RFP# 2026-01 - Medical Coverage.pdf
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- Attached to
- RFP# 2026-01 – Medical Coverage
- Solicitation number
- RFP-118485
- Issued by
- Accomack County, Virginia
About this file
This is a Request for Proposal issued by Accomack County School Board in Virginia seeking medical coverage administration services effective October 1, 2026 through September 30, 2027. The County is requesting both fully insured and self-funded medical plan quotes from carriers and third-party administrators, with optional pharmacy administration services through either the responding vendor or a designated third-party provider. Proposals must address 30 significant evaluation criteria encompassing quality of care, financial stability, network access, service quality, cost competitiveness, wellness programs, and utilization management expertise. Responses are due by May 22, 2026 at 2:00 p.m. via electronic submission through eVA, with seven printed binders and a PDF on thumb drive delivered to Accomack County School Board, C/O Beth Onley, 23296 Courthouse Ave, Accomack, VA 23301. Financial exhibits must be emailed separately to Mark III Brokerage consultant Heath Thomas at Heath@markiiieb.com. No site visits or bidders' conferences are mentioned in the RFP. The contract term is one year with renewal quotes required by June 1, 2027 for subsequent plan years, indicating multi-year potential.
Pricing must be provided on a per-employee-per-month (PEPM) basis with itemized administrative fees for network access, utilization management, specific stop-loss coverage at $150,000 with 24/12 terms, and plan administration. All quotes must be firm and contingent upon no additional claims data beyond the RFP date. The incumbent carrier is Anthem, which has provided fully insured coverage since October 1, 2024, with no significant service issues reported. The prior carrier, United Healthcare, maintained coverage for over 20 years. Administrative fees must be guaranteed through at least September 30, 2027, and all pharmacy rebates must be returned to the school board quarterly with year-end reconciliation. The County will cover the cost of a Milliman analysis of network discounts if the selected vendor is chosen. Evaluation criteria are weighted as follows: pricing (25 points), plan design matching ability (20 points), network access matching (20 points), service and support (15 points), technology and implementation tools (10 points), and references (10 points). A 150-day advance notice is required for any rate increases or provisional changes, and responses must include transition of care procedures, compliance confirmations, and detailed service implementation plans.
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Text version
Request for Proposal
RFP# 2026-01
For
Accomack County School Board
April 20, 2026
Accomack County School Board Medical Request for Proposals Effective October 1, 2026
Mark III Proprietary Product Document
Enclosed is a request for proposal to provide medical coverage for Accomack County School Board in Accomac Virginia.
The effective date of coverage for this quote is October 1, 2026.
Enclosed are the following:
Significant Issues, General Information, Eligibility
Census Plan Change History Current Plan Designs Marketing Guidelines Network Questionnaire Deviation Specifications Form Experience Information (informational only as stop loss is not required)
You will be asked to address each significant issue, as defined within, with reasons and/or examples of why your firm should be selected by Accomack County School Board to provide coverage for their employees. Certain information must be returned with your response. You will need to review the entire bid specifications to formulate a response.
Your response is due no later than May 22, 2026 by 2:00pm. Please email Heath Thomas directly all financial exhibits. Please deliver seven binders and a complete PDF of the submission provided on a “thumb drive” to the address below.
Offers may be submitted electronically online via eVA using the Offeror’s established eVA Supplier Account. The entire proposal response including any / all attachments and any / all addenda must be submitted electronically in eVA no later than the closing date and time stated on the electronic solicitation posting.
To learn how to submit an online proposal in eVA please refer to the online supplier training page at: https://eva.virginia.gov/supplier-training-materials.html
The link to the video “Viewing and Responding to Solicitations” can be found on the Supplier Training Materials page at: https://www.youtube.com/watch?v=KSxcAkOekW0
It is the responsibility of the Offeror to ensure the proposal and all required attachments are properly completed, readable and uploaded to eVA by the date and time deadline stated on the electronic solicitation posting. Offerors should allow sufficient time to account for any technical difficulties they may encounter during online submission or uploading of documents. In the event of technical difficulties, suppliers should contact eVA Customer Care at 1-866-289-7367 or via email at eVACustomerCare@DGS.Virginia.gov.
Mark III Proprietary Product Document
Please note that along with submitting response electronically online via eVA: It is still required for offerors to email all financial exhibits to Heath Thomas and deliver seven binders to the address below.
All responding vendors need to adhere to the format of this Request for Proposal. This includes completing all enclosed forms and submitting all information requested. Incomplete information will inhibit the County’s ability to accurately evaluate your response. Failure to do so will disqualify your response.
Mark III is the consultant for Accomack County School Board and all questions should be sent directly to Heath Thomas. His contact information is as follows:
Heath Thomas Phone: 804-240-8986 Email: Heath@markiiieb.com
Send all RFP responses to:
Accomack County School Board C/O Beth Onley 23296 Courthouse Ave Accomac, VA 23301
The County Schools, its staff, nor elected officials should not be contacted regarding this RFP.
ALL quotes should be provided NET of COMMISSION.
Only carriers and third-party administrators are to respond to the RFP.
NOTICE: THE GOAL IS TO RECEIVE FIRM PROPOSALS.
QUOTES/RESPONSES THAT ARE CONTINGENT UPON RECEIVING ADDITIONAL CLAIMS DATA
BEYOND THE RFP DATE WILL BE VIEWED LESS FAVORABLY. FIRM STOP LOSS QUOTES ARE
REQUIRED. Clearly note all lasers if applicable.
* ALL PROPOSALS WILL BE CONSIDERED.
Confidential Information
The following information is proprietary and highly confidential. The request for proposal is being provided to you solely for the purpose of evaluating the customer, and coverage in question. Dissemination of the information contained herein shall be limited to your employees who are directly involved in the evaluation process. Under no circumstances is any of the information contained herein to be disseminated, disclosed, or otherwise communicated to any person or entity not involved in the evaluation process.
Bid Specifications
Mark III Brokerage, Inc prepared the enclosed specifications. Duplication or use of any part of the bid specifications, questions, or material contained herein, without the explicit consent of Mark III Brokerage, Inc., is strictly prohibited.
Significant Issues
The decision of Accomack County School Board to change from their current arrangements will be dependent, in part, upon the following significant issues:
1. Quality of Care provided to the employees and their dependents.
2. Sound financial status of your firm. To address this issue, include your most recent financial statement, ratings from A.M. Best, and Standard & Poor's.
3. Outstanding service, including, but not limited to, strong client service support, your home office underwriting, contracting and legal service departments, claims processing, and related customer service.
4. A strong network, which provides excellent access to hospitals and physicians in the locations where employees reside. Please complete a Provider Access Report using the following criteria: a primary care physician within 5 miles and a network hospital within 10 miles of the employee.
5. Competitive Provider Discounts.
6. Assistance in employee wellness strategies to include financial contributions for wellness incentives and programs.
7. UM/UR expertise.
8. Competitive fee structure.
9. Future stability of cost.
10. Providing comprehensive experience reports monthly to the client and Mark III so that an evaluation can occur on plan performance.
11. Vendor flexibility when plan design changes are necessary to meet the needs of the employees and the employer.
12. Ongoing quality service and a service team that is dedicated to solving problems that arise during the plan year.
13. An ongoing employee education program to assist the employees understanding of the plan's nuances.
14. The ability to provide a firm proposal for both administrative and financial services for the renewal, including stop loss by June 1, 2027. Please note in your response that you will provide the renewal quote by June 1, 2027
The quote for this year is for beginning October 1, 2026.
15. For carriers: The ability to provide medical only administration should use of a third-party pharmacy vendor be in the County’s best interest.
16. Please provide two quotes clearly noted with and without pharmacy administration.
17. Provide a full pass through of all rebates quote with all rebates being returned to the client quarterly as well year- end reconciliation if minimums are offered.
History
Accomack County School Board is being challenged to provide quality services at a reasonable cost to the taxpayers. As a result, the leadership is required to ensure that all aspects of the financial operation are as competitive as possible. Given this, Accomack County School Board wants to ensure that all components of the medical insurance program are competitive. The County is interested in identifying vendors that can provide a high level of service and have competitive costs to administer the health insurance program.
Carrier History
Since October 1, 2024 the Accomack County School Board has been covered under Anthem with a fully insured contract. Prior to that, the Schools’ was covered under United Health Care for 20+ years. There are no significant issues with the current provider.
Eligibility
• Each full-time employee certified for benefits whose customary employment, excluding overtime work, is at least 30 hours per week will be eligible to participate in the plan.
• Accomack County School Board has retiree coverage as well for pre-65 retirees.
Census
A census of the employees enrolled in all plans is attached which details the employee's age, sex, and the zip code where the employee resides. The census may be manipulated by actives, retirees, etc.
Plan Designs
When responding to the RFP, please provide quotes that as closely as possible match the current plan design provided in the request submitted. The current plan documents for medical are included in the request submitted.
Marketing Guidelines
These guidelines apply to a self-funded quote. Accomack County School Board is interested in exploring both self-funded options and fully insured quotes.
IMPORTANT: If vendors, other than your firm, will be providing any services, they must also complete these Marketing Guidelines (where applicable) in addition to any specific questionnaires and cost illustration forms pertaining to their specific services.
1. Please attempt to duplicate the current plan design and benefit provisions.
2. Please provide self-funded quote for the medical coverage for admin only along with your normally recommended programs. Please note if vendors other than your firm will be used to provide any service (Utilization Review, Utilization Management, PPO network, Pharmacy, Mental Health/Substance Abuse, etc.).
3. The effective date of coverage is October 1, 2026. Confirm that your administrative fees are guaranteed until September 30, 2027 at a minimum. If you are willing to guarantee your administrative fees for a longer period, please indicate the maximum guarantee period.
4. A 150-day advance notice of renewals, rate increase and/or provisional changes is required to be furnished to Mark III always throughout the policy year should there be reason for a change.
All renewals will due no later than June 1st of each policy period for an October 1 effective date.
Please confirm agreement. Please insure all account management staff are informed of this requirement as well as underwriting. This will not be negotiable.
5. Will you agree to waive the "actively at work" provision? That is, anyone who is eligible for coverage on the effective date of the contract, but is not actively at work due to vacation, leave, sickness, etc., will become covered?
6. Will you agree to "no-loss/no-gain" for all persons currently insured? That is, no one will be placed in less favorable position due to a change in carriers than if there had been no change, including giving credit for waiting periods partially or completely met and for current treatment practices. Given there are no pre-existing condition provisions allowable under ACA, this really should not be an issue but please confirm.
7. Pre-existing conditions are not to be applicable for any current employee or covered dependent and not allowable under ACA. Please confirm agreement.
8. Confirm that you will email our office a monthly paid claims report (separated by product line as well as medical and pharmacy). Include the number of covered employees, administrative fees, and paid claims. Please indicate if there are any charges for providing this service. Stop loss reimbursements must be sent to us as well.
9. Are there any administrative costs built into your claims data? For example:
a. Capitation
b. Network Access Fees
c. Mental Health/Substance Abuse
d. Provider fees
e. Vision
f. Nurse Line
Please describe any administrative costs that are outside a pure claim including value based pricing fees and note if billed as an administrative fee if applicable.
10. Any current or future COBRA participants must be covered in your proposal. Please confirm.
11. Please indicate if your firm is compliant with HIPAA standards for Privacy of Individually Identifiable Health Information.
12. The County has retiree coverage until employees are age 65. Both age and years of service determine retiree status. Please confirm that retirees will be covered under the plan.
Mark III Proprietary Product Document
13. From what office will you service this account? Who would be the representative(s) assigned to this account? Describe in detail.
14. Do you agree to provide all processing and settlement of claims data? From what office would you pay claims? Would there be a dedicated unit? If so, what is the size of that unit? Is there a toll-free number to the claims office which is available to employees? Describe in detail.
15. Please describe the procedures that a claimant would use when claim problems need to be resolved. Would you have a designated person(s) for the insured to contact regarding claims questions? How many? Would the person answering questions from insured be the actual person who processes the claims for the group? Describe in detail.
16. If your services are terminated, how do you handle coverage for an employee who is disabled or hospitalized on the date of termination? What are the extended benefits under your contract?
17. How do you define an open enrollment at the anniversary date?
18. The Coordination of Benefits provision is currently based upon 100% of allowable expenses.
Please confirm that you will use COB and all other prudent cost control procedures in adjudicating claims. How do you determine whether other benefits are payable due to COB and/or subrogation? What procedures do you follow? Please describe your procedures for recovering duplicate payments. Describe your internal claims audit procedures.
19. Will you agree to provide SPD booklet drafts one month before the effective date for review? Will you agree to provide all employees and dependents with their ID cards prior to the effective date?
20. Confirm that you will prepare and distribute all necessary forms (i.e. enrollment) if any are required, including your marketing materials for your programs.
21. Do you have the ability to monitor plan eligibility for dependents, retirees, and retiree dependents; automatically notify members and terminate those no longer eligible for coverage;
and notify Accomack County School Board of such terminations.
22. Please describe your employer online enrollment capabilities (i.e., timing of the change in the systems (real time or delay), can ID cards be printed, etc.).
23. There will be some additional modest printing costs that are associated with the open enrollment period for the County. Confirm that you will pay for those printing costs associated with your program.
24. Please provide a copy of your most recent financial statement and your current rating for the following (include date of rating):
A.M. Best S&P Moody’s
25. In the event you are chosen as the medical plan administrator, please describe how employees and dependents that are currently receiving medical treatment (i.e. last trimester of a pregnancy, scheduled surgery) from a physician that is not in your network are treated for transition of care issues?
26. Please describe your implementation process. What guarantees are you willing to provide regarding implementation?
27. If you have any charges, which are not addressed in your quotation, please describe fully.
28. Are you prepared to place a percentage of your remuneration at risk as a penalty for substandard performance relating to member services or patient satisfaction? If so, please explain, including how your performance will be evaluated.
29. Please provide a list of three of your public sector clients that have 500 or more employees who have medical coverage with your firm.
30. Describe any deviations from these specifications in the Deviation from Specifications Form. Points not addressed will be construed to comply with these specifications.
31. Do you provide an Internet based administrative system for the employer to use for eligibility? Does this system allow the employer to retrieve claims reports? What Internet tools do the employees have?
Questionnaire – Network
Mark III Proprietary Product Document
1. Please describe your PPO/POS network. Is it local or part of a national chain? Is it hospital or physician based (i.e., IPA, Group Model, Staff Model), or other? Please explain. If you are quoting anything other than these products, please outline those products as well.
2. Indicate the method used to reimburse providers.
a. Are hospitals reimbursed on a per diem, fee-for-service, discount off charges, DRG, capitation, or other method?
b. Are primary care physicians reimbursed on a per diem, fee-for-service, discount off charges, DRG, capitation, salaried, withhold, bonus structure, combination or other method?
c. Are specialists reimbursed on a per diem, fee-for-service, discount off charges, DRG, capitation, salaried, withhold, bonus structure, combination or other method?
d. Are there discounts for other types of providers within your PPO/POS network such as pharmacy, lab, and X-rays? If so, please describe your strategy and average discounts.
3. What is the overall average discount of normal billed rates for your PPO/POS physicians and for your PPO/POS hospitals in the area?
How do you calculate network savings? Do you include deductibles, copays, and coinsurance? Do you calculate the savings based on when first adjudicated or when they are finally adjudicated?
4. What hospitals are in your network? Please enclose a complete listing of all providers in the PPO/POS network. Enclose a current physician directory clearly indicating which are not accepting new patients. In the case of hospitals, indicate whether full services are provided, or limited specialized services.
5. Please provide a complete employee zip code match for your PPO/POS zip code service area. Use one primary care physician within 5 miles and a network hospital within 10 miles as your criteria. Give the number of primary care physicians in the network area. Give the number of primary care physicians taking patients.
6. Do you require an on-site inspection of the physicians' offices as part of the initial credentialing?
7. If an IPA is in the network, will each individual physician automatically be accepted?
8. Do you require covering physicians (weekend, holidays, etc.) to meet the same credentialing criteria as network physicians?
9. How often do you re-credential physicians/providers?
10. Do you independently verify the following credentials with the issuer?
a. State licensure
b. American Board of Medical Specialist Board Certification
c. Hospital staff privileges
d. Drug Enforcement Agency License
e. National Practitioner data bank
f. Professional liability insurance
11. Will you contract with specific providers and tailor the network to meet specific client needs?
12. How will out of network area care be handled? What are the procedures and penalties?
13. What is your procedure for handling referrals to specialists? Describe how the patient referral process works from the primary care physician to the specialist? Is there any financial penalty to the primary care physician for making a referral to the specialist?
14. How do you monitor the number of referrals made by your physicians and how do you encourage them to refer to other preferred providers?
15. What mechanisms do you use to channel patients to participating hospitals if the proposed admission is to a non-preferred hospital? Are you able to provide data on a routine basis showing proposed admissions to non-preferred hospital, which were channeled by you to preferred hospital? Are you able to provide this data by hospital?
16. Explain in detail your network provider selection criteria for both physicians and hospital
(i.e. Board certification, malpractice history, range of services offered, etc.). What are the minimum criteria that hospitals, ancillary providers, and physicians must meet before being admitted to your network?
17. When a physician drops from the network (for any reason), what are the procedures to notify the patient and employer?
a. How and when are they notified?
b. Who notifies the plan and the physician's office?
Mark III Proprietary Product Document
c. How often are provider lists updated to reflect these changes?
d. Is the update provided online?
18. Identify how you monitor the following areas to ensure quality of care:
a. Outcomes
b. Frequency of service (i.e. x-rays, lab tests, etc.)
c. Intensity of services
19. For the last three years, please provide the following based on your Virginia data:
a. The number of hospital days per 1,000 participants
b. The number of admissions per 1,000 participants
c. The average length of stay
d. A breakdown of hospital admissions by type of admission (medical/surgical, obstetrical, psychiatric, etc.)
e. The number of office visits per 1,000 participants
20. Do you periodically visit the provider offices? If so, what aspects of the setting are evaluated?
21. Do you conduct employee satisfaction surveys free of charge to the client? Are they client specific or based on your book of business? If so, how frequently are they conducted?
Please provide a copy of your latest employee satisfaction survey.
22. Confirm that your quoted fees for your network include:
a. Combined hospital and physician network
b. Inpatient and outpatient utilization review and large case management
c. Provider credentialing
d. Quality monitoring program
e. Custom print provider directories for each employee
f. Identification cards for each employee and family
g. Recruiting additional providers at client request
h. Network performance reports
i. Other (Please list any charges that is not listed)
23. Network Location:
PPO Network Location
Mark III Proprietary Product Document
Location Counties
Number of Hospitals
Number of PCPs
Number of Specialists
Number of Skilled Facilities
Home Health Care Agency Available
Lab Facilities Available
Number of Pharmacies
Vision Providers
Accomack County, Virginia Northampton County, Virginia Virginia Beach City, Virginia Norfolk City, Virginia Newport News, Virginia Wicomico Maryland Somerset, Maryland Worcester, Maryland
24. Please provide discounts by location based on the census provided using the grid below and inserting zip codes from the census:
Average 2024 Discounts – Accomack County School Board 3-Digit Zip
Code Employee
Count Inpatient Outpatient Physician Total Hospital Lab Radiology
Total
Please add rows as needed.
Pharmacy:
1. For prescription drugs, do you use an outside vendor? If so, whom?
2. Carriers and Medical TPAs: Please provide pricing with and without pharmacy administration.
3. Do you rely on a formulary, require step therapy, or require prior authorization for certain drugs? Are there any specifically excluded drugs or limitations on drugs available? If so, are changes on the limitations communicated to the employees?
4. Please describe your mail order drug program.
5. Describe your specialty services to handle specialty medications. Are these medications paid as part of the pharmacy plan or medical plan? Describe your management of this class of drugs.
6. Are you able to carve out specific pharmacies in your network should the employer decide to do so?
7. Please describe unique characteristics that make your management of the pharmacy administration a positive for the County.
8. If specific local pharmacies will agree to your mail order pricing, will you contract with them for a 90-day supply?
9. Please provide a pharmacy offer with all rebates returned to the client. No traditional pharmacy quote is desired with spread pricing.
Please outline your definition of a generic and brand under your pharmacy offer.
10. Define all fixed costs for pharmacy administration. Please complete the grids below:
Administration Cost Cost Per Electronic Claim Cost Per Paper Claim Dispensing Fee for Retail Brand Dispensing Fee for Retail Generic Dispensing Fee for Mail Order Brand Dispensing Feel for Mail Order Generic Identify any compensation sent to a third party
Guaranteed Rebate per Script
Brand
Discount from Average Wholesale Price Retail Brand Retail Generic Mail Order Brand Mail Order Generic
Annual Reporting:
Provide a year-end report, outlining the following:
a) claims discounts versus the average wholesale price for brand and generic on both a retail and mail order basis
b) amount of dispensing fees paid during the year
c) Account of manufacturer rebates for prescriptions taken by members
d) Generic utilization rate and amount of savings available for drugs filled as brand name when a generic drug was available.
Utilization Management:
1. Describe your utilization review process. Specifically discuss the use of pre-admission certification, concurrent review, retrospective review, unnecessary outpatient utilization and discharge planning. Please distinguish between in-network and out of network services if procedures differ in any way.
2. Describe how utilization management services will be provided (locally, regionally, etc.)
Does the level or intensity of UM service change by the type of product (ACO, POS, HDHP, and PPO)? Can you change the intensity of utilization management as directed by the employer?
3. Do you have any programs that specifically address mental health or substance abuse utilization? Please describe.
4. Please specify your hours of operation for customer service and utilization review services.
What happens if a patient or provider calls at other times? Is there a single telephone number for all areas and is it toll-free for callers?
5. For your utilization management program, how are RNs, LPNs, or other medical or technical personnel used in the review process? Are all calls initially answered by an RN/LPN or screened by other personnel?
6. How many physicians are available to review cases that the review coordinator declines to certify? How many of these physicians are your company's employees? How are they selected?
7. What guidelines are in place for determining how quickly these physicians are contacted and how quickly they discuss the case with the attending physicians?
8. What threshold (dollars, days, diagnosis) is used for case management intervention?
9. Who has the authority to deny certification of a proposed admission or continuing care?
What processes are followed in such cases, and who is notified, and within what time frame?
10. Based on the utilization statistics included in the claims data, what level of improvement do you expect to achieve? Will you guarantee this result? How? Does your company guarantee that savings resulting from the UR program will exceed the administrative cost to the employer?
11. What is the ratio of covered lives to number of case managers (e.g., referral and pre-authorization management)?
12. Does your organization provide self-care products (e.g., decision books) and demand management resources (e.g., nurse lines)? If yes, please provide information and pricing.
13. Does your organization provide specialized disease management programs (e.g., asthma, diabetes)? If yes, provide information and pricing by product. If subcontracted, what is the subcontractor’s name?
14. Do you have Return on Investment (ROI) data to support these products or services? Will you guarantee these results?
15. Will you consider a proportion of the return (i.e., savings) as payment for these products/services?
16. Do you have any inside limitations on durable medical equipment or medical supplies such as self-administered catheters or colostomy bags?
17. Please ensure your quote includes routine vision benefits in the medical fee and claims pick that are a part of your offer.
18. How many members does your company cover in Virginia and Nationally?
Mark III Proprietary Product Document
19. Describe your network coverage for dependents and retirees that are out of your service network?
Annual Reporting: Providing annual utilization report, detailing the hospitals and providers utilized indicating frequency of utilization and amount of claims paid, and network savings by physician, inpatient, outpatient, prescription drugs, and including wellness screenings data.
Self-funded Claims Administration
1. For what dates is your claim administration fees guaranteed?
2. What is your deposit requirement? How is it calculated?
3. What would cause your claim administration fee to increase during the policy year?
4. How long is your quote valid?
5. Do you have Professional Liability and Fidelity Bond coverage? What amounts?
6. Will you release the name of claimants, dollar amounts of medical plan payments, dates paid and condition monthly for large claimants?
7. Explain and outline your estimated total dollar cost guarantees (plan administration and claims) for the first year and renewal years? If you cannot offer total dollar cost guarantees, what cost guarantees can you offer the first year and subsequent years?
8. If your services are terminated, describe how run-out claims administration would be handled and the cost for those services.
9. If your services are terminated, describe how run-out claims administration would be handled and the cost for those services.
10. The renewal will be due by to Mark III Brokerage, Inc. by June 1st yearly with any rate increases and/or provisional changes. Please confirm your agreement.
11. Agree that at termination or expiration of the contract, all data and records necessary to administer the health care program shall be transferred to the new contractor within thirty days of Accomack County School Board’s request. Such transfer may be accomplished either by tape or by paper based upon the mutual agreement between the outgoing contractor and Accomack County. This data may include, but shall not be limited to:
calendar year deductible and annual out-of-pocket limit credits applicable for each member for services incurred prior to the termination date; large claimant data including dollar amounts paid, diagnosis and prognosis; and annual utilization reports.
12. Do you offer terminal funding liability? If so, what is the cost?
ADD: Where the Beneficiary has also filed a claim or an appeal under any law applicable to benefit entitlement, such as worker's compensation, unemployment compensation, or disability of any state, Vendor will recommend appropriate action (such as holding such claim in a pending file), or shall turn the claim over to Accomack County School Board if the claim becomes involved in legal action or proceedings under such laws.
Stop-Loss Coverage
1. Please quote no aggregate and quote a specific stop-loss limit of $150,000 at 24/12.
2. Include medical and pharmacy in the specific stop-loss coverage.
3. Is your proposal firm, without any contingencies?
4. What dates are your quoted rates guaranteed?
5. Please quote with the expectation that the contract will transition to a paid basis at renewal.
Plan Pricing: This must be completed and in the binder with your standard financial exhibits. Do not refer to your standard exhibits.
Complete this exhibit to be considered. If a fee is built into the admin fee, then simply put $0.00 by that particular fee.
Cost Illustration – Self-Funded Plan
October 1, 2026 – September 30, PEPM Administrative Fees
A. Network Access Fee $ B. Utilization Management Fee $ C. Specific Stop Loss Fee (24/12 & $150K) $ D. Plan Administration Fee $
Total Administration Fees (SUM:A-D) $ Claim Liability
PEPM Expected Monthly Paid Claims $
Please confirm your firm will cover the cost of a Milliman analysis of discounts via census should you win the bid.
Subsequent Renewals:
Each June 1 provide a detailed renewal underwriting analysis to Accomack County School Board for the upcoming October 1 plan year. This requirement is subject to change based on needs.
Detailed utilization data comparing current and prior years (if applicable) must be provided.
Scoring Summary
Evaluation Criteria Points
Pricing 25
Mark III Proprietary Product Document
Ability to match Plan Design 20 Ability to Match Network Access 20
Service and Support 15 Technology/Tools/Implementation 10
References 10
Deviation Specifications Form
Please Check One:
( ) Our proposal adheres to all items specified in the Request for Proposal. If chosen as the vendor, we will agree to abide by the terms of our response to this RFP.
( ) Our proposal adheres to all items specified in the Request for Proposal, except as detailed below. If chosen as the vendor, we will agree to abide by the terms of our response to this RFP.
Signed by:
Company Name:
Name and Title:
Date:
| Request for Proposal |
| RFP# 2026-01 |
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