HCPS_Attachment_A_Medical-Rx_Read_Me_First_&_RFP_Instructions_10.31.25_1_1.xlsm
XLSM spreadsheet 603 KB Posted
- Attached to
- Medical/Rx
- Solicitation number
- 25598-RFP-DST
- Issued by
- Hillsborough County, Florida
About this file
This is a Request for Proposal (RFP) instruction document issued by The School Board of Hillsborough County, Florida (HCPS), located in Tampa, for comprehensive medical benefits and pharmacy services. HCPS seeks proposals for coverage of approximately 24,328 eligible employees, with current enrollment of 19,121 participants as of August 2025, including 18,601 active employees, 44 COBRA participants, and 476 pre-65/post-65 retirees and surviving spouses. The RFP encompasses behavioral health and pharmacy benefits for active employees, under-age-65 retirees, Medicare-eligible retirees, and COBRA participants, effective January 1, 2027. HCPS is transitioning from a fully insured model through Aetna to a self-funded approach and consolidating from five existing plans to three new plans: HMO, High PPO, and Low PPO, all with open, national networks. Respondents may propose one of four structures: Self-Funded Administrative Services Only (ASO) with pharmacy carved in, Self-Funded ASO with pharmacy carved out, Self-Funded Third-Party Administrator (TPA) with pharmacy carved in, or Self-Funded TPA with pharmacy carved out. The RFP materials include Attachment A (this instruction document), Attachment B (Medical Questionnaire), Attachment C (Rx Minimum Requirements), and Attachment D (Rx Questionnaire, provided separately to qualified respondents). Technical questions are due by November 20, 2025, with proposals due December 12, 2025, submitted through VendorLink. The contract term begins January 1, 2027, with annual renewals provided no later than April 15 preceding each renewal date, and vendors must provide a five-year rate guarantee.
Aon Consulting, Inc. serves as the broker of record and receives compensation of $3.62 per employee per month (PEPM) with an annual cap of $825,000. Historically, HCPS has paid approximately 91% of medical premiums, with proposals required net of any additional commissions. The incumbent carrier is Aetna/CVS, which has provided coverage since 2024, with Humana providing coverage in 2023 and prior years. Respondents must fund and line item separately the costs for two carved-out programs currently bundled with medical coverage: a 2nd Opinion program through Teladoc and a Wellness program administered by Vitality, including incentives, rewards, and biometric screenings. Behavioral health, virtual care, vision riders, and prescription drug coverage are included in all medical plans. The Employee Assistance Plan is carved out separately. Respondents are expected to closely match current plan designs or clearly note any deviations; however, HCPS will accept plan design variations and will consider innovative alternate proposals believed to drive additional claims savings. The primary objective of the RFP is claims cost mitigation. Vendors must complete federal certifications, including compliance with Appendix II to 2 CFR Part 200, and meet minimum requirements including at least five years of pharmacy benefit management experience in Florida, registration with the Florida Office of Insurance Regulation, and network accessibility of 95% or more. The RFP evaluation criteria allocate 45 points for cost and value, 15 points for plan administration, 20 points for service capabilities, 15 points for network access, and 5 points for related experience and references.
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1. Read Me First
| Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A |
| Client Name: The School Board of Hillsborough County, FL |
| Client Overview and RFP Request |
| The School Board of Hillsborough County, headquartered in Tampa, FL, 33601 and referred to throughout this document as HCPS is requesting quotes for medical benefits including behavioral health and pharmacy, for its active employees, under age 65 retirees, Medicare-eligible retirees, and COBRA participants effective on January 1, 2027. The total number of eligible employees is approximately 24,328, of which 78.5% currently are enrolled in Medical/Rx coverage. Enrollment as of August 2025 includes 18,601 active employees, 44 COBRA participants, and 476 pre-65/post-65 retirees and surviving spouses for total enrollment of 19,121. |
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.
| Compensation |
| Aon Consulting, Inc. is the broker of record for HCPS and receives compensation for our services through commissions. Medical commissions are paid $3.62 PEPM with a cap of $825,000 annual. Proposals should be provided net of any additional commissions. |
| Terms of Agreement |
| Please refer to HCPS RFP document for the contract term of agreement. Vendors shall provide a five year fee guarantee. |
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.
| Eligibility |
| Eligible persons must elect or waive benefits during annual open enrollment held in September/October for a January 1 effective date. If no change is elected during annual enrollment, then employees automatically continue their current coverage. New employees must elect or waive coverage within 30 days of hire and shall be insured after the first of the month following 60 days not to exceed 90 days. |
Enrollment elections may not be changed until the next open enrollment period, unless there is an IRS-qualified change in status.
| Groups | Description |
| Benefit Eligible Permanent employees | Eligible after first of the month following 60 days of employment. HCPS provides coverage to all employees meeting 30 hours per week for ACA. |
| Dependent | Spouse, as defined by Florida Law |
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
| Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A | |
| Tabs to Complete with Your Proposal | |
| Based on what you are proposing, you may not need to complete all Questionnaires of this RFP. The table below is intended to help you understand what you are required to complete based on what you are proposing. The proposal types are noted along the top of the table. An "X" represents required material for that proposal consideration. You may submit for more than one of the proposal types. Separate RFP responses are not required for each type of proposal. |
| Proposal Options | |||||
| No. | Document Name | Tabs | Self-Funded ASO or TPA, | ||
| Rx Carved In | Self-Funded ASO or TPA, | ||||
| Rx Carved Out | Rx Only |
(Rx Carved Out)
| 1 | Attachment A - Medical-Rx Read Me First & RFP Instructions | Proposal Confirmation | X | X | X |
| 2 | Attachment B - Medical Questionnaire | All Tabs | X | X | |
| 3 | Attachment D - Rx Questionnaire | All Tabs | X | optional | X |
3. General Info
| Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A |
| General Information |
| Client Information | ||
| 01 | Client Name | The School Board of Hillsborough County, FL |
| 02 | Client Address, City, State, and ZIP Code | 2920 N 40th St, Tampa FL 33605 |
| 03 | Where is the group sitused (legal jurisdiction)? | Florida |
| 04 | Size of Client (Benefit-Eligible) | 24,328 |
| 05 | Industry Description | Public School District |
| Aon Consulting, Inc. Contact Information | ||
| 01 | Aon Consulting, Inc. Client Lead Name (Client Owner) | Jeff Jinks |
| 02 | Aon Consulting, Inc. RFP Lead Names | Heather Hronek/Amy Booher |
| 03 | Aon Consulting, Inc. RFP Secondary Names | Sh'bria Newsome/Ava Boornazian |
| 04 | Aon Consulting, Inc. Office Location | Tampa |
| Commission Information - Fully Insured Medical | ||
| 01 | Commission Basis | Yes |
| 02 | Confirm current commission percentage amount, tiered percentages, or flat dollar amount | $3.62 PEPM, capped at annual max of $825,000 |
| Plan Information | ||
| 01 | Number of Medical/Rx Plans to be Marketed | 3 |
| 01 | Medical Plan Name & Type: (Specify: PPO, HMO, etc. and any type of plan name "Buy-Up" or "Gold", etc.) | HMO |
| 02 | Plan Year Effective Date | 1/1/27 |
| 03 | Should the proposed plan design match the current plan design as closely as possible? | Yes |
| 03a | If a quoting vendor cannot exactly match the current plan design, will you accept plan design deviations? | Yes |
| 03b | May respondents also provide alternate plans that they believe are innovative and may drive additional claims savings? | Yes |
| 04 | Are there are any Rate Guarantees or Rate Caps in place? | No |
| 05 | RX Plan is currently included with medical | Yes |
| 01 | Medical Plan Name & Type: (Specify: PPO, HMO, etc. and any type of plan name "Buy-Up" or "Gold", etc.) | High PPO |
| 02 | Plan Year Effective Date | 1/1/27 |
| 03 | Should the proposed plan design match the current plan design as closely as possible? | Yes |
| 03a | If a quoting vendor cannot exactly match the current plan design, will you accept plan design deviations? | Yes |
| 03b | May respondents also provide alternate plans that they believe are innovative and may drive additional claims savings? | Yes |
| 04 | Are there are any Rate Guarantees or Rate Caps in place? | No |
| 05 | RX Plan is currently included with medical | Yes |
| 01 | Medical Plan Name & Type: (Specify: PPO, HMO, etc. and any type of plan name "Buy-Up" or "Gold", etc.) | Low PPO |
| 02 | Plan Year Effective Date | 1/1/27 |
| 03 | Should the proposed plan design match the current plan design as closely as possible? | Yes |
| 03a | If a quoting vendor cannot exactly match the current plan design, will you accept plan design deviations? | Yes |
| 03b | May respondents also provide alternate plans that they believe are innovative and may drive additional claims savings? | Yes |
| 04 | Are there are any Rate Guarantees or Rate Caps in place? | No |
| 05 | RX Plan is currently included with medical | Yes |
| Carrier History | ||
| 01 | Carrier History within the past 15 years. | Aetna/CVS (2024 - current) |
Humana (2023 and prior)
| Incumbent Contact Information | ||
| List Medical Plans covered by this Incumbent Carrier | All Medical | |
| 01 | Medical/Rx Administrator Name | Aetna/CVS |
| 02 | Benefits Administrator Contact Name | Alight Solutions |
| 03 | EAP Vendor | Aetna Resources for Living |
| 04 | Wellness Plan Administrator | Vitality |
| 05 | 2nd Opinion Vendor | Teladoc |
| 06 | Telehealth Vendor | Teladoc as well as Rx carved-in solution |
| 07 | Virtual Primary Care Vendor | Rx carved-in solution |
4. Additional Information
Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A
| Plan Names | |||
| Throughout the RFP and Reporting you may see the plans referred to in different ways. Please use this table to guide you. | |||
| Plan Name | Plan Names Utilized on Documents | Plan Names Utilized in Incumbent Reporting | |
| HMO | Aetna HMO, HMO | HMO Plan | |
| High PPO | Aetna High PPO, High PPO | High PPO Plan | |
| Low PPO | Aetna Low PPO, Low PPO | Low PPO Plan |
Required Attachment Exhibits
| Proposal Option | Attachment | Please Name Item: | ||
| All Options | Subcontractors | "[Proposer] Subcontractors" | ||
| All Options | Implementation Timeline | "[Proposer] Implementation" | ||
| All Options | Sample Reporting Package | "[Proposer] Sample Reporting Package" | ||
| 1. Self-Funded ASO or TPA, Rx Carved In | ||||
| 2. Self-Funded ASO or TPA, Rx Carved Out | Geo-Access Report | "[Proposer] Geo Access Report" | ||
| 1. Self-Funded ASO or TPA, Rx Carved In | ||||
| 2. Self-Funded ASO or TPA, Rx Carved Out | Provider Disruption | "[Proposer] Provider Disruption Report" | ||
| 1. Self-Funded ASO or TPA, Rx Carved In | ||||
| 2. Self-Funded ASO or TPA, Rx Carved Out | Innovative Options | "[Proposer] Innovative Options Description" |
5. Proposal Confirmation Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A
| Which types of plans are you submitting a proposal for? | ||||||
| Proposal Options | ||||||
| Medical & Rx Carved In | Medical with Rx Carved Out | Rx Only | ||||
| Please select from the drop downs under each option | Self-Funded ASO, | |||||
| Rx Carved In | Self-Funded TPA, | |||||
| Rx Carved In | Self-Funded ASO, | |||||
| Rx Carved Out | Self-Funded TPA, | |||||
| Rx Carved Out | Rx Only |
(Rx Carved Out)
| Select: Proposing, Not Proposing | ||||
| HCPS is requesting self-funded proposals to be provided in conjunction with medical ASO or TPA. | ||||
| Vendors responding to Medical shall promote all HCPS point solution products, including Telemedicine, 2nd Opinion Expert Medical Opinion, and EAP. | ||||
| Vendors responding to Medical shall fund the wellness program on HCPS's behalf, including incentives/rewards, biometric screenings, and other costs associated with the plan. | ||||
| If you are responding with Rx either carved in or carved out, please respond to the following: | ||||
| Response | Explanation | |||
| Please confirm how your company interprets SB1550. | text |
6. Hold Harmless
| Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A |
| Medical RFP - Hold Harmless Language |
You agree to the following Hold Harmless language:
| Hold Harmless |
| By submitting a response to this RFP, you agree to indemnify and hold harmless Aon, its directors, officers, employees and agents against any and all liability, loss, damage or expense (including reasonable attorney’s fees and costs) which may arise or result from your fraudulent or willful misconduct or from your responses to and participation in this RFP solicitation. |
7. Attachments Request for Proposal (RFP) for The School Board of Hillsborough County, FL - ATTACHMENT A
| Supporting Documents for RFP: | Documents Link and Formatting |
| Censuses: Active and COBRA | Password: sdhc13009 |
| Current Benefit Summaries and/or SPD's for each Plan and Product included in the RFP | 2026 SBCs and combined Benefit Summary |
2025 SBCs and SPDs
| Rates & Contributions (2023-2026) | |
| Enrollment History & Claims vs. Premium Data (2023-2025) | |
| Large Claimant Reports (2023-2025) | |
| Rx Data | Additional data will be provided with Rx Questionnaire if the vendor meets Minimum Requirements |
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