Response to Offeror Questions document.docx
DOCX document 48 KB Posted
- Solicitation number
- 25RFP17863
- Issued by
- Pennington County, South Dakota
About this file
This is a Response to Offeror Questions document issued by the South Dakota Bureau of Human Resources and Administration for RFP #25RFP17863 regarding Medical Network and Pharmacy Administration Services. The State seeks an Administrative Services Organization (ASO) to provide comprehensive claims administration, enrollment services, provider network management, medical management, and Pharmacy Benefit Manager (PBM) services for approximately 12,435 active employees across four medical plans. The contract period spans five years from July 1, 2026, through June 30, 2031, with potential for two five-year renewals. The State administers eligibility internally and transmits standard, non-customized 834 eligibility files to the TPA. The State requires a dedicated call center with a dedicated phone line to handle approximately 600 customer service calls per month, with specific staffing during 7-8 a.m. and 5-7 p.m. time periods. Proposals were due by December 15, 2025, at 5:00 p.m. CDT, with final vendor selection anticipated by January 16, 2026, and implementation to be completed 60 days prior to the FY27 Annual Enrollment period beginning April 15, 2026.
Key clarifications addressed in this Q&A include confirmation that the State currently operates with a carve-in PBM arrangement with CVS Caremark, though carve-out options may be considered; however, all TPAs must provide carve-in options with full pass-through of rebates and transparent contracting requirements. The State's partnership with Hinge Health will continue regardless of any TPA change, and vendors must provide a virtual care solution comparable to Doctor on Demand. COBRA administration will continue with WEX, requiring a file feed implementation. The State requires both a robust South Dakota network and comprehensive national network to ensure uniform quality of care and access for dependents living outside the state and traveling members. Professional liability insurance requirements are $1 million per claim. The State administers its wellbeing initiatives internally and does not seek TPA integration with current wellness programs. Cost proposals must be submitted as separate Excel documents, and submissions exceeding the 20MB email attachment limit may be submitted via multiple clearly labeled emails.
View the file
Other files
Show all 43
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
| RFP #25RFP17863 | Medical Network and Pharmacy Administration | BHRA |
| 500 East Capitol | ||
| Pierre SD, 57501-5070 |
Date: November 17, 2025 Subject: Respondent’s Questions & State’s Response, RFP #25RFP17863 In accordance with the subject Request for Proposals (RFP), the following are answers to respondent’s questions which have been submitted prior to the specified deadline of November 14, 2025; 5:00 p.m. CT. These questions are for informational purposes only; they do not alter the requirements specified within the RFP. Any changes to the RFP will be accomplished by the Office of Procurement Management via an addendum.
*The State's response will be in Bold font following the respondent’s questions.
1. Per the Benefits Guide, COBRA is administered by WEX, is this correct? If so, is this anticipated to continue?
State’s Response: Yes, there is no plan to the COBRA administrator. In addition, a file feed from WEX would need to be implemented.
2. Propel/LiveWellSD: Is the LiveWellSD, a wellness program run by the State of SD? Is the State of SD not seeking Wellness offerings?
State’s Response: : LiveWellSD is the branding under which a number of initiatives lead by the State of SD and our benefit partners for the total wellbeing employees and their dependents. Offerings of respondents would be included in the overall program.
3. Doctor on Demand/Hinge Health – if a TPA change takes place, are the relationships with these vendors to continue? If so, are there integrations that need to take place?
State’s Response: The State’s partnership with Hinge Health will continue regardless of any potential TPA change. If a TPA change occurs, standard integrations or data connections required to support Hinge Health would need to be established as part of implementation.
With respect to virtual healthcare, the State will require a virtual care solution comparable to Doctor on Demand. Vendors should outline their virtual care capabilities and confirm their ability to support a solution that meets or exceeds the current level of service.
4. Is Alex directly with State of SD or current TPA?
State’s Response: The current benefit support tool is a direct contract with the vendor. The State has issued a separate RFP for the benefits decision-support tool (Alex). Therefore, the vendor selection for this service, effective July 1, 2026, is still to be determined.
5. Section 3.3.1.4 -PBM Services Carve-out -Please confirm if a Carve-out option for the PBM must be provided (i.e. can a bidder only submit a carve-in option)? Are there requirements with the State regarding rebates / transparent contracts?
State’s Response: The State currently has a carve-in relationship and is requesting that all TPA’s provide a carve-in option. However, carve-out options may also be considered.
Are there requirements with the State regarding rebates/transparent contracts?
Yes, the State requires rebate guarantees and transparent contracting. The State will require full pass through of rebates attributable to their population and will require the TPAs to provide discount and rebate guarantees.
6. Section 3.4 I 1 -Eligibility and Enrollment Administration This section asks if administrators can administer eligibility based on State’s eligibility criteria. The online benefits guide, page 7, it appears that eligibility may be administered by State of SD.
a. Please confirm if State is administering eligibility.
b. How is State remitting eligibility files to TPA?
i. Standard, non-customized 834?
ii. Vendor Transmitted? Name Vendor
State’s Response: The State administers eligibility and transmits eligibility files as a standard, non-customized 834.
7. Section 3.4.C.1 -Customer Service -Can the State provide the volume of calls received from 7-8 am and 5-7pm?
State’s Response: The State receives approximately 600 customer service calls per month. In the last twelve (12) months call volumes for the requested time periods were 110 calls and 193 calls respectively. Please note that overall call volume increases during Open Enrollment.
Will the State require a dedicated call center with a dedicated phone line?
State’s Response: The State will require a dedicated employees and a dedicated phone line as part of the customer service model.
Can the state also provide a total volume of calls per month?
State’s Response: Yes. The State receives approximately 600 calls per month.
8. Section 3.4.K.1 -Network -Please provide a more detailed explanation and expectation for a national network as it pertains to the requirement for “uniform quality of care and services.”?
State’s Response: The State requires both a robust South Dakota network and a comprehensive national network. The intent behind the requirement for a national network with “uniform quality of care and services” is to ensure that covered dependents living outside of South Dakota, as well as members who are traveling, have access to in-network providers. This helps ensure consistent access to high-quality care nationwide while reducing out-of-network costs for both the State and plan members.
9. Attachment D vs Attachment I -Cost Proposal -Cost Proposal is included in Attachment D as tab 4 and as Attachment I - how would you prefer the Cost Proposal to be returned?
State’s Response: The State would prefer the cost proposal be returned as a separate document in excel.
10. Attachment D -Cost Proposal -Cost Proposal states that Utilization Review and Disease Management Programs are Carved out to Health Management Partners (HMP), please confirm that this is a typo and that bidders are in fact asked to bid on UR and DM.
State’s Response: Yes, this was a typo in Attachment D and should be disregarded. Bidders are required to provide pricing for Utilization Review (UR) and Disease Management (DM) as outlined in the RFP.
Attachment D – Row 23 -Cost Proposal -Please elaborate on the meaning of “all levels” where is says Claims Fiduciary (all levels) State’s Response: In the Cost Proposal, the term “all levels” under Claims Fiduciary refers to the full scope of fiduciary responsibilities associated with claims administration. This includes all tiers or types of claims review and fiduciary oversight required under the plan, rather than a limited or segmented level of fiduciary responsibility. Bidders
Attachment D Row 69 -Long Term Goals -Presume that strategic goals would be for 2026-2027?
State’s Response: Long-term strategic goals should align with the anticipated five-year contract term (2026–2031), rather than only 2026–2027. Bidders should frame long-term goals with the full contract period in mind.
Attachment D Row 70 – Wellbeing – is the State seeking Wellbeing Program?
State’s Response: This topic was addressed in Question #2. The State is not seeking changes to its existing wellbeing/wellness offerings at this time.
Is the State looking for TPA to integrate with current Wellbeing that is administered by the State? Please elaborate on who is administering the Wellbeing program.
State’s Response: No, the State is not seeking TPA integration with the current wellbeing program. The State administers its wellbeing initiatives internally and is not requesting additional integration through this RFP.
Attachment D 71 - Vendors -Please describe your other Vendors and their administered programs, are you seeking any replacement of these Vendors now or near future?
State’s Response: Please refer to the Benefits Guide for a list of the State’s current vendors and the programs they administer. The State is not anticipating any major changes to these vendor relationships at this time.
Attachment D 83-Compliance -Vendor maintains professional liability insurance that exceeds $1 million per claim. RFP document calls for $3 million.
State’s Response: The correct requirement is $1 million per claim for professional liability insurance. The reference to $3 million in the RFP document was incorrect.
11. In Section 1.6, it states that attachments must be limited to 20MB in size. Does the state have access to a mass storage like dropbox, where we can drop our submission of the RFP into, if over the size limit? If that is not an option, will multiple emails be allowed if the file size is too large for a single email?
State’s Response: The State does not provide access to a mass storage solution such as Dropbox for RFP submissions. If your submission exceeds the 20MB attachment limit, multiple emails will be accepted.
Please ensure all emails are clearly labeled so the State can confirm receipt and assemble the complete submission.
File details come from the government source that posted it. Updated .