up to $225.00 per month for a County retiree with thirty (30) years of public sector employment.
31. The Contractor accepts the demographic information provided by the County as full disclosure.
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