Exhibit A - Scope of Work.pdf

EXHIBIT A

SCOPE OF WORK

Background:

The Travis County Healthcare District DBA Central Health is the local public entity that provides access to high-quality health care for people who are low income and under/uninsured. We work with a network of partners to eliminate health disparities to reach our vision of Travis County becoming a model healthy community. We believe passionately in our mission: By caring for those who need it most, Central Health improves the health of our community.

The Travis County Healthcare District System is comprised of three entities: Central Health, CommUnity Care, and Sendero. Throughout this Scope of Work, the term “System” will be used to refer to all three entities. Central Health will be procuring these services on behalf of the entire System.

Currently, the System is contracted with Aetna Medical ASO with bundled CVS pharmacy benefit management. The System currently offers the following medical networks:

• Aetna Seton ACO

• Aetna Texas Medical Neighborhood (TMN)

• Aetna HDHP

The System offers three (3) medical plans and please refer to Exhibit A-1: 2026 Medical, Prescription drug, Summary of Benefit Coverages (attached to SOW). They have strong interest in utilizing point solutions within the carrier, such as Hello Heart and Hinge Health that are current vendors.

The dental and vision are currently fully-insured with Aetna. There are two contributory dental plans and two voluntary vision plans. Please refer to Exhibit A-2: 2026 Dental Summary of Benefit Coverages (attached to SOW) and Exhibit A-3: 2026 Vision Summary of Benefit Coverages (attached to SOW).

Purpose:

The purpose of this Request for Proposal (RFP) is to assist the System in identifying and securing a comprehensive medical, prescription drug, dental and vision solution for the Travis County Healthcare District System that meets the following objectives:

• Delivers high-quality, cost-effective medical and prescription drug coverage that protects the System’s self-funded plan and provides financial risk mitigation.

• Provides high-quality dental and vision benefits in a cost-effective manner to employees.

• Conducts a thorough evaluation of current medical, prescription drug, dental and vision insurance plans against new and enhanced coverage options in the marketplace.

• Partner with vendor capable of delivering superior claims management, risk management services, and ongoing support to both the System and its benefits administration team.

• You may quote on any or all of the following lines of coverage in this RFP: medical, prescription drug, dental and vision.

• One or more awards will be given for medical, prescription drug, dental and vision based on evaluation criteria.

Scope of Work:

Please complete the appropriate tabs in Exhibit A-13: Medical ASO, Dental, Vision Questionnaire and Exhibit A-14: PBM Questionnaire for the lines that you will be quoting.

Task 1: Medical Claim Administration – Successful vendor must provide the following services pertaining to Medical Claims Administration.

• Provide exceptional member services for team members and their dependents.

• Ability to seamlessly integrate with point solutions, such as iCAF and BR Focus.

• Partner with the System as a core component of the overall culture of wellness initiatives.

• Bring innovative solutions to help manage ongoing claims costs.

• The ability to scale to a growing population.

• Processing claims timely and accurately.

Task 2: Pharmacy Benefit Manager Claim Administration – Successful vendor must provide the following services pertaining to Pharmacy Benefit Manager Claims Administration.

• Provide exceptional member services for team members and their dependents.

• Provide notice to team members when formulary changes and cost containment programs are introduced.

• Bring innovative drug cost solutions to help manage rising prescription drug costs.

• The ability to scale to a growing population.

• Processing claims timely and accurately.

Task 3: Dental Insurance – Successful vendor must provide the following services pertaining to Dental Insurance:

• Keep the System abreast of dental benefit changes within the market.

• Provide broad network access to team members and their dependents.

• Include dental benefit enhancements, such as maximum rollover benefits and other key features if available.

• Provide exceptional member services for team members and their dependents.

Task 4: Vision Insurance – Successful vendor must provide the following services pertaining to Vision Insurance.

• Keep the System abreast of vision benefit changes within the market.

• Provide broad vision network access through national retailers to team members and their dependents.

• Provide exceptional member services for team members and their dependents.

Task 5: Fee Structure – Consultant’s pricing encompasses all of the services in this scope and provides the best value to the System. Please provide the following information:

• Confirm that your medical, prescription drug, dental and vision insurance proposal pricing is net of commissions and disclose any other fees or administrative costs associated with the coverage.

• Provide a breakdown of these fees and administrative costs.

• Fill out and include Exhibit B – Pricing Sheet within your proposal.

o The quote needs to encompass any or all the following:

Medical Administrative Services Only (ASO) Prescription drug bundled with the Medical ASO PBM Coverage (carveout prescription drug) Fully-insured Dental Coverage Fully-insured Vision Coverage o Please use the following files to develop your quote:

Exhibit A-1: 2026 Medical, Prescription Drug, Summary of Benefit

Coverages (attached to SOW) Exhibit A-2: 2026 Dental Summary of Benefit Coverages (attached to

SOW)

Exhibit A-3: 2026 Vision Summary of Benefit Coverages (attached to

SOW)

Exhibit A-4: Medical, Prescription Drug and Claim Information (Excel file uploaded separately)

Exhibit A-5: Dental Plan and Claim Information (Excel file uploaded separately)

Exhibit A-6: Vision Plan and Claim Information (Excel file uploaded separately)

Exhibit A-7: Medical, prescription drug, Large Claim Report (Excel file uploaded separately)

Exhibit A-8: Top 50 Drugs Report (Excel file uploaded separately) Exhibit A-9: Medical, prescription drug, Provider Utilization Report

(Excel file uploaded separately) Exhibit A-10: Dental Provider Utilization Report (Excel file uploaded separately) Exhibit A-11: Vision Provider Utilization Report (Excel file uploaded separately) Exhibit A-12: Census Exhibit A-13: Medical ASO, Dental, Vision Questionnaire Exhibit A-14: PBM Questionnaire Exhibit A-15: Data Requirements

Applicable Standards:

Compliance with Federal, State, and Local Laws. Vendor shall provide the services and activities to be performed under the terms of this Agreement in compliance with the Constitutions of the United States and Texas and with all applicable federal, state, and local orders, laws, regulations, rules, policies, and certifications governing any activities undertaken during the performance of this Agreement, including, but not limited to: Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. Section 794); the Americans With Disabilities Act of 1990, Public Law 101-336 [S.993] ("ADA"), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations. The vendor shall not discriminate against any employee, applicant for employment, based on race, religion, color, gender, national origin, age, or handicapped condition. In performance of all Agreement services and activities, the vendor will comply with applicable state and federal licensing and certification requirements, health and safety standards, and regulations prescribed by the U. S.

Department of Health and Human Services, the Texas Department of State Health Services, or any other state regulatory agency.

Deliverables:

Proposal Submittals:

• Proposed Service Level Agreements (SLAs) if any

• Exhibit A-13: Questionnaire (in excel)

• Exhibit A-14: PBM Questionnaire (in excel)

• Exhibit B-1: Medical ASO Pricing Sheet

• Exhibit B-2: Fully-insured Dental Pricing Sheet

• Exhibit B-3: Fully-insured Vision Pricing Sheet

Deliverables During Contract Duration:

Services. Vendor's services shall consist of all elements of work, materials, and preparation required to provide the scope of services described in “II) Scope of Work” above to Central Health. Vendor will work closely with Central Health staff in developing and refining deliverables.

Reporting. Vendor agrees to and shall cooperate and coordinate to the greatest extent possible with the Central Health Board of Managers and Central Health staff in the performance of the Services. Vendor shall meet on an as-needed basis with Central Health staff to discuss the progress and goals of the Services.