RFP_3015_25.pdf

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BIDDERS MUST RESPOND TO THE ELECTRONIC RFP (eRFP)

LOCATED ON PROPOSALTECH.

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State of New Hampshire

REQUEST FOR PROPOSAL

For

ADMINISTRATION OF MEDICAL BENEFITS

RFP # 3015-25

RESPONSE DUE BY:

April 17, 2025 at 2:00 PM Eastern Time (ET)

Department of Administrative Services Division of Risk & Benefits

TABLE OF CONTENTS

1 Introduction

A. Background B. Objective

2 Bidding Instructions and Conditions

2.1 Proposal Conditions

2.2 Estimated RFP Timetable

2.3 Evaluation Process

2.4 Step #1: Minimum Qualifications

2.5 Step #2: Technical Scoring & Performance Guarantees

2.6 Step #3: Financial Scoring

2.7 Step #4: Contract Award

2.8 Bidder Contacts

3 Required Plan Designs, Services and Programs A. Plan Design B. Preferred Outpatient Surgery and Lab Locations Plan Provision C. General Services D. Value-Based Purchasing Services E. Wellness Program F. Incentive Shopping Program G. Implementation

4 Network Access and Network Match

5 Performance Guarantees Implementation Operations Reporting Clinical

6 Technical Questionnaire

6.1 Value-Based Purchasing

6.2 Administrative, Member, & Claim Paying Services

6.3 Reporting, IT & Data Integration

6.4 Claims and Appeals

6.5 Federal Compliance: Mental Health Parity and Addiction Equity Act Final Rule, Transparency in Coverage Final Rule, and No Surprises Act

6.6 Health Management Programs

6.7 Wellness Services

6.8 Preferred Outpatient Surgery and Lab Locations

7 Financial

7.1 Administrative Fees, Network Access Charges, and Wellness

7.2 Claim Costs - Provider Reimbursement & Discounts

7.3 Required Medical Trend Guarantee Administration Withhold

7.4 Provider Contracting Financial Impact

7.5 Commitment to Fee/Price Transparency and Contracted Services Flexibility

8 Client References

9 Appendices – Group Information

Appendix A: Required Plan Designs, Services & Programs Appendix B: Provider Network and Access and Behavioral Health Services Appendix C: Definition of Terms Appendix D: Network Match, Preferred Outpatient Surgery and Lab Identification, Claims Repricing Appendix E: Employee Census, Monthly Enrollment, Monthly Claims Experience Appendix F: Plan Deviation Form Appendix G: State of NH Transmittal Letter Appendix H: P-37 Form Contract Appendix I: BUSINESS ASSOCIATE AGREEMENT Appendix J: REQUIRED PROTECTION OF CONFIDENTIAL INFORMATION AND DATA SECURITY

Appendix K: PARTICIPATING BIDDER AGREEMENT

State of New Hampshire RFP for Administration of Medical Benefits #3015-25

1 INTRODUCTION

1.1 This Request for Proposal (“RFP”) is issued by the Department of Administrative Services (DAS), acting through the Division of Risk and Benefits, for a contract for the administration of medical benefits as described herein.

A. Background The State of New Hampshire (“State”) self-funds and administers its Employee and Retiree Health Benefit Plan (HBP) for approximately 27,300 covered lives as summarized in the chart below. The covered population consists of active employees/dependents located throughout New Hampshire and the surrounding New England states. Included in the active enrollment is a “Special Group” of approximately 510 subscribers and their dependents from other organizations that have been either legislatively or traditionally offered coverage under the State's HBP. In addition, the State provides medical benefits to non-Medicare retirees/dependents located throughout the country. In this RFP document and the supporting information, the “Non-Medicare Retiree Plan” may also be referred to as the “Retiree <65 Plan”.

The chart below outlines the January 2025 enrollment by population and type of plan:

Active Plan Options Subscribers Dependents Total Members

HMO Plan 8,139 11,692 19,831

POS Plan 2,287 3,120 5,407

Total Actives 10,426 14,812 25,238

Non-Medicare Retiree Plan Subscribers Dependents Total Members

POS Plan 1,356 453 1,809

PPO Plan (Reside outside of New England) 221 73 294

Total Non-Medicare Retirees 1,577 526 2,103

Anthem Health Plans of New Hampshire has administered the self-funded medical benefits since January 1, 2008. The State is currently under contract with Express Scripts for Pharmacy Benefit Management Services.

Pharmacy benefits are not being considered in this RFP.

The State also provides a fully insured Medicare Advantage plan to its Medicare eligible retirees. The MAPD plan is under contract with Anthem and is not part of this RFP.

Every two years, the State collectively bargains employee health benefits, including plan design, health promotion programs and employee-facing initiatives, with the State's unions. There are several unions represented, including the New Hampshire State Employees' Association of New Hampshire, SEIU 1984 (SEA), the New Hampshire Trooper's Association (NHTA), NHTA - Command Staff, Teamsters Local 633 and the New England Police Benevolent Association (NEPBA) with multiple Locals. At this time, all unions have agreed to the same plan designs and programs.

B. Objective The State has two main objectives for the RFP:

1. The State is seeking proposals to provide medical administration services for its self-funded Employee and Retiree Health Benefit Plan (HBP), including the services and programs described in Section 3 of this document.

Important Notice: As a requirement of this RFP, the selected Bidder shall demonstrate their ability to offer preferred outpatient surgery and lab locations where plan participants can seek services not subject to their deductible that would typically apply for these same services performed at non-preferred locations. The selected Bidder shall demonstrate these preferred locations are available in all geographic regions of New Hampshire. (Section 3.1.B provides a description of the current “Site-of-Service” program.) If the Bidder does not have existing preferred outpatient surgery and lab locations in all geographic regions of New Hampshire, the Bidder shall include in its bid (as requested in Section 6.8) a plan to establish preferred location access to all geographic regions. The State will not enter into an Agreement with a selected Bidder that cannot demonstrate preferred outpatient surgery and lab locations in all geographic regions of the State.

2. The State seeks to partner with its third-party medical plan administrator (TPA) to enhance the quality and cost-effectiveness of health care purchased by the State through a comprehensive, value-based approach to purchasing, contract management and payment. The partnership shall involve collaboration between the State and its TPA in all aspects of purchasing, provider contracting and activating members with the ultimate goal of changing the way healthcare is delivered to all members of the State's plan in support of total population health.

As mentioned above, all unions have independently agreed to the same plan design and programs. The State requires Bidders to duplicate the current plan design for the active plans. (See Appendix A for the current active plan design.) The current Collective Bargaining Agreements (CBA) are effective through June 30, 2025;

however, each CBA has an evergreen provision. Medical benefit changes are typically implemented on a calendar year basis.

The State's contract with a third-party medical plan administrator requires the TPA to implement any changes in plan design or coverage resulting from collective bargaining throughout the term of the contract. In addition, the TPA shall provide financial modeling to assist the State with consideration of plan changes. It is possible for the State to be required to manage multiple plan designs to comply with each of the collectively bargained units. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required under collective bargaining agreements.

The State also requires that Bidders duplicate the current retiree health benefit plans due to current legislative authorization. (See Appendix A for the current retiree plan design.) Additionally, the State's contract with a TPA requires the TPA to implement any changes in plan design or coverage resulting from legislative authorization throughout the term of the contract. In addition, the TPA shall provide financial modeling to assist the State with consideration of plan changes. The State reserves the right within any contract awarded under this RFP to re-negotiate elements of the contract as required by legislative changes.

It is essential that the Bidder “duplicate” plan design, and provide similarity in services, statewide network and program access for plan members. See Section 3 and Appendix A for plan design, services, and programs and Section 4 for network access and match.

Value-Based Purchasing and Contracting Objectives As stated above, one of the State's major objectives is to partner with its third-party medical plan administrator to enhance the quality and cost-effectiveness of health care purchased by the State through a comprehensive, value-based, measurable approach to purchasing, contract management and payment.

The State requires bidders to describe the methods and programs that demonstrate how they will promote and incentivize member utilization of high quality, cost effective providers. Discuss multiple strategies used which may include any of the following: strategic provider contracting, risk sharing programs, bundled payment strategies, centers of excellence, primary care and specialty care transformation, performance-based provider compensation programs, etc. Bidders should include how provider performance is measured.

The State's value-based purchasing (VBP) strategy will require the selected Bidder to work proactively and collaboratively with the State to achieve objective and measurable improvements in performance. VBP involves ongoing performance measurement and actively working to move performance along a continuum at the TPA and healthcare provider levels. For example, the State will require the successful Bidder to develop and report on annual improvement goals and measures. The selected Bidder will participate in semi-annual meetings with the State to review its progress towards the improvement goals and its performance to contract standards.

Coordinated activity across the Bidder's provider contracting, network management, and quality improvement functions are required for the selected Bidder to be successful in this VBP approach. To meet the objectives for this procurement, the State seeks a partner who will:

manage a network of providers that is accessible and responsive, assure continuity and quality of care;

provide care management and service coordination, and maximize program efficiencies and patient activation;

implement successful alternative payment models to create financial support and incentives for healthcare providers to focus on the value of healthcare services rather than the volume of services;

provide reporting that effectively illustrates the ROI on the above-mentioned payment models;

improve and enhance primary care services and care coordination provided to members, including the integration of behavioral health services and physical health services;

work collaboratively with the State, and any outside vendor the State engages, to continuously improve health care provided to our members and improve their health status, including the methods of measurement used to demonstrate improvement along a continuum; and proactively offer suggestions and recommendations throughout the contract period for strategies that enhance the State and the TPA's efforts to improve quality and cost-effective healthcare purchasing, including but not limited to, encouraging healthcare provider engagement and member activation toward an overall improved health status and how it will be measured.

The State recognizes the importance of applying a variety of incentives and disincentives for demonstrated selected Bidder performance. The State will work with the selected bidder to develop a Performance Report Card to assemble performance indicators that assess dimensions of the selected Bidder's performance. It is the State's objective to recognize the selected Bidder for their excellence in performance and improvement within existing financial constraints. Performance incentives and disincentives will be linked to some of the measures in the Performance Report Card.

Contract Length & Specifics The contract shall commence upon approval of the Governor and Executive Council (the “effective date”), through December 31, 2029 with the option to extend for up to two additional years as mutually agreed by the parties and approved by the Governor and Executive Council (G&C). Implementation activities shall commence within seven days of Governor and Executive Council approval but in no event earlier than August 1, 2025. The administrative services outlined in this RFP shall commence on January 1, 2026. Payments for contractual services shall commence January 1, 2026 and shall not be made during the implementation period.

2 BIDDING INSTRUCTIONS AND CONDITIONS

2.1 PROPOSAL CONDITIONS

2.1.1 Mandatory Instructions for Bidders

Interested bidders must read the entire RFP, complete all sections of the RFP and submit the required documents in the manner specified in the RFP by the stated proposal submission deadline. Electronic responses must be completed and submitted through ProposalTech. Bidders are responsible for reviewing the most updated information related to this RFP before submitting proposals.

Each bidder is required to provide an electronic copy of the State of New Hampshire's Transmittal Letter (see Appendix G), signed by a person authorized to bind the company to all commitments made in the RFP response.

The legal entity that would be entering into a resulting contract with the State must be the same legal entity submitting a proposal and signing the Transmittal Letter (e.g. no trade names).

Failure to follow these instructions may be grounds for rejection of your RFP response.

2.1.2. RFP Inquiries

Any questions regarding how to use ProposalTech should be directed to Proposal Tech Support at 877- 211-8316 x84.

All other questions regarding this RFP, including questions related to the form contract P-37, must be submitted to Abigail Poole, the State's point of contact, at abigail.f.poole@das.nh.gov. All questions must be submitted in writing prior to the deadline for Bidder Inquiries and/or Requests for Clarification (March 27, 2025 at 3:00 ET). The questions will be consolidated and/or paraphrased and responded to via a written addendum, or addenda that will be posted on the State's website on or before April 3, 2025. Note that this date is subject to change at the State's discretion. In addition, the bidder inquiry addenda will be visible in ProposalTech.

In response to requested exceptions to the P-37, the State will review requested exceptions and accept, reject or note that it is open to discussion of the proposed exception at its sole discretion. Questions about or requested exceptions to the RFP, P-37, and/or any relevant attachments not raised during the inquiry period are waived. Oral statements, representations, clarifications, or modifications concerning the RFP shall not be binding upon the State.

The State may, at its discretion, amend this RFP on its own initiative or in response to issues raised by inquiries as it deems appropriate.

RFP inquiries must be submitted by an individual authorized to commit the organization to provide the services necessary to meet the requirements of this RFP. The Bidder must include complete contact information including the Bidder's name, telephone number, and e-mail address.

Appendix K is a Participating Bidder Agreement (PBA) which must be filled out and sent to Emily Peters through the messaging feature in Proposal Tech to obtain data referred to in Appendices D and E. Upon receipt of a Bidder's signed PBA (Appendix K), Segal will check to see if the Bidder has a current Global or Bid-Related NDA on file with Segal. If there is no NDA on file with Segal, an NDA document will be issued to the Bidder for signature.

No data will be issued without first having a signed NDA on file.

Upon receipt of the newly signed NDA, or confirmation of an existing NDA on file, Segal will establish a secure workspace and upload the data files. A system-generated email with instructions for accessing the workspace will be sent to the Bidder's designated data recipient.

2.1.3. Addenda

In the event it becomes necessary to add to or revise any part of this RFP prior to the scheduled proposal submittal deadline, the Division of Risk and Benefits shall post any Addenda on ProposalTech and the State's Bidder website. In the event of an addendum/addenda to this RFP, the State, at its sole discretion, may extend the proposal submission deadline, as it deems appropriate. Before submission and periodically prior to the RFP closing, check the ProposalTech platform or the State website for any addenda or other materials that may have been issued affecting the RFP. The website address is https://das.nh.gov/purchasing/vendorresources.aspx

2.1.4. Bidder Certifications

All Bidders must be duly registered as a Bidder authorized to conduct business in the State of New Hampshire. Bidders shall comply with the certifications below at the time of submission and through the term of any resulting contract. Failure to comply shall be grounds for disqualification of proposal and/or the termination of any resultant contract.

o STATE OF NEW HAMPSHIRE VENDOR APPLICATION: Prior to bid award, Bidders must have a completed Bidder Application Package on file with the NH Bureau of Purchase and Property.

See the following website for information on obtaining and filing the required forms (no fee):

https://DAS.NH.Gov/Purchasing o NEW HAMPSHIRE SECRETARY OF STATE REGISTRATION: A bid award, in the form of a contract(s), will ONLY be awarded to a Bidder who is registered to do business AND in good standing with the State of New Hampshire. Please visit the following website to find out more about the requirements for registration with the NH Secretary of State:

https://sos.nh.gov/corporation-division/

2.1.5. PUBLIC DISCLOSURE

The identification of confidential responses has been turned on for this RFP. If you feel that a response to a question contains proprietary/confidential information, click the “Disclosure” tab located underneath the question and check the box for “Exemption from Disclosure.” Provide a reason for the exemption in the text field provided. If you do not provide a reason for exemption, the question will not be considered answered. DO NOT make every response confidential. If you have any questions regarding this process, please contact ProposalTech Support at 877-211-8316 x84. See also the additional Public Disclosure information below.

A. DISCLOSURE OF INFORMATION SUBMITTED IN RESPONSE TO RFP

Information submitted in response to this RFP (including all materials submitted in connection with it, such as attachments, exhibits, addenda, etc.), any resulting contract, and information provided during the contractual relationship may be subject to public disclosure under the Right-to-Know, RSA 91-A.

Confidential, commercial or financial information may be exempt from public disclosure under RSA 91- A:5, IV. If you believe any information submitted in response to this RFP should be kept confidential, you must specifically identify such information for the State by following the redaction designation instructions in ProposalTech. Marking or designating an entire proposal, attachment or section as confidential shall neither be accepted nor honored by the State.

A Bidder that does not believe any information in its proposal to be exempt from disclosure must also provide a letter indicating as such to the Point of Contact indicated herein.

Submissions which do not conform to these instructions by failing to include redactions and related reasons for redaction, or a letter indicating the proposal does not include any confidential information, or by including redactions which are contrary to these instructions or operative law may be rejected by the State as not conforming to the requirements of the proposal.

Pricing, which includes but is not limited to administrative costs and performance guarantees, in your proposal or any subsequently awarded contract shall be subject to public disclosure regardless of whether it is marked as confidential.

Notwithstanding a Bidder's designations, the State is obligated by the Right-to-Know law to conduct an independent analysis of the confidentiality of the information submitted in a proposal. If a request is made to the State by any person or entity to view or receive copies of any portion of your proposal, or if the State otherwise wishes to make your proposal public, the State shall first assess what information it is obligated to release. If you have not provided redactions in your proposal the State will release the proposal in its entirety with only the redactions the State deems necessary (if any). If you have provided redactions in your proposal, the State will notify you that a request has been made or that the State wishes to make your proposal public. The State will indicate what, if any, information it has assessed is confidential and will not be released, and specify the planned release date of the remaining portions of the proposal. To halt the release of information by the State, a Bidder must obtain and provide to the State, prior to the date specified in the notice, a court order valid and enforceable in the State of New Hampshire, at its sole expense, enjoining the release of the requested information.

By submitting a proposal, you acknowledge and agree that:

o The State may disclose any and all portions of the proposal or related materials which are not marked as confidential and/or which have not been specifically explained in the letter to the person identified as the point of contact for this RFP;

o The State is not obligated to comply with your designations regarding confidentiality and must conduct an independent analysis to assess the confidentiality of the information submitted in your proposal; and o The State may, unless otherwise prohibited by court order, release the information on the date specified in the notice described above without any liability to you.

B. ELECTRONIC POSTING OF RFP RESULTS AND RESULTING CONTRACT

Pursuant to RSA 21-G:37, all responses to this RFP shall be considered confidential until the award of a contract. At the time of receipt of proposals, the State will post the number of responses received with no further information. No later than five (5) business days prior to submission of a contract to the Department of Administrative Services, the State will post the name and rank or score of each Bidder.

Pursuant to RSA 91-A and RSA 9-F:1, the Secretary of State will post to the public any document submitted to G&C for approval, including any resulting contract, on its website (https://sos.nh.gov/administration/miscellaneous/governor-executive-council/). By submitting a proposal, Bidder acknowledges and agrees that, in accordance with the above-mentioned statutes and policies, (and regardless of whether any specific request is made to view any document relating to this RFP), any contract resulting from this RFP that is submitted to G&C for approval will be made accessible to the public online.

2.1.6. TERMS OF SUBMISSION

The State assumes no responsibility for understandings or representations made by its officers or employees prior to and in the event of the execution of a contract, unless such understandings or representations are specifically incorporated into this RFP. Verbal discussions pertaining to modifications or clarifications of this RFP shall not be considered part of this RFP unless confirmed in writing. Any information provided by the Bidder verbally shall not be considered part of that Bidder's response. By submitting a proposal, a Bidder agrees that in no event shall the State be either responsible for or held liable for any costs incurred by a Bidder in the preparation of or in connection with the proposal, or for work performed prior to the effective date of a resulting contract. Proposals must be valid until the effective date of any resulting contract.

2.1.7. SUBMISSION FORMAT

Instructions, formats, and approaches for the development of RFP information contained within the RFP are designed to ensure that the submission of data essential to the understanding of the Bidder's response is received in a consistent and comparable format.

Bidder RFP response must be submitted using the ProposalTech platform. Paper submissions, or submissions in any other format, will not be accepted.

Detailed instructions for the completion and submission of your proposal will be found in the electronic RFP (eRFP) on ProposalTech. ProposalTech will be available to assist you with technical aspects of utilizing the system.

All sections must be answered completely and, as outlined in the RFP, using ProposalTech. It is not acceptable to use the term “See Attached” as a response to any of the questions, fee quotation forms, plan or network comparisons. Such a response may jeopardize your chances for consideration.

The State reserves the right to ask Bidders follow-up clarifying questions through ProposalTech as may be necessary to fully evaluate bidder capabilities.

2.1.8. PROPOSAL SUBMISSION DEADLINE

All RFP submissions must be submitted electronically, using the ProposalTech platform no later than 2:00 PM ET on Thursday, April 17, 2025. A complete RFP submission will include responses to all sections of the RFP, including a complete response to the financial section. Incomplete submissions or submissions received after the date and time specified will be marked as late and will not be considered.

A Bidder's disclosure or distribution of proposals other than to the Department of Administrative Services, Bureau of Purchase and Property, or ProposalTech shall be grounds for disqualification. No more than one (1) proposal per respondent shall be submitted.

Include one complete proposal with pricing as a separate document.

2.1.9. RFP DELIVERY

This RFP is being conducted electronically using the ProposalTech platform. A Bidder will not be able to submit their proposal until all required sections have been completed in their entirety. ProposalTech provides Bidders with a status of their proposal listed at the top of the page. Once a Bidder submits their proposal, the submission will be confirmed by the status changing to “Posted”. Bidders must submit (or “post”) their proposal by the specified deadlines indicated in Section 2.1.8.

The State shall not be held liable for any costs incurred by the Bidder in preparing or submitting an RFP response.

2.1.10. ADDITIONAL INFORMATION

The State reserves the right to:

o Make a written request for additional information from a Bidder to assist in understanding or clarifying a proposal response;

o Waive minor or immaterial deviations from the RFP requirements, if determined to be in the best interest of the State;

o Omit any planned evaluation step if, in the State's view, the step is not needed;

o Reject any and all proposals, or any part thereof. Note that participating in this RFP process in no way obligates the State to pursue a contract with any of the Bidders participating in the

RFP;

o Make independent investigation in evaluating a proposal.

o Consider available information regarding the Bidder, whether gained from the Bidder's proposal, question and answer conferences, references, or any other source during the evaluation process. This may include, but is not limited to, information from the New Hampshire Department of Insurance, as well as any other state or federal regulatory entity.

2.1.11. RESTRICTION OF CONTACT WITH STATE EMPLOYEES

From the release date of this RFP, all contact with the State regarding this RFP, except the point of contact specifically mentioned in Section 2.1.2 of this RFP, is prohibited. This prohibited contact includes personnel employed by or under contract with the State. Improper contact is grounds for rejection of your response.

2.1.12. CANCELLATION

Notwithstanding any other provision of this RFP, this RFP does not commit the State to award a contract. The State reserves the right, at its sole discretion, to reject any and all proposals, or any portions thereof; to cancel all or any part of this RFP at any time. Cancellation of this RFP, in whole or in part, shall not bar the State from issuing an RFP for the same services or from purchasing the same services through other means.

2.1.13. ETHICAL REQUIREMENTS

From the time this RFP is published until a contract is awarded, no Bidder shall offer or give, directly or indirectly, any gift, expense reimbursement, or honorarium, as defined by RSA 15-B, to any elected official, public official, public employee, constitutional official, or family member of any such official or employee who will or has selected, evaluated, or awarded an RFP, or similar submission. Any Bidder that violates RSA 21-G:38 shall be subject to prosecution for an offense under RSA 640:2. Any Bidder who has been convicted of an offense based on conduct in violation of this section, which has not been annulled, or who is subject to a pending criminal charge for such an offense, shall be disqualified from bidding on the RFP, or similar request for submission and every such Bidder shall be disqualified from bidding on any RFP or similar request for submission issued by any state agency.

2.1.14. SUBCONTRACTING

Contractor may perform certain services hereunder through one or more of its subsidiaries or affiliates.

However, pursuant to Section 12 of the form contract P-37, subcontracting of services shall require prior approval by the State. If Bidder plans to utilize subcontractors, subsidiaries, or affiliates, for any portion of the services identified in this RFP, please include the subcontractor information, to include an outline of the services or functions in which Bidder would plan to subcontract, the length of your relationship with the subcontractor, and a brief company profile. A list of these subcontractors shall be attached to the contract with the selected Contractor and shall constitute prior approval by the State (of those subcontractors) consistent with Section 12 of the form contract P-37.

Contractor must also notify the State of any service provider or system change that differs from what is outlined in the RFP response, whether the new provider is, or the new system is run by, a subcontractor, subsidiary, affiliate, the Contractor itself, or another entity. Such notification shall be required during implementation and throughout the term of the Agreement.

Contractor may, without prior written approval, contract with third-party vendors to provide ancillary services, which are not medical benefit administration services hereunder, but rather are services that support Contractor's conduct of its business operations.

Contractor shall be accountable for the performance of all subsidiaries, affiliates, partner networks and subcontractors and shall be responsible for all performance guarantee penalties that may result from underperformance of the subsidiary, affiliate and/or subcontractor.

2.1.15. REQUIRED CONTRACT TERMS AND CONDITIONS

a. The form contract P-37 (attached hereto as Appendix H) shall form the basis for any resulting contract. The successful Bidder and the State, following notification of award, shall promptly execute the P-37 contract, as amended by the parties to incorporate the service requirements of this RFP, price conditions established by the Bidder's offer, and any other reasonable administrative practices and services. In no event is a Bidder to submit its own standard contract terms and conditions as a replacement for one or all of the State's terms in response to this RFP.

In addition to the insurance requirements outlined in the P-37, Contractor will be required to obtain and maintain in force data security and cyber-liability insurance in an amount not less than $10 million as referenced in Appendix J, Required Protection of Confidential Information and Data Security.

The terms of this RFP and the selected Bidder's response will be used to form the terms of any resulting contract. References in the P-37 to Exhibits A, B, and C are references to the required structure of any resulting contract (Exhibit A - Special Provisions/Amendments to the P-37, Exhibit B - Scope of Services, and Exhibit C - Payment Terms) and are not references to sections of this RFP.

b. The Business Associate Agreement (attached hereto as Appendix I), is required to comply with the Health Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the HITECH Act applicable to business associates, shall be promptly executed by the successful Bidder and the State, following notification of contract award.

c. In addition to the Business Associate Agreement, the Bidder will be required to comply with the Required Protection of Confidential Information and Data Security (attached hereto as Appendix J).

d. State data will not be sold or aggregated for external reporting purposes without first consulting the State.

e. The State intends to incorporate this RFP and the selected Bidder's response into the resulting contract by reference. In the event there is a conflict between the resulting contract and the selected Bidder's response to the RFP the term more favorable to the State shall control.

2.1.16. DEBARTMENT

Vendors who are ineligible to bid on request for proposals, bids or quotes issued by the Department of Administrative Services, Division of Procurement and Support Services pursuant to the provisions of RSA 21-I:11-c shall not be considered eligible for an award under this RFP.

2.1.17. NON-COLLUSION

The Bidder's signature on a proposal submitted in response to this RFP guarantees that the prices, terms and conditions, and work quoted have been established without collusion with other vendors and without effort to preclude the State from obtaining the best possible competitive Proposal.

2.1.18. PROPERTY OF THE STATE

All material received in response to this RFP shall become the property of the State and will not be returned to the Bidder. Upon contract award, the State reserves the right to use any information presented in any proposal.

2.1.19. CHALLENGES TO IDENTIFICATION OF SELECTED VENDOR

Within five (5) business days of the State's posting of the rank or score on its website, Bidders may, in accordance with RSA 21-G:37, request that the agency review its selection process. The request must be in writing and must specify all points on which the Bidder believes the agency erred in its process and shall contain such argument in support of its position as the Bidder seeks to present. In its request for review, a Bidder shall not submit, and the State will not accept nor consider, any substantive information that was not included in the original proposal. The State will respond to the request within five (5) business days of its receipt.

2.1.20. NON-COMMITMENT

Notwithstanding any other provision of this RFP, this RFP does not commit the State to award a Contract. The State reserves the right, at its sole discretion, to reject any and all Proposals, or any portions thereof, at any time; to cancel this RFP; and to solicit new Proposals under a new acquisition process.

2.2 ESTIMATED RFP TIMETABLE

2.2.1

Action Due Date (Eastern Time)

RFP Released March 13, 2025

Deadline for Bidder Inquiries and/or Requests for Clarification

March 27, 2025 at 3:00 PM ET

Response to Bidder Inquiries and/or Requests for Clarification

No later than April 3, 2025

Proposal Submission Deadline April 17, 2025 at 2:00 PM ET

Contract Effective Date Upon Governor & Executive Council (G&C) approval (no earlier than August 1, 2025)

Contract Implementation Period G&C Approval through December 31, 2025

TPA Effective Date January 1, 2026

2.3 EVALUATION PROCESS

2.3.1 Segal has been retained by the State to assist in the evaluation of each Bidder's responses for completeness and responsiveness to the RFP and to assist in the review of such responses. The State's designated evaluation team will review and score Bidder responses and select the highest ranking proposal. All proposals will be evaluated in accordance with the State procedures set forth in Steps #1 through #4 below.

The State will conduct an initial screening to verify Bidder compliance with the proposal submission requirements set forth herein. The State may waive or offer a limited opportunity to cure immaterial deviations from the RFP requirements if it is determined to be in the best interest of the State.

2.4 STEP #1: MINIMUM QUALIFICATIONS

Each proposal shall be evaluated initially to determine compliance with the State of New Hampshire’s Minimum Qualifications. Any proposal that fails to meet one (1) or more of the following six (6) qualifications shall be eliminated from further consideration for this contract. Any proposal that meets all of the minimum qualifications shall be further evaluated in accordance with the State’s selection criteria. Therefore, to receive further consideration, a proposal must check “YES” to each of the following questions and, if applicable, comply fully with the “Submission Requirement(s)” for each such qualification.

2.4.1 Is the Bidder currently licensed to provide third party administration services for large group, self-funded health benefit plans in New Hampshire? Submission Requirements: Attach proof of licensure and good standing. The license shall remain current throughout the term of any resulting contract.

Single, Radio group.

1: Yes, 2: No

2.4.2 Is the Bidder able and willing to demonstrate its financial stability? Submission Requirements: a) Bidder's most recent financial report; b) most recent independent auditor's report; and c) SSAE 16, SAS-70, or equivalent external audit of Bidder's operations. Attach to proposal.

Single, Radio group.

1: Yes, 2: No

2.4.3 Does the Bidder currently have sufficient access to network providers (physicians, specialists and hospitals) regional and nationwide? Bidders must meet the following access standards: Physician Provider Access: 90% of eligible members access to two network physicians within 15 miles Hospital Provider Access: 90% of eligible members access to one network hospital within 15 miles Submission Requirements: Full and complete responses to the provider network information requests made in Section 4 of this RFP.

Single, Radio group.

1: Yes, 2: No

2.4.4 Is the Bidder able to demonstrate its ability to offer preferred outpatient surgery and lab locations in all geographic regions of the State (Section 3.1.B provides a description of the current “Site-of-Service” program) or include in its bid a plan to establish preferred location access to all geographic regions? Submission Requirements: Full and complete responses to the preferred outpatient surgery and lab location information requests made in Section 6.8 of this RFP.

Single, Radio group.

1: Yes, 2: No

2.4.5 Is the Bidder able to administer the current plan design for the active health plans for a January 1, 2026, effective date as outlined in Section 3.1.A? This includes two plan offerings: an in-network only benefit option (e.g., HMO, EPO) and an in-network/out-of-network benefits option (e.g., POS, PPO). Submission Requirements: Completion of Plan Deviation Form in Appendix F.

Single, Radio group.

1: Yes, 2: No

2.4.6 Is the Bidder able to administer the current plan design for the non-Medicare retiree health plans for a January 1, 2026 effective date as outlined in Section 3.1.A? This includes a plan that offers a national network and in-network/out-of-network benefits (e.g., POS, PPO). Submission Requirements: Completion of Plan Deviation Form in Appendix F.

Single, Radio group.

1: Yes, 2: No

2.5 STEP #2: TECHNICAL SCORING & PERFORMANCE GUARANTEES (40 TOTAL

POINTS)

2.5.1 The Bidder's response to information requested in Sections 5 and 6 of the RFP will be evaluated based on the extent to which the Bidder documents conformance with specifications, as well as the completeness, soundness, and creativity of the Bidder's response, all as evaluated by the State.

The State will evaluate proposals based on technical criteria, including:

Performance Guarantees - the extent to which the Bidder demonstrates a willingness to agree to the requested performance guarantees and the proposed dollar amount at risk. (Section 5)

Questionnaire Score - the extent to which the Bidder demonstrates its ability and experience in the categories indicated in the chart below in Section 2.7. (Section 6)

2.6 STEP #3: FINANCIAL SCORING (60 TOTAL POINTS)

2.6.1 A. Total Projected Costs Score (40 Points of Financial Scoring) - Sections 7.1 and 7.2

The proposals will be scored based on the total projected costs (i.e., claims and administrative costs) as determined by the State for the four-year period from January 1, 2026, to December 31, 2029. The lowest cost proposal will receive 100% of the 40 points allocated for the “Total Projected Costs” (TPC) Financial Score. All other financial proposals will be scored on a sliding scale where the bidder's score will be reduced by 1 point for every percentage point it is higher than the lowest cost proposal. As the scale is sliding, scores will be adjusted for partial percentage differences.

The following exhibit illustrates how the “Total Projected Costs” (TPC) financial score will be calculated from the 40 points available:

Formula Example, where:

Lowest Bid TPC = $1,000 and Bidder TPC = $1,025

A Cost Difference = (Bidder's TPC / Lowest Bid TPC) - 1 ($1,025 / $1,000) - 1 = 0.025

B Convert Decimal to Percent Value

= A x 100 0.025 x 100 = 2.5

C 1 Point Reduction per Percentage Higher

= 1 x B 1 x 2.5 = 2.5

Bidder's TPC Score = 40 - C 40 - 2.5 = 37.5

B. Required Medical Trend Guarantee Administration Withhold Score (5 Points of Financial Scoring) - Section 7.3

Five (5) of the financial score points are based on the Bidder's acceptance of the required medical trend guarantee. Acceptance of all aspects of the trend guarantee described within this section will receive all of the allocated 5 points. Proposed deviations that diminish the value of the trend guarantee will lower the Bidder's score.

C. Provider Contracting Financial Impact Score (5 Points of Financial Scoring) - Section 7.4 Five (5) of the financial score points are based on the Bidder's responses to the Provider Contracting Financial Impact questions and to the extent they offer competitive medical trend guarantees and demonstrate experience with Alternative Payment Models and other provider reimbursement strategies.

D. Commitment to Fee/Price Transparency and Contracted Services Flexibility Score (10 Points of Financial Scoring) - Sections 7.1, 7.2 and 7.5

Ten (10) of the financial score points are based on the Bidder's responses to the Commitment to Contracted Services Flexibility questions in Section 7.5, including their willingness to both allow the State to carve-out services from the contract and to reduce the administrative fees as a result. This score will also consider the Bidder's willingness to provide the requested detailed responses to the administrative fee and claims repricing exhibits in Sections 7.1 and 7.2.

2.7 STEP #4: CONTRACT AWARD

2.7.1 The State shall award a contract, if at all, to the Bidder submitting the highest ranked proposal. Formal and final selection of the Bidder, however, is contingent upon the successful negotiation and the proper execution of all contract documents (acceptable to the State) and the approval of the Governor and Executive Council and upon continued appropriation of funding for the contract. If the State is unable to reach agreement with the Bidder, the State may, at its sole discretion and at any time and without liability to the

Bidder, immediately terminate such contract discussions with the Bidder and undertake discussion with the Bidder submitting the next highest ranked proposal, and so on.

Evaluation of the proposals shall include, the criteria below. Bidders will receive scores up to the maximum points allocated to each item outlined below.

Criteria Points Section(s)

PERFORMANCE GUARANTEES 10 5

TECHNICAL QUESTIONNAIRE 30

Value-Based Purchasing 10 6.1

Administrative, Reporting, Appeals, Federal Compliance, Preferred Locations

10 6.2 to 6.5, and 6.8

Health Management Programs 5 6.6

Wellness Services 5 6.7

FINANCIAL* 60

Total Projected Costs 40 7.1 and 7.2

Required Medical Trend Guarantee Administration Withhold

5 7.3

Provider Contracting Financial Impact 5 7.4

Commitment to Fee/Price Transparency and Contracted Services Flexibility

10 7.1, 7.2 and 7.5

TOTAL POINTS 100

* All fees to be assumed by the State for all the requested services shall be included in the financial section of this RFP.

2.8 BIDDER CONTACTS

2.8.1 Designate the individual(s) responsible for representing your company during the RFP process and day-to-day service if awarded the contract.

RFP Process Day-to-Day Service Representative Name 5 words. 5 words.

Phone 5 words. 5 words.

Email 5 words. 5 words.

2.8.2 Non-Exclusive Contract:

1.1 Any resulting Contract from this RFP will be a Non-Exclusive Contract. The State reserves the right, at its discretion, to retain other contractors to provide any of the Services or Deliverables identified under this procurement or make an award by item, part or portion of an item, group of items, or total Proposal.

3 REQUIRED PLAN DESIGNS, SERVICES AND PROGRAMS

3.1 A. Plan Design

Due to the existence of collective bargaining agreements and required legislative authorization, the State requires Bidders to match the active and retiree plan designs.

Please review the attached Summaries of Benefits and complete the “Plan Deviations Form” located in Appendix F. If no deviations are provided on this form, it will be assumed that your organization can administer the current plan designs exactly as written in the following attached Summary of Benefits.

o State of NH Active HMO Plan.pdf o State of NH Active POS Plan.pdf o State of NH Ret U65 POS Plan.pdf o State of NH Ret U65 PPO Plan.pdf

B. Preferred Outpatient Surgery and Lab Locations Plan Provision

The State's Active Plans have an option that allows members to avoid paying the deductible for diagnostic lab tests and outpatient surgery services if the member chooses to use designated low-cost providers. The current provision is called “Site-of-Service” and it functions similarly to a tiered-network in that plan participants reduce (or avoid) out-of-pocket costs for using preferred providers and the plan benefits from utilization of low-cost providers.

See design summaries and the “Site-of-Service” benefit information in Appendix A.

The State's Active Plans are collective bargained with this plan provision. Your proposal must offer a benefit comparable to the current preferred outpatient surgery and lab feature. The following link provides “Site-of-Service” program information: https://www.anthem.com/stateofnhsaves/.

o Confirm that you are able to offer this feature.

o Provide a description of your preferred location offering including how pricing differentials factor into tiering.

o Indicate which providers are in your proposed preferred location offering in your response to the network section of this RFP (see Section 4.8).

o Indicate whether your preferred location offering includes other possible services that, if implemented by the State, could result in additional cost savings for the plan.

o As a requirement of this RFP, the selected Bidder shall demonstrate their ability to offer preferred outpatient surgery and lab locations in all geographic regions of the State. In the event that the Bidder does not have an existing preferred outpatient surgery and lab locations in all geographic regions of New Hampshire, the Bidder shall include in its bid (as requested in Section 6.8) a plan to establish preferred location access to all geographic regions.

C. General Services

To be eligible to receive a score for the Technical Questionnaire in Section 6, Bidders are required to offer comprehensive medical administration services with a full range of customer (client and member) service including, but not limited to:

Indicate the name and address of the legal entity providing any of the services below, if different than the bidding entity. If any of these services are offered by another legal entity (e.g., subcontractor, partner provider network), the State expects that the awarded Vendor will be responsible for all the other entities' actions in the operation of services provided to the State.

o Maintain the medical networks included in your proposal o Claims Adjudication - accurate, timely, appropriate claims processing. Also includes the ability to process multi-tier benefit levels for preferred networks/providers if selected o Member Enrollment and Eligibility Maintenance (providing necessary support to the State's eligibility, dental, flexible spending account (FSA), Health Reimbursement Arrangement (HRA), and pharmacy benefit management vendors) o Receive pharmacy claims data feed from the State's Pharmacy Benefits Manager to be used as directed by the State o Employer and Participant portal - 24/7 access, claims and EOB review, year to date out of pocket, etc.

o Wellness and other ancillary programs, including but not limited to:

On-site Flu Vaccination Clinic On-site Biometric Screenings State's preferred Digital Health App or one equal to preferred health app Community Health Education Reimbursement Program Diabetes Prevention and Management Program Nicotine Cessation Program Digital MSK program o Telemedicine o Patient and Provider Education o Disease Management o…