HCPS_Attachment_A_Medical-Rx_Read_Me_First_&_RFP_Instructions_10.31.25_1_1.xlsm

1. Read Me First

HCPS is fully insured through Aetna through 12/31/25, but will be moving to Self Funded under Aetna effective 1/1/26. In 2026, HCPS is moving to 3 new medical plans (more details below). HCPS is providing several structures for respondents to choose from as they consider the best solution to propose for HCPS. The goal of any response is that it will help the District achieve their goals of claims cost mitigation. HCPS leaves it to each respondent's discretion on what option to propose:

1. Self-Funded ASO option with rx carved in

2. Self-Funded ASO option with rx carved out

3. Self-Funded TPA option with rx carved in

4. Self-Funded TPA option with rx carved out

Under this single RFP, there will be two separate Questionnaires relased - one for Medical and one for Rx. Please review the RFP Instruction tab to confirm the questionnaire components to respond to based on proposal submission. The material related to this RFP is as follows:

1. Attachment A - Medical-Rx Read Me First & RFP Instructions (this workbook)

2. Attachment B - Medical Questionnaire

3. Attachment C - Rx Minimum Requirements. Respondents quoting Rx coverage will need to complete this sheet. Upon meeting the minimum requirements, the Rx Questionnaire will be provided.

3. Attachment D - Rx Questionnaire. This Questionnaire will not be posted on VendorLink and will be provided separately to respondents who meet the Minimum Requirements.

4. Supplemental Data (may be multiple attachments)

The current medical plan bundles costs for two additional programs that are carved out through separate vendors: 2nd Opinion and Wellness. All proposals should build in the costs to cover these programs and line item them out separately for visibility. Respondents to the Medical RFP are expected to pay these costs directly to these vendors on HCPS's behalf, including incentives/rewards, biometric screenings, and other costs associated with the plan. A separate RFP was released for the Wellness program effective 1/1/27 under 25477-RFP-DST WELLNESS PROGRAM.

The contract will be renewed on the contract anniversary date, January 1. Renewals for Medical/Rx shall be provided to HCPS annually no later than April 15 preceding the renewal date.

Enrollment elections may not be changed until the next open enrollment period, unless there is an IRS-qualified change in status.

Children to age 26 (as required by the Healthcare and Education Affordability act of 2010) - biological, legal guardian, step or legally adopted Special Provisions Regarding Dependents A child born to a dependent child is covered for a minimum of 18 months or as long as that dependent child remains eligible for coverage as a dependent.

Coverage for children age 26-30 is provided is they meet the following criteria:

-unmarried with no dependent children -resident of the state for Florida and a student, AND -no medical insurance as a named subscriber, insured enrollee, or covered person under any other group, blanket, or franchise health insurance policy or individual health benefits plan; or not be entitled to benefits under Title XVII of the Social Security Act Retirees All retirees are eligible to continue coverage at termination for FRS retirement;

Eligible Surviving spouses may continue coverage;

Total rates/plans for retirees are the same as actives

Overview of Medical/Pharmacy Plan Designs, Enrollment, Rates and Contributions

As of 1/1/26, medical/rx coverage will be provided on a Self-Funded basis and new medical plans will be in place: HCPS moved from 5 plans to 3 plans and eliminated the upfront benefit allowance/HRA. As of 1/1/26, the medical program includes three plans: HMO, High PPO, and Low PPO, all with an open, national network.

If you are proposing to match current plans, please quote the plans as closely as possible and note any deviations on the plan design sheets included in Attachment B. Behavioral health, virtual care, vision rider, and prescription drug coverages are included in all medical plans today. The Employee Assistance Plan is currently carved out of the medical plans. All deviations MUST be clearly noted and explained on these sheets.

A summary of the current plans is provided in Attachment B, in the "Provisions" worksheets and the SBCs and benefit summaries are provided for each plan that include more details. 2026 SPDs will not be available until March 2026, after the RFP has closed. Rates and contributions for 2023 through 2026 are included as attachments.

Historically, HCPS has paid about 91% of medical premiums.

HCPS also offers Humana group Medicare Advantage plans to their retirees today. Those plans are separate and are not included in this RFP.

2. RFP Instruction

(Rx Carved Out)

3. General Info

Humana (2023 and prior)

4. Additional Information

Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A

Required Attachment Exhibits

5. Proposal Confirmation Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A

(Rx Carved Out)

6. Hold Harmless

You agree to the following Hold Harmless language:

7. Attachments Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A

2025 SBCs and SPDs