Exhibit A - Specifications and Requirements for RFP AABA 2027-0049.pdf

Exhibit A Page 1 of 17

DPA Solicitation #:

RFP AABA 2027*0049

Health and Welfare Actuarial and Broker Consultant for the State of

Colorado

EXHIBIT A – SPECIFICATIONS AND REQUIREMENTS

Exhibit A Page 2 of 17

1. Exhibit A - Scope of Work

2. Section 1: General Information

1. Program Background

1.1. Department of Personnel & Administration: The Department provides centralized human resources, information, tools, resources and materials needed for the State of

Colorado government to function. The Department provides the infrastructure by which the rest of the State government operates. The programs and services provided by DPA are vitally important to the efficient and effective operation of

State government.

1.1.1. For more information about the Department visit: www.Colorado.gov/DPA.

1.1.2. For more information about the benefits offered visit:

https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits.

2. Purpose

1.2. The purpose of this solicitation is to solicit proposals from qualified firms to provide employee benefits consulting/brokerage and actuarial consulting to the State of

Colorado, including assisting the State of Colorado with soliciting, negotiating, awarding, and managing all contracts used by the Employee Benefits Unit. This includes work for services/contracts that the State does not currently utilize.

3. Project Background

1.3. As of September, 2026: Total medical enrollment was 35,566 employees. About 91% of eligible employees.

http://www.colorado.gov/DPA https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits

Exhibit A Page 3 of 17

1.4. As of September 2026, total member enrollment (employees plus dependents) was

71,031

Statewide Total (including COBRA)

Tier

Plan EE Only EE+Spouse EE+Child(ren) Family Total

Kaiser

Copay Basic 1117 321 390 431 2259

Copay Plus 3554 796 1428 978 6756

HDHP 832 139 196 278 1445

Kaiser Total: 5503 1256 2014 1687 10460

Cigna

Copay Basic 4958 1382 1646 2637 10623

Copay Plus 4422 1437 1722 1584 9165

HDHP 2998 711 671 938 5318

Cigna Total: 12378 3530 4039 5159 25106

Medical Total: 17881 4786 6053 6846 35566

Exhibit A Page 4 of 17

1.5. As of September, 2026: Total dental enrollment (all with Delta Dental) was 36,101 employees; about 93% of eligible employees.

Statewide Total (including COBRA)

Plan EE Only EE+Spouse EE+Child(ren) Family Total

Kaiser

Copay Basic 1123 642 1047 1652 4464

Copay Plus 3556 1592 3898 3875 12921

HDHP 832 278 526 1090 2726

Kaiser Total: 5511 2512 5471 6617 20111

Cigna

Copay Basic 4977 2762 4374 10415 22528

Copay Plus 4425 2874 4788 6308 18395

HDHP 3008 1424 1839 3726 9997

Cigna Total: 12410 7060 11001 20449 50920

Medical Total: 17921 9572 16472 27066 71031

Tier

Plan EE Only EE+Spouse EE+Child(ren) Family Total

Delta Dental

Basic 7561 2760 1345 2004 13670

Basic Plus 10534 3498 3798 4601 22431

Dental Total: 18095 6258 5143 6605 36101

Exhibit A Page 5 of 17

1.6. As of September, 2026: Total dental enrollment (all with Delta Dental) was 73,979 members (employees plus dependents).

1.7. As of September, 2026: Total vision enrollment (all with EyeMed ) was 35,063 employees; about 89% of eligible employees.

1.8. As of September, 2026: Total vision enrollment (all with EyeMed) was 71,180 members (employees plus dependents).

Plan EE Only EE+Spouse EE+Child(ren) Family Total

Delta Dental

Basic 7985 6243 3515 7791 25534

Basic Plus 11049 7567 10760 19069 48445

Dental Total: 19034 13810 14275 26860 73979

EyeMed

Basic 7373 2031 2105 3236 14745

Enhanced 9867 3083 3328 4040 20318

Vision Total: 17240 5114 5433 7276 35063

EyeMed

Basic 7395 4060 5577 12554 29586

Enhanced 9908 6165 9166 16355 41594

Vision Total: 17303 10225 14743 28909 71180

Exhibit A Page 6 of 17

1.9. As of September, 2026, enrollment numbers for other State employee benefits are as follows:

Benefit Type Enrollment Numbers

Short Term Disability (STD) 39,439

Optional Long Term Disability 17,360

Employee Basic Life Insurance 39,824

Optional Employee Life Insurance 20,102

Optional Spouse Life Insurance 6,348

Optional Child Life Insurance 13,817

Healthcare FSA 5698

Dependent Care FSA 901

4. Anticipated Contract Term

1.10. The initial term of the awarded Contract is expected to begin on July 1, 2027 and end on June 30, 2028.

1.11. The total duration of the Contract, from the start date until termination, and including the State's exercise of any options, is not anticipated to exceed five (5) years. The State may extend the Contract beyond the anticipated term in this subsection, in accordance with the Colorado Procurement Code and its implementing rules, in the event that the State determines the extension is necessary to align the

Contract with other State contracts, to address State programmatic or policy changes related to the Contract or to provide sufficient time to transition the Work.

1.12. The State may, within its sole discretion, choose to not exercise any option or

Extension Term in the Contract for any reason. If the State chooses to not exercise for any Extension Term, it may re-procure the performance of the Work in its sole discretion.

Exhibit A Page 7 of 17

3. Section 2: Scope of Work Overview

The Offeror’s flat annual fee pricing shall cover, at a minimum, all tasks detailed in this Scope of

Work, which represents the baseline requirements for the consultant:

1. Broker and Actuary

1.1. General Professional Services

1.1.1. Provide monthly and annual reports, including an analysis of income and expense for the prior year and a projection for the forthcoming year, including projected adequate reserve levels for self-funded plans.

1.1.2. Attend rate-setting meetings.

1.1.3. Attend meetings with benefits vendors as necessary.

1.1.4. Provide analysis and consultation regarding Fiscal notes, including but not limited to reviewing legislative language, developing cost-benefit analyses, and providing policy guidance.

1.1.5. Assist in contract negotiations.

1.1.6. Assist State of Colorado in short- and long-term employee benefit strategic planning.

1.1.7. Audit resulting contracts for accuracy of coverage, terms, and conditions.

1.1.8. Make fact-based presentations to management on current state of benefit plans and recommended changes.

1.1.9. Monitor ongoing contracts, including provider plan administration, provider compliance with contract, and incurred claims. Work with providers to correct any deficiencies.

1.1.10. Provide information on employee benefit issues, trends and proposed or new legislation.

1.1.11. Annually update required legal notices and assist in preparation of stated notices.

Exhibit A Page 8 of 17

1.1.12. Coordinate the collection of open enrollment resources and documents from vendors.

1.1.13. When employee benefits are solicited, prepare bid specifications, identify appropriate markets, analyze proposals submitted, make recommendations, and assist in negotiation of (preferably multi-year) rate guarantees.

1.1.14. Attend negotiations and meetings in person, as requested by the State.

1.1.15. Review open enrollment communications authored by the State of Colorado or its vendors.

1.1.16. Assist with resource gathering and coordination of events, for example, health fairs and flu shots as needed.

1.1.17. Conduct an initial compliance audit of applicable federal, state, and local laws impacting our employee benefits program. Assist the State of Colorado with required corrective actions. Keep the State of Colorado team informed of changes and/or new legislation and assist with the implementation of changes required to comply with the legislation. Provide training to State of

Colorado HR professionals as requested.

1.2. Direct Primary Care / Near-Site Clinics

1.2.1. Provide observations and feedback on the scope of direct primary care services.

1.2.2. Assist with analysis of claims data, clinic-provided-services data, and return on investment analysis.

1.3. Administrative/Other Support

1.3.1. Help the State maintain compliance with all laws and regulations and keep the State in compliance.

1.3.2. Review plan documents (including Section 125 Plan Wrap Document), summary plan descriptions, other materials from vendors, including amendments and restatements for accuracy.

1.3.3. Serve as liaison with providers in making any needed changes.

Exhibit A Page 9 of 17

1.3.4. Assist with claims resolutions, eligibility issues, employee benefit issues, and vendor problems.

1.3.5. Assist the State with implementations and communication of new programs or changes to existing programs, which may include attending and presenting information when requested.

1.3.6. Review and/or develop communication materials pertaining to State Health and Welfare programs in compliance with applicable requirements, as requested.

1.3.7. Assist with the procurement process for all State of Colorado benefits and benefit-related contracts. Including drafting initial solicitations, evaluating proposals, assisting the evaluation committee, attending evaluation committee meetings, making recommendations, and assisting with contract negotiations.

1.4. Renewal and Contract Negotiation and Management

1.4.1. Annual review and negotiation of performance guarantees and renewal rates for all benefit plans.

1.4.2. Advise and assist when competitive proposals, bids, or quotes should be solicited from other carriers.

1.5. Benefit Plan Design/Redesign

1.5.1. Review existing benefit plans for competitiveness in the marketplace.

1.5.2. Advise and consult on benefit trends locally and nationally, including information on plans that are not currently offered by the State.

1.5.3. Recommend plan changes based on the needs of State employees.

1.5.4. Incorporate findings into the strategic plan.

1.5.5. Assist in evaluating current benefits packages such as benefits offered versus not offered, tier levels, co-pays, deductibles and maximum out of pocket expenses, etc. for balance with the State’s culture, philosophy, and objectives.

Exhibit A Page 10 of 17

1.6. Pharmacy Consulting

1.6.1. Support Requests for Proposals (RFP) for Pharmacy Benefit Manager (PBM) services for multiple vendors—Kaiser & MedImpact(CIGNA plans).

1.6.2. Support annual PBM Market Checks to ensure the pharmacy program / PBM financial terms for the upcoming year(s) is (are) competitive and, when necessary, negotiate revised financial terms and contract addendums to ensure all terms are in the States best interest.

1.6.3. Manage the Requests for Proposals (RFP) process including, but not limited to, preparing RFPs, reviewing responses, preparation of bid analysis, and making recommendations regarding the responses received. Initially this process will focus on the development of a “Reverse Auctioneer RFP” as outlined in Law

HB 21-1237, C.R.S. § 24-50-1201 - 1204 (2021). The selected auctioneer will prepare a reverse auction RFP for PBMs. As a consultant you’ll review their methodology and validate the savings projections made by the auctioneer.

Consultant will also take the lead in the implementation of a new PBM and/or other changes coming from the reverse auction.

1.6.4. Conduct PBM contract reviews and negotiations, as needed.

1.6.5. Provide ongoing vendor management and oversight.

1.6.6. Evaluate and recommend pharmacy plan designs, pharmacy coverage rules and clinical pharmacy management programs, as needed, to help meet the

State’s goals and objectives.

1.6.7. Participate in monthly calls and quarterly pharmacy performance reviews, which include review of reports and analyses prepared by the PBM.

1.6.8. Assist in drafting and review of member and provider communications regarding pharmacy plan or program implementations and/or changes.

1.6.9. Support and help manage implementation of pharmacy programs and plan changes (e.g., ensure testing is completed, communications are mailed timely, etc.).

1.6.10. Share emerging trends and/or drug coverage / management opportunities.

Exhibit A Page 11 of 17

1.6.11. Provide ad hoc consulting (e.g., help respond to the State’s and/or plan participant’s questions related to the pharmacy program and/or the PBM;

provide input into actuarial spend / trend assumptions, etc.).

1.7. Wellness Program: State of Health delivery, management, and procurement.

1.7.1. Assist the State in the expansion and ongoing management of the State of

Health workforce health improvement program.

1.7.2. Assist the State in evaluating the workforce health improvement program.

Evaluation is defined as working hand-in-hand with the Statewide Wellness

Manager to:

1.7.2.1. Evaluate and develop program elements that support and enhance the

State of Health framework,

1.7.2.2. Identify challenges, employee engagement opportunities, coordination with the State's health partners, and

1.7.2.3. Analyze individualized employee data to advise the State on the health of the population and the effectiveness of the program. Data should be used to design improvement opportunities, new evidence-based interventions, and industry enhancements.

1.7.3. Assist the State in conducting annual program evaluation and identifying gaps in care and program delivery.

1.7.4. Provide clinical expertise to identify and implement innovative program enhancements based on new and emerging evidence-based guidelines for chronic care prevention and management, clinical research, health risk assessments, and biometrics / health screenings.

1.7.5. Perform continuing administration of the State of Health program, which includes:

1.7.5.1. Weekly review and triage of program applications and assignment of candidates to the indicated health coaching team (presently Marathon, Cigna, Kaiser, and CSEAP);

Exhibit A Page 12 of 17

1.7.5.2. Weekly review and reconciliation of health coaching team screening activities (E.G. Of the X applications, which were enrolled, which were not enrolled, and why were or weren’t they enrolled);

1.7.5.3. Weekly updates of master dataset, including:

1.7.5.3.1. Adding new participants as reported by health coaching teams;

1.7.5.3.2. Adding biometric and evaluation data;

1.7.5.3.3. Updating program enrollment/completion status;

1.7.5.3.4. Pulling a separate eligibility file for certain program partners

(presently Cigna and HealthBreak).

1.7.6. The ideal candidate will provide a dedicated client management team of subject matter experts with relevant clinical or community-based experience and credentials for the following skillset areas:

1.7.6.1. Motivational interviewing theory, principles, strategies, and intervention methods;

1.7.6.2. Program evaluation in an employer-sponsored setting;

1.7.6.3. Data analysis for measuring program outcomes, impact, and process elements;

1.7.6.4. Primary care delivery and clinical integration (E.G. Healthcare verticals, ACOs, PCMH);

1.7.6.5. Behavioral health treatment and recovery strategies, methods, and principles;

1.7.6.6. Chronic condition management strategies, methods, and principles;

1.7.6.7. Population health improvement strategies, methods, and principles;

1.7.6.8. Benefits and health management program communications and promotion;

Exhibit A Page 13 of 17

1.7.6.9. Specific credentials may be CHES, MCHES, NBC-HWC, CDE, RN, or advanced degrees in health promotion, behavioral sciences, public health, biostatistics, etc.

1.8. Benefits Administration

1.8.1. Manage the solicitations process including, but not limited to, preparing solicitations, reviewing responses, preparation of bid analysis, and making recommendations regarding the responses received.

1.8.2. Assist in the implementation of the new contracts/vendors.

1.8.3. Provide ongoing vendor management and oversight.

1.8.4. Evaluate and recommend system changes that simplify or improve the experience for Benefit Administrators, the Employee Benefits Unit and employees using the system.

1.8.5. Participate in calls with vendors as needed and quarterly pharmacy performance reviews.

1.8.6. Participate in calls with the State of Colorado as needed; the State meets with its current consultant at least once every other week.

1.8.7. Suggest educational content and review communications within the system.

1.8.8. Provide an administrative person to assist the Employee Benefits Unit during open enrollment (typically: March - June) to assist with troubleshooting, report preparation, testing, vendor file feeds, resolving system issues, corresponding with employees who have issues/questions, vendor questions, audits and other administrative tasks needed by our team during open enrollment.

1.8.9. Share emerging trends and/or management opportunities.

2. Actuarial

The following Scope of Work should be considered the minimum that the actuary will provide:

2.1. All Benefits Contracts:

2.1.1. Provide ad hoc reporting as necessary.

Exhibit A Page 14 of 17

2.1.2. Establish annual premium rates.

2.1.3. Identify claim and risk trends.

2.1.4. Review and analyze claims experience, claim service, and claim administration to ensure maximum benefit to the State.

2.1.5. Advice and consultation on methods for improving cost containment and claims administration; where applicable, provide cost analysis of possible impact on plan.

2.1.6. Attend meetings with vendors as required.

2.1.7. Annual rate setting. This includes the development of a Rate Modeler that enables the State to model the impact of proposed plan changes, employer/employee contribution scenarios, and other funding alternatives.

2.1.8. Provide analysis and consultation regarding Fiscal notes, including but not limited to reviewing legislative language, developing cost-benefit analyses, and providing policy guidance. Responses may be required in less than 4 hours.

2.1.9. Review performance guarantees and check math vs. contract terms.

2.1.10. Assist in contract negotiations.

2.1.11. Attend negotiations and meetings in person, as requested by the State.

2.2. In addition to the requirements above, Contractor will provide the following for the medical plans:

2.2.1. Provide a monthly report, including an analysis of income and expense for the prior 12 months compared to the State’s budgeted amounts on both an incurred and paid basis.

2.2.2. Provide an annual report, including an analysis of income and expense for the prior year and a projection for the forthcoming year, including projected adequate reserve levels for the plan. Perform annual audit of pharmacy claims to determine if any payouts are due to the State per the terms of the

Pharmacy Benefits Manager (PBM) contract.

Exhibit A Page 15 of 17

2.2.3. Advise on required reserves for medical and dental plans.

4. Section 4: Evaluation Criteria

1. Technical Capabilities

1.1. This criterion includes:

1.1.1. Broker: Provide reporting analysis and projections, attend rate-setting meetings, meet with vendors and attend vendor meetings as necessary, respond to Fiscal notes, assist in contract negotiations, help develop short and long-term planning, audit contracts for accuracy of coverage, terms, and conditions, monitor contracts, provide information on trends, maintain compliance with laws, prepare solicitations and prepare reports summarizing/discussing vendor proposal. Provide administrative support, review and redesign benefit packages, provide pharmacy consulting, assist with State of Health, and assist with benefits administration.

1.1.2. Actuarial Services: provide reporting and analysis of claims and budget, provide ad hoc reporting as necessary, establish premiums, advise on reserves, identify risk trends, review claims experience, attend meetings, review Fiscal notes, and assist in contract negotiations.

2. Management Capabilities

2.1. This includes personnel dedicated to this project, consistent and timely communication with the State, experience applicable to the Work, ability to meet posted deadlines, project management, and team structure. Management Capability

Component also includes knowledge of proposal requirements, general company information, support capability, and experience serving the public sector.

3. Cost Proposal

3.1. This includes providing answers to all questions in the Cost Proposal section of

Exhibit B, as well as providing clear and easy-to-understand costs and breakdowns.

The Cost Proposal shall include all material, labor, facilities, equipment, supplies, Exhibit A Page 16 of 17 and travel necessary to perform the services detailed in this solicitation. Any fees not included in an Offeror’s proposal will not be considered.

4. Overall Quality and Completeness of Bid Submission

4.1. This criteria is to evaluate whether a submitted proposal is complete, with all questions answered. Because the successful Offeror will be providing presentations and reports as part of the deliverables from the Scope of Work, this criteria also includes evaluating an Offeror’s ability to communicate plans clearly, use of proper grammar, design of example reports provided, and the overall quality of the presentation in response to all questions answered.

5. Accessibility

5.1. All Work performed as a result of this solicitation must comply with all applicable provisions of §§24-85-101, et seq., C.R.S., and the Accessibility Standards for

Individuals with a Disability, as established by the Office Of Information Technology pursuant to Section §24-85-103 (2.5), C.R.S. and 3) all State of Colorado technology standards related to technology accessibility and with Level AA of the most current version of the Web Content Accessibility Guidelines (WCAG), incorporated in the

State of Colorado technology standards.

5. Section 5: Optional Finalist Presentations

1. Oral presentations / interviews

1.1. The State may, at its discretion, request in-person presentations from finalists. The

State may ask for presentations from some Offerors and not others, the State may not ask for any presentations. After the Evaluation Committee scores each Offeror’s proposal, the Offerors whose proposals are deemed to be reasonably likely of being considered for award may be invited to oral presentations.

1.2. Offerors are cautioned to ensure that their proposals adequately convey the soundness of their approach and understanding of the requirements and specifications, as the Oral Presentations will only serve to narrow down final choices;

the Oral Presentations will not be a place to offer extra information that was omitted from the initial proposal, or a way for Offerors to incentivize themselves to

Exhibit A Page 17 of 17 the State with extraneous sales pitches. Offerors should not assume that they will have an opportunity to present at a final presentation and written proposals should include their most favorable offer.

1.3. If a presentation is requested, the participating Offeror’s presentation team must include the core team members proposed in the proposal. A list of questions will be emailed to participating Offerors prior to the oral presentation date and these questions will form the presentation’s foundation. Presentations and interviews will be at the Offeror's expense.