Summary of Exhibit B-1 - Medical ASO Pricing Sheet

This document is a medical Administrative Services Organization (ASO) pricing sheet for RFP 2604-002 issued by the State of Texas. The RFP requests comprehensive medical insurance coverage and services from qualified vendors. Vendors must provide quotes that address all required coverages detailed in the accompanying exhibits, including the 2026 Medical Summary of Benefit Coverages, Medical Plan and Claim Information, Medical Large Claim Report, Top 50 Drugs Report, and Medical Provider Utilization Report. The pricing sheet establishes the framework for vendors to submit detailed cost proposals covering the full scope of medical ASO services and related administrative functions.

The pricing submission requires vendors to itemize costs across multiple service categories, including medical claim administration fees, pharmacy rebate credits, network access fees, shared savings arrangements, claim fiduciary fees for second-level appeals, utilization management programs, case management, disease management, nurse line services, diagnostic imaging programs, maternity management, telehealth services, stop-loss carve-out and reporting fees, pharmacy carve-out fees, PBM data integration fees, cost containment programs such as facility charge review and subrogation, itemized bill review services, runout administration fees, and any additional fees not otherwise addressed. Vendors must calculate a total monthly administrative fee based on the census coverage and service cost base provided, with the final pricing serving as the basis for contract award and ongoing compensation under the agreement.