Dated 10/16/23

STATE OF SOUTH DAKOTA

BUREAU OF HUMAN RESOURCES AND ADMINISTRATION

500 EAST CAPITOL AVENUE

PIERRE, SOUTH DAKOTA 57501-3182

State of South Dakota Medical Network and Pharmacy Administration Services PROPOSALS ARE DUE NO LATER THAN 5:00 PM, CDT ON Monday, December 15, 2025

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FIRM NAME: AUTHORIZED SIGNATURE:

ADDRESS: TYPE OR PRINT NAME:

CITY/STATE: TELEPHONE NO:

ZIP (9 DIGIT): FAX NO:

E-MAIL:

PRIMARY CONTACT INFORMATION

CONTACT NAME: Peggy Canter TELEPHONE NO: 605.773.4099

FAX NO: 605.773.6947 E-MAIL: Peggy.Canter@state.sd.us

RFP #: 25RFP17863 State POC: Bureau of Human Resources and Administration - Peggy Canter

EMAIL: Peggy.Canter@state.sd.us

1.0 GENERAL INFORMATION

1.1 PURPOSE OF REQUEST FOR PROPOSAL (RFP)

The South Dakota State Employee Benefits Program offers self-funded Medical Benefits to Active employees. We are issuing this RFP for the Medical Network and Pharmacy Administration Services.

This tool must be available to support our Fiscal Year 2027 Annual Enrollment period, starting on or around April 15, 2026.

1.2 ISSUING OFFICE AND RFP REFERENCE NUMBER

The Bureau of Human Resources and Administration is the issuing office for this document and all subsequent addenda relating to it, on behalf of the State of South Dakota, Bureau of Human Resources and Administration. The reference number for the transaction is RFP #25RFP17863. This number must be referred to on all proposals, correspondence, and documentation relating to the RFP.

1.3 LETTER OF INTENT

Any interested offerors must submit a Letter of Intent and the completed Offeror Privacy and Security Agreement (Attachment B) by email prior to receiving Benefit Plan Census data and as described in Section 3.0: Scope of Work. The offeror must complete the highlighted portions in the Offeror Privacy Security Agreement.

The Letter of Intent and completed Offeror Privacy and Security Agreement must be submitted via email to Peggy.Canter@state.sd.us no later than 5:00 p.m. CDT. Please place the following in the subject line of your email: “Vendor Name – Letter of Intent for RFP#25RFP17863

The Letter of Intent must indicate the services for which the offeror will submit a proposal: Medical Network and Pharmacy Administration. Upon receipt of the Letter of Intent and completed Offeror Privacy and Security Agreement, the State will provide the census and claimes information.

1.4 SCHEDULE OF ACTIVITIES (SUBJECT TO CHANGE)

RFP Publication November 3, 2025 Letter of Intent Offeror Questions Due

November 7, 2025 (5:00 p.m. CDT) November 14, 2025

Responses to Offeror Questions November 25, 2025 Proposal Submission Due December 15, 2025 (5:00 p.m. CDT) Oral Presentations/discussions (if required) January 5, 2026 – January 12, 2026 Technical Review Final Vendor Selection

January 5, 2026 – January 12, 2026 January 16, 2026

Anticipated Award Decision/Contract Negotiation January 2026

There will be a determination made based on the proposal whether finalist interviews will be required. The finalist interviews, if needed, could be either requested in person or virtually. The prospective Contractor will be required to participate in all interviews.

1.5 SITE VISITS

The State may require site visits for offerors. Site visits if desired will be arranged by Peggy Canter.

1.6 SUBMITTING YOUR PROPOSAL

All proposals must be completed and received by the Bureau of Human Resources and Administration by the date and time indicated in the Schedule of Activities.

mailto:Peggy.Canter@state.sd.us

Proposals received after the deadline will be late and ineligible for consideration.

The offeror must provide one (1) copy of their entire proposal, including all attachments, in Microsoft Word, EXCEL or PDF electronic format by email to Peggy.Canter@state.sd.us. The email, including attachments, must be limited to 20MB in size. The State will only accept electronic proposals via email.

All proposals must be signed, in ink or electronically, by an officer of the responder, legally authorized to bind the responder to the proposal. Proposals that are not properly signed may be rejected.

No proposal shall be accepted from, or no contract or purchase order shall be awarded to any person, firm or corporation that is in arrears upon any obligations to the State of South Dakota, or that otherwise may be deemed irresponsible or unreliable by the State of South Dakota.

1.7 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY

EXCLUSION – LOWER TIER COVERED TRANSACTIONS

By signing and submitting this proposal, the offeror certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation, by any Federal department or agency, from transactions involving the use of Federal funds.

Where the offeror is unable to certify to any of the statements in this certification, the bidder shall attach an explanation to their offer.

1.8 NON-DISCRIMINATION STATEMENT

The State of South Dakota requires that all contractors, vendors, and suppliers doing business with any State agency, department, or institution, provide a statement of non-discrimination. By signing and submitting their proposal, the offeror certifies they do not discriminate in their employment practices with regard to race, color, creed, religion, age, sex, ancestry, national origin or disability.

1.9 CERTIFICATION RELATING TO PROHIBITED ENTITY

For contractors, vendors, suppliers, or subcontractors who enter into a contract with the State of South Dakota by submitting a response to this solicitation or agreeing to contract with the State, the bidder or offeror certifies and agrees that the following information is correct:

The bidder or offeror, in preparing its response or offer or in considering proposals submitted from qualified, potential vendors, suppliers, and subcontractors, or in the solicitation, selection, or commercial treatment of any vendor, supplier, or subcontractor, is not an entity, regardless of its principal place of business, that is ultimately owned or controlled, directly or indirectly, by a foreign national, a foreign parent entity, or foreign government from China, Iran, North Korea, Russia, Cuba, or Venezuela, as defined by SDCL 5-18A. It is understood and agreed that, if this certification is false, such false certification will constitute grounds for the State to reject the bid or response submitted by the bidder or offeror on this project and terminate any contract awarded based on the bid or response. The successful bidder or offeror further agrees to provide immediate written notice to the contracting executive branch agency if during the term of the contract it no longer complies with this certification and agrees such noncompliance may be grounds for contract termination.

1.10 RESTRICTION OF BOYCOTT OF ISRAEL

For contractors, vendors, suppliers, or subcontractors with five (5) or more employees who enter into a contract with the State of South Dakota that involves the expenditure of one hundred thousand dollars ($100,000) or more, by submitting a response to this solicitation or agreeing to contract with the State, the bidder or offeror certifies and agrees that the following information is correct:

The bidder or offeror, in preparing its response or offer or in considering proposals submitted from qualified, potential vendors, suppliers, and subcontractors, or in the solicitation, selection, or commercial treatment of any vendor, supplier, or subcontractor, has not refused to transact business activities, has not terminated business activities, and has not taken other similar actions intended to limit its commercial relations, related to the subject matter of the bid or offer, with a person or entity on the basis of Israeli national origin, or residence or incorporation in Israel or its territories, with the specific intent to accomplish a boycott or divestment of Israel in a discriminatory manner. It is understood and agreed that, if this certification is false, such false certification will constitute grounds for the State to reject the bid or response submitted by the bidder or offeror on this project and terminate any contract awarded based on the bid or response. The successful bidder or offeror further agrees to provide immediate written notice to the contracting executive branch agency if during the term of the contract it no longer complies with this certification and agrees such noncompliance may be grounds for contract termination.

1.11 CERTIFICATION OF NO STATE LEGISLATOR INTEREST

Offeror (i) understands neither a state legislator nor a business in which a state legislator has an ownership interest may be directly or indirectly interested in any contract with the State that was authorized by any law passed during the term for which that legislator was elected, or within one year thereafter, and (ii) has read South Dakota Constitution Article 3, Section 12 and has had the opportunity to seek independent legal advice on the applicability of that provision to any Agreement entered into as a result of this RFP. By signing an Agreement pursuant to this RFP, Offeror hereby certifies that the Agreement is not made in violation of the South Dakota Constitution Article 3, Section 12.

1.12 MODIFICATION OR WITHDRAWAL OF PROPOSALS

Proposals may be modified or withdrawn by the offeror prior to the established due date and time.

No oral, telephonic, telegraphic or facsimile responses or modifications to informal, formal bids, or Request for Proposals will be considered.

1.13 OFFEROR INQUIRIES

Offerors may email inquiries concerning this RFP to obtain clarification of requirements. No inquiries will be accepted after the date and time indicated in the Schedule of Activities. Inquiries must be emailed to Peggy Canter at Peggy.Canter@state.sd.us with the subject line “RFP #25RFP17863”.

The State will respond to offeror’s inquiries (if required) via e-mail. In addition, all inquiries and the State’s response will be posted on the state’s e-procurement system. Offerors may not rely on any other statements, either of a written or oral nature, that alter any specification or other term or condition of this RFP. Offerors will be notified in the same manner as indicated above regarding any modifications to this

RFP.

1.14 PROPRIETARY INFORMATION

The proposal of the successful offeror(s) becomes public information. Proprietary information can be protected under limited circumstances such as client lists and non-public financial statements. An entire proposal may not be marked as proprietary. Offerors must clearly identify in the Executive Summary and mark in the body of the proposal any specific proprietary information they are requesting to be protected.

The Executive Summary must contain specific justification explaining why the information is to be protected. Proposals may be reviewed and evaluated by any person at the discretion of the State. All materials submitted become the property of the State of South Dakota and may be returned only at the State's option.

1.15 LENGTH OF CONTRACT

The State is requesting proposals for a contract period of five years effective July 1, 2026, through June 30, 2031, with the State having the option of two (2) five (5) year extensions for a total of 15 years maximum. A maximum fee guarantee is required for the initial five-year term of contract. Renewal extensions are not guaranteed to occur.

1.16 GOVERNING LAW

Venue for any and all legal action regarding or arising out of the transaction covered herein shall be solely in CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT, HUGHES COUNTY,South Dakota. The laws of South Dakota shall govern this transaction.

1.17 DISCUSSIONS WITH OFFERORS (ORAL PRESENTATION/NEGOTIATIONS)

An oral presentation by an offeror to clarify a proposal may be required at the sole discretion of the State.

However, the State may award a contract based on the initial proposals received without discussion with the Offeror. If oral presentations are required, they will be scheduled after the submission of proposals.

Oral presentations will be made at the offeror’s expense.

This process is a Request for Proposal/Competitive Negotiation process. Each Proposal shall be evaluated, and each respondent shall be available for negotiation meetings at the State’s request. The State reserves the right to negotiate on any and/or all components of every proposal submitted. From the time the proposals are submitted until the formal award of a contract, each proposal is considered a working document and as such, will be kept confidential. The negotiation discussions will also be held as confidential until such time as the award is completed.

1.18 BIT STANDARD SECURITY CONTRACT TERMS AND CONDITIONS:

Due to the sensitive nature of the data involved in this RFP and the resulting contract, any contract resulting from this RFP will include the State’s standard IT security contract terms along with any additional contract terms as negotiated by the parties. Once a winning offeror is selected, the State will provide to the vendor the IT security terms that will apply to the contract. As part of the negotiation process, some of the IT security contract terms may be altered or deleted. There is also a list of technical questions called the “security and Vendor Questions” that an offeror may be required to complete upon begin selected as a finalist or as the winning offeror of this RFP. If these questions are requested to be completed prior to the selection of a winner, these questions may be used in the evaluation process.

1.19 TECHNICAL REVIEW

At the State’s discretion, the State may require a technical review of the offeror based on the offeror’s proposal and response to the Security and Vendor Questionnaire.

2.0 STANDARD CONTRACT TERMS AND CONDITIONS

Any contract or agreement resulting from this RFP will include the State’s standard terms and conditions as listed below, along with any additional terms and conditions as negotiated by the parties:

2.1 The Contractor will perform those services described in the Scope of Work, attached hereto as Section 3 of the RFP and by this reference incorporated herein.

2.2 The Contractor’s services under this Agreement shall commence on July 1, 2026 and end on June 30, 2031, unless sooner terminated pursuant to the terms hereof. The State will have the option to renew this Agreement for two (2) additional five (5) year periods as mutually agreed upon by all parties.

Renewal Options: At a minimum, renewal is contingent upon satisfactory performance of the contract by the Contractor as determined by the State. The Parties agree that the State may renew this Agreement at its option under the same terms and conditions, unless otherwise modified by a special contract term, condition, specification, or amendment. Notice of intent to renew will be given by the State to the Contractor at least 90 days prior to the end of the current contract term. If the notice of intent to renew is given, the Agreement will renew unless terminated by either party pursuant to the Termination provision of this Agreement.

2.3 The Contractor will not use State equipment, supplies or facilities. The Contractor will provide the State with its Employer Identification Number, Federal Tax Identification Number or Social Security Number upon execution of this Agreement.

2.4 The State will make payment for services upon satisfactory completion of the services. The TOTAL

CONTRACT AMOUNT is an amount not to exceed the agreed upon contract amount. The State will not pay Contractor's expenses as a separate item. Payment will be made pursuant to itemized invoices submitted with a signed state voucher. Payment will be made consistent with SDCL ch. 5-26.

2.5 The Contractor agrees to indemnify and hold the State of South Dakota, its officers, agents and employees, harmless from and against any and all actions, suits, damages, liability or other proceedings that may arise as the result of performing services hereunder. This section does not require the Contractor to be responsible for or defend against claims or damages arising solely from errors or omissions of the State, its officers, agents or employees.

2.6 The Contractor, at all times during the term of this Agreement, shall obtain and maintain in force insurance coverage of the types and with the limits as follows:

A. Commercial General Liability Insurance:

The Contractor shall maintain occurrence based commercial general liability insurance or equivalent form with a limit of not less than $3,000,000.00 for each occurrence. If such insurance contains a general aggregate limit it shall apply separately to this Agreement or be no less than two times the occurrence limit.

B. Professional Liability Insurance or Miscellaneous Professional Liability Insurance:

The Contractor agrees to procure and maintain professional liability insurance or miscellaneous professional liability insurance with a limit not less than $3,000,000.00.

C. Business Automobile Liability Insurance:

The Contractor shall maintain business automobile liability insurance or equivalent form with a limit of not less than $1,000,000.00 for each accident. Such insurance shall include coverage for owned, hired and non-owned vehicles.

D. Workers’ Compensation Insurance:

The Contractor shall procure and maintain workers’ compensation and employers’ liability insurance as required by South Dakota law.

Before beginning work under this Agreement, Contractor shall furnish the State with properly executed Certificates of Insurance which shall clearly evidence all insurance required in this Agreement. In the event a substantial change in insurance, issuance of a new policy, cancellation or nonrenewal of the policy, the Contractor agrees to provide immediate notice to the State and provide a new certificate of insurance showing continuous coverage in the amounts required.

Contractor shall furnish copies of insurance policies if requested by the State.

2.7 While performing services hereunder, the Contractor is an independent contractor and not an officer, agent, or employee of the State of South Dakota.

2.8 Contractor agrees to report to the State any event encountered in the course of performance of this Agreement which results in injury to the person or property of third parties, or which may otherwise subject Contractor or the State to liability. Contractor shall report any such event to the State immediately upon discovery.

2.9 Contractor's obligation under this section shall only be to report the occurrence of any event to the State and to make any other report provided for by their duties or applicable law. Contractor's obligation to report shall not require disclosure of any information subject to privilege or confidentiality under law (e.g., attorney-client communications). Reporting to the State under this section shall not excuse or satisfy any obligation of Contractor to report any event to law enforcement or other entities under the requirements of any applicable law.

2.10 This Agreement may be terminated by either party hereto upon 180 days’ written notice. In the event the

Contractor breaches any of the terms or conditions hereof, this Agreement may be terminated by the State at any time with or without notice. If termination for such a default is effected by the State, any payments due to Contractor at the time of termination may be adjusted to cover any additional costs to the State because of Contractor's default. Upon termination the State may take over the work and may award another party an agreement to complete the work under this Agreement. If after the State terminates for a default by Contractor it is determined that Contractor was not at fault, then the Contractor shall be paid for eligible services rendered and expenses incurred up to the date of termination.

2.11 This Agreement depends upon the continued availability of appropriated funds and expenditure authority from the Legislature for this purpose. If for any reason the Legislature fails to appropriate funds or grant expenditure authority, or funds become unavailable by operation of law or federal funds reductions, this Agreement will be terminated by the State. Termination for any of these reasons is not a default by the State nor does it give rise to a claim against the State.

2.12 This Agreement may not be assigned without the express prior written consent of the State. This Agreement may not be amended except in writing, which writing shall be expressly identified as a part hereof, and be signed by an authorized representative of each of the parties hereto.

2.13 This Agreement shall be governed by and construed in accordance with the laws of the State of South

Dakota. Any lawsuit pertaining to or affecting this Agreement shall be venued in Circuit Court, Sixth Judicial Circuit, Hughes County, South Dakota.

2.14 The Contractor will comply with all federal, state and local laws, regulations, ordinances, guidelines, permits and requirements applicable to providing services pursuant to this Agreement, and will be solely responsible for obtaining current information on such requirements.

2.15 The Contractor may not use subcontractors to perform the services described herein without the express prior written consent of the State. The Contractor will include provisions in its subcontracts requiring its subcontractors to comply with the applicable provisions of this Agreement, to indemnify the State, and to provide insurance coverage for the benefit of the State in a manner consistent with this Agreement. The Contractor will cause its subcontractors, agents, and employees to comply, with applicable federal, state and local laws, regulations, ordinances, guidelines, permits and requirements and will adopt such review and inspection procedures as are necessary to assure such compliance.

2.16 Contractor hereby acknowledges and agrees that all reports, plans, specifications, technical data, miscellaneous drawings, software system programs and documentation, procedures, or files, operating instructions and procedures, source code(s) and documentation, including those necessary to upgrade and maintain the software program, and all information contained therein provided to the State by the Contractor in connection with its performance of services under this Agreement shall belong to and is the property of the State and will not be used in any way by the Contractor without the written consent of the State. Papers, reports, forms, software programs, source code(s) and other material which are a part of the work under this Agreement will not be copyrighted without written approval of the State.

2.17 The Contractor certifies that neither Contractor nor its principals are presently debarred, suspended, proposed for debarment or suspension, or declared ineligible from participating in transactions by the federal government or any state or local government department or agency. Contractor further agrees that it will immediately notify the State if during the term of this Agreement Contractor or its principals become subject to debarment, suspension or ineligibility from participating in transactions by the federal government, or by any state or local government department or agency.

2.18 Any notice or other communication required under this Agreement shall be in writing and sent to the address set forth above. Notices shall be given by and to Peggy Canter, Director of Total Rewards on behalf of the State, and by ________________, on behalf of the Contractor, or such authorized designees as either party may from time to time designate in writing. Notices or communications to or between the parties shall be deemed to have been delivered when mailed by first class mail, provided that notice of default or termination shall be sent by registered or certified mail, or, if personally delivered, when received by such party.

2.19 The Contractor agrees to provide all technical support for its plan participant website and to complete any information updates, changes or additions to the State of South Dakota, Bureau of Human Resources and Administration website in a timely and accurate manner.

2.20 Upon termination of this agreement and following a written request from the State, the Contractor will provide data and other pertinent records related to services performed under this Agreement including, without limitations, the Personal Information (collectively, “Service Information”) to the State or a designee chosen by the State (“Recipient”) within 30 days, unless otherwise mutually agreed upon. The transfer of Serbice Information to the Recipient, the Contractor will not retain the right to use and disclose any of the Service Information collected or otherwise received by the Contractor during the term of this Agreement.

In the event of the termination of this Agreement, the Contractor will turn over all plan records whether in paper or electronic form to the State within ninety (90) days following the termination of the Agreement.

2.21 In the event that any court of competent jurisdiction shall hold any provision of this Agreement unenforceable or invalid, such holding shall not invalidate or render unenforceable any other provision hereof.

2.22 All other prior discussions, communications and representations concerning the subject matter of this

Agreement are superseded by the terms of this Agreement, and except as specifically provided herein, this Agreement constitutes the entire agreement with respect to the subject matter hereof.

3. Scope of Work

3.1 Plan Information:

There are approximately 13,108 employees eligible to participate in the South Dakota State Employee Health Plan.

As of annual enrollment for July 1, 2025 there are 12,435 total Active employees enrolled. In addition, there are 69

COBRA.

An eligible employee is defined as an employee placed in a permanent position, employed by a participating agency and scheduled to work 20 or more hours a week at least six months of the year.

3.1.1 Eligibility, Effective Date, Contributions

Detailed information may be found on SOSD website by clicking HERE.

Please refer to the chart below for an overview of the State self-funded medical plan information. Detailed information regarding the plans may be found on the State website https://benefits.sd.gov. Bidders are encouraged to provide administrative proposals assuming current benefits as well as the proposed FY27 benefits. Any plan design changes are subject to legislative funding.

Plan Vendor Funding SPD/Plan Doc Medical HDHP 1 Wellmark BCBS Self-insured, Contributory Separate attachment

Medical HDHP 2 Wellmark BCBS Self-insured, Contributory

Separate attachment

Medical LDHP Wellmark BCBS Self-insured, Contributory

Separate attachment

Medical Copay Wellmark BCBS Self-insured, Contributory

Separate attachment

Pharmacy CVS Caremark Self-insured, Contributory

Separate attachment

3.1.2 Stop Loss Coverage

Stop Loss will not be part of the #25RFP17863 process. Currently, there is no stop loss coverage for the medical plans.

3.1.3 Census

Attachment A, one medical census will be posted in a secure website.

The census file is password protected. Both a Letter of Intent, and the Offeror Privacy and Security Agreement (Attachment B), must be completed and submitted as instructed in order to receive access to the password.

3.2 ATTACHMENTS:

The Following attachments are included to provide the information required to generate a proposal for the State:

3.2.1 Plan Designs and Cost Proposal

Attachment A Census Data-Provided Securely Attachment B Offeror Privacy and Security Agreement Attachment C FY26 Benefit Guide Attachment D Questionnaire Attachment G Summary Plan Description (SPD) Document Attachment H Network Access (Physicians and Hospitals) Attachment I Cost Proposal Attachment J BIT Security and Vendor Questions Attachment K BIT Technology Standards Attachment N Deviations / Exceptions Attachment O Business Associate Agreement (BAA) https://www.sd.gov/bhra?id=cs_kb_article_view&sysparm_article=KB0044566&sys_kb_id=cecdffcf9748f2107fc1b480f053af95&spa=1

For Administrative Services Organization (ASO) medical carriers and eligible TPAs, fees and rates are requested for the coverages outlined below. In the event you are not able to provide all coverages requested, respond with those you are able to offer.

Proposals will be accepted from ASO carriers, and qualified TPAs capable of offering all the following services provided under one contractual arrangement: claims and enrollment administrative services, provider network and contracting services, medical management services and PBM services. Proposals that would require a separate contractual arrangement for any of the services listed (except for PBM services) will NOT be considered.

Respondents may respond to all the plan designs and coverages contained in the RFP. All responses meeting the minimum requirements as described in Section 4.0: Proposal Requirements and Company Qualifications and Section 5.0: Proposal Response Format will be evaluated.

The State may modify current benefits for 2026/2027 or later plan years. Due to the self-insured nature of the medical plans, it is not expected that any modifications made would materially impact the cost of ASO/TPA services. Unless otherwise stated in your proposal, we will presume that your fee proposals are valid regardless of the modifications made by the State.

Proposals MUST itemize fees as indicated in the RFP “Attachment D – Questionnaire” and “Attachment I – Cost Proposal” (separate Excel workbook). The Cost Proposal must be submitted in Excel and not in any other format.

3.2.2 Deviations Form

Please list any deviations on the form located in Attachment N. Indicate all areas where your proposal may differ from the requested services or contract and insurance language. Clearly list all plan benefit features that you cannot administer with the current plan design or any contract or insurance deviations.

Do not say “see proposal” or include your standard benefit summary and expect the State to determine where differences exist. Do not indicate that your “standard contractual provisions will apply beyond basic plan design features” without indicating differences. The State needs to thoroughly understand any differences you are proposing. If you do not have any deviations, please mark N/A. If nothing is indicated on this form, then it will be assumed your proposed benefits match the current benefits exactly even if you include a benefit summary that states differently. Use additional pages as necessary.

3.3 Medical Network:

3.3.1 Self-Insured Medical Plans for SOSD

1. Bidders may quote the current plan designs and the proposed FY26 plan designs on a self-insured basis.

2. Plans are to be quoted to include claims and enrollment administrative services, provider network and contracting services, medical management services and PBM services

3. Do not quote Specific or Aggregate Stop Loss.

4. Bidders should provide PBM services on a carve-in and carve-out basis.

3.3.2 Cost Transparency Tool (Must be optional only)

Cost Transparency Tools included in your core administrative fees will be free.

The Respondent may choose to subcontract with an external Transparency Tool vendor who provides more targeted participant direction as well as incentives for provider selection. Such programs must be quoted as an optional service. The State will decide on its own whether it wishes to offer these optional Transparency Tools.

3.4 Medical Plan Administration

The Contractor for each health plan will provide the following services:

A. Account Management

1. Provide a designated Account Manager and Account Management Team

2. Attend Client meetings

3. Provide performance guarantees for the implementation of the program

4. Provide implementation credits to offset the State’s costs

B. Secure Internet Access

1. Access to Claims Administration Portal for Employees to view claim status, EOB’s, etc.

2. Employer and Designated Consultant access to Claims Data Reporting Portal to view and download online reports.

C. Customer Service

1. Provide customer service to answer inquiries on claims, eligibility, provider network, services, coverage, or other inquiries Monday through Friday from 7:00 AM to 7:00 PM CDT.

D. Annual Enrollment Support

1. Prepare and provide Benefit Presentations in collaboration with the State

2. Attend Annual Enrollment Meetings

E. Communication and Education Materials

1. Prepare Summary Plan Descriptions and Plan Summaries by May 1st of each year in order to be available during the Annual Enrollment Period

2. Provide bilingual communication and educational materials

F. Identification Cards

1. Provide Identification Card generation

G. Claims Administration

1. Provide claims forms

2. Receive claims and process payments of benefits in accordance with the plan designs

3. Correspond with participants and providers if additional information is necessary to complete the processing of claims

4. Determine, based on medical necessity guidelines, benefits payable under the Plan, pursuant to the terms and conditions of the State’s Benefit Plan

5. Coordinate benefits payable under the Plan and with other benefit plans, if applicable

6. Provide notice to the Participants regarding the reason(s) for denial of benefits (which are denied) and provide for the review of such denied claims

7. Provide an explanation of benefits resulting from claims transactions to plan participants

8. Provide 1099 forms

9. Provide SBCs

10. Perform Recovery of Payments of $25 or more

11. Administer a Fraud and Abuse Detection Program

12. Provide Full Claims Fiduciary Services (all levels of appeals – no litigation).

13. Provide all levels of full and fair review of claims, claims denials and member appeals. Determination of payment or denial of claims or of appealed claims will be made by the Contractor following analysis and review.

H. Medical Management

1. Provide Utilization Management services

2. Provide Disease Management services

3. Provide Complex Care Management services

4. Authorization & medical necessity for genetic testing as it pertains to the National Health Care Anti-

Fraud Association.

I. Eligibility and Enrollment Administration

1. Administer eligibility based on the State’s eligibility criteria

J. Reporting

1. Provide reporting of all benefits being administered as requested in the Reporting section of the Questionnaire.

K. Network

1. Access to nationwide network of providers with uniform quality of care and services.

3.5 Other Requirements:

3.5.1 The Contractor must be willing to sign a Business Associate Agreement (Attachment O) with the State.

4.0 PROPOSAL REQUIREMENTS AND COMPANY QUALIFICATIONS

4.1 The offeror is cautioned that it is the offeror's sole responsibility to submit information related to the evaluation categories and that the State of South Dakota is under no obligation to solicit such information if it is not included with the proposal. The offeror's failure to submit such information may cause an adverse impact on the evaluation of the proposal.

4.2 Offeror's Contacts: Offerors and their agents (including subcontractors, employees, consultants, or anyone else acting on their behalf) must direct all of their questions or comments regarding the RFP, the evaluation, etc. to the buyer of record indicated on the first page of this RFP. Offerors and their agents may not contact any state employee other than the buyer of record regarding any of these matters during the solicitation and evaluation process. Inappropriate contacts are grounds for suspension and/or exclusion from specific procurements. Offerors and their agents who have questions regarding this matter should contact the buyer of record c/o Marsh & McLennan Agency, LLC.

4.3 The offeror must submit a copy of its most recent audited financial statements. The offeror must submit the above requested information in a separate file document labeled “VendorName_Proprietary_Financial_Statements”.

4.4 The Offeror must provide the following information related to at least three previous and current service/contracts, performed by the offeror’s organization, which are similar to the requirements of this

4.4.1 Name, address and telephone number of client/contracting agency and a representative of that agency who may be contacted for verification of all information submitted;

4.4.2 Dates of the service/contract; and

4.4.3 A brief, written description of the specific prior services performed and requirements thereof.

4.5 As part of the proposal, the offeror will provide a plan detailing the implementation timeline including any implementation phases. Implementation must be completed by 60 days prior to the State’s Annual Enrollment period. The plan will also define responsibilities assigned to the offeror and responsibilities assigned to the State. Failure to provide an implementation timeline will be grounds to reject an offeror’s proposal. The offeror must label the electronic document “VendorName_Implementation_Timeline”.

4.6 Proposals must include performance guarantees to ensure the offeror will complete the obligations of its proposal. Performance guarantees must be provided in each of the following areas:

4.6.1 Implementation and Annual Enrollment

4.6.2 Claims administration

4.6.3 Customer service

4.6.4 Member satisfaction

4.6.5 Reporting

4.7 The offeror must thoroughly review the South Dakota Bureau of Information and Telecommunications (“BIT”) standard contract terms and conditions pertaining to IT security (see “BIT Technology Standards” document), which is attached as Attachment K.

The offeror must indicate in their response if there are any standard IT security terms which are not acceptable to the offeror. The offeror must include in their response reasons why the IT terms are unacceptable. The State will consider any IT contract term that was not indicated as unacceptable as being acceptable by the offeror.

4.8 The offeror must review and respond to the BIT Security and Vendor Questions which is attached as Attachment J.

4.9 Network Access:

Offerors will:

1. Provide a Geoaccess report describing the participant access to medical providers with the following criteria:

a. PCPs – 2 within 10 miles

b. Specialists – 2 within 10 miles

c. Hosptials – 1 within 20 miles

2. Describe the current network structure whether it is a proprietary network or a contracted network (must identify) through a third party or a combination of both.

3. Describe the initiatives the offeror will take to develop the network of providers in the State of South Dakota in the event the offeror is selected as the medical plan provider for State of South Dakota employees.

4. The offeror must submit the above requested information in a separate file document labeled “VendorName_Network_Access”.

4.10 No Broker Submission:

4.10.1 For the purposes of this RFP, the State will not accept proposals from brokers on behalf of service providers that they represent. The State will receive proposals directly from service providers only. Also, costs proposed for services cannot include fees, commissions or revenue sharing (e.g. percentage of discount savings, etc.) with any broker or consultant.

5 PROJECT DELIVERABLES/APPROACH/METHODOLOGY

The offeror must describe in detail how its proposed deliverables will meet the needs of the State as described in Section 3. At its sole discretion, the State may consider a solution that includes any of these deliverables or consider deliverables not originally listed.

An offeror must highlight any requirement in Section 3, Section 4, or Section 5 that the offeror’s proposed deliverables cannot comply with, and the offeror must provide any suggested “work-around” to the requirement in question or a future date that the offeror will be able to comply with the requirement.

5.1 GENERAL IT REQUIREMENTS

5.1.1 Single Sign-On Requirements

If the offeror’s proposal includes a deliverable with a login component, the proposal must describe how the deliverable will integrate with the State’s standard identity management service single sign-on (SSO).

The State’s SSO supports the industry standard OAuth 2.0 protocol. This identity management will handle password recovery and multi-factor authentication (MFA). MFA is required for all application Administrators and may be required for other users. The State’s SSO requirement and links to Microsoft’s official documentation can be found at:

https://www.sd.gov/bit?id=bit_standards_single_sign_on.

5.1.2 SSO Logout Initiation Requirements

• The offeror’s deliverable must provide users with a clear and easily accessible logout mechanism

(e.g., a “Logout” button/link).

• The logout functionality of the offeror’s deliverable must trigger a session-based logout process utilizing the sign-out endpoint found in the metadata document provided during implementation.

5.1.3 Session Timeout Requirements

• The offeror’s deliverables must allow for a customizable, State-defined inactive user session timeout period.

• The offeror’s deliverables must notify users of impending session expiration five minutes before the timeout occurs, providing users with the option to extend the session.

5.1.4 Session Termination on Browser Close Requirement

The offeror’s deliverables must clearly notify users that closing the browser window or tab is not a valid logout because the SSO session may remain active. The notice must further notify users that they are responsible for explicitly logging out to ensure complete session termination.

5.1.5 Onboarding/Provisioning of Users Requirement

The offeror’s proposal must describe how new users are onboarded or provisioned into the deliverable. The offeror must provide an automated process for onboarding and offboarding users or must provide a process that requires minimal manual steps.

5.1.6 Web Application Vulnerability Scan Requirements

Any web-based deliverable must undergo a web application vulnerability scan (“Vulnerability Scan”).

The Vulnerability Scan must identify misconfigurations or vulnerabilities such as those found in the OWASP Top Ten and must detail the certainty level of each finding.

Unless expressly indicated in writing, the State assumes all price estimates and bids are for the delivery and support of deliverables that will pass Vulnerability Scans. If the State determines that any aspect of the deliverable has security vulnerabilities that must be corrected, the State will inform the offeror of the nature of the issue and the offeror will be required to respond in writing regarding mitigation plans for the security vulnerabilities. If the deliverable does not pass the initial Vulnerability Scan or the offeror cannot provide a satisfactory Vulnerability Scan report, additional scans may be required to confirm the deliverable is secure.

https://www.sd.gov/bit?id=bit_standards_single_sign_on

Vendor Hosted: For vendor hosted web-based deliverables, any offeror who makes it to the “Tech Review” stage of the RFP process must provide the State a copy of the full report of the deliverable’s most recent Vulnerability Scan, a summary will not be accepted. The offeror should mark the vulnerability report as “Confidential” if it treats such a report as confidential information. If the offeror requires a Non-Disclosure Agreement (NDA) to be in place before the State may review the Vulnerability Scan report, the offeror must notify the State of such a requirement and resolve the signing of an NDA with enough time to respond to this RFP within the timeframe.

The offeror’s Vulnerability Scan report must consist of, at a minimum:

• The system that was evaluated,

• The categories that were evaluated (examples: SQLi, XSS, or RCE),

• What were the general findings,

• Technical detail of each issue found,

• Remediation status of enumerated issues (if any).

The cost of any Vulnerability Scans done by the offeror or the offeror’s costs associated with the State performing Vulnerability Scans must be part of the offeror’s cost proposal. Failure of a deliverable to satisfactorily pass a Vulnerability Scan may result in the offeror’s proposal being rejected.

5.1.7 Email Domain Name Requirement

If the offeror’s proposal includes a website or a web application that generates email and is hosted by the offeror or in the State’s cloud, the proposed website or web application cannot use state email domains as the originating domain name.

5.1.8 Banned Entity Requirement

The offeror’s proposed deliverables cannot include any hardware or hardware components manufactured by Huawei Technologies Company, Nuctech, or ZTE Corporation or any subsidiary or affiliate of such entities. This includes hardware going on the State’s network as well as the offeror’s network if the offeror’s network is accessing the State’s network or accessing State data. This includes Infrastructure as a Service, Platform as a Service, or Software as a Service situations. Any company that is considered to be a security risk by the government of the United States of America under the International Emergency Economic Powers Act, in a United States appropriation bill, an Executive Order, or listed on the US Department of Commerce’s Entity List will be included in this ban.

5.2 VENDOR HOSTED SOLUTION REQUIREMENTS

5.2.1 General Vendor Hosted Requirements

In the offeror’s proposal, the offeror must describe its:

• Data loss prevention methodology;

• Data sanitization methodology and procedures;

• Identity and access management;

• Security intelligence;

• Annual security training and awareness;

• Manual procedures and controls for security;

• Perimeter controls;

• Security certifications and audits.

6.0 PROPOSAL RESPONSE FORMAT

6.1 All Proposals must be completed and received by the date and time indicated in the Schedule of Activities.

Proposals received after the deadline will be late and ineligible for consideration.

6.2 All proposals must be organized and tabbed with labels for the following headings:

6.2.1 RFP Form. The State’s Request for Proposal form (1st page of RFP) completed and signed.

6.2.2 Executive Summary. The one-to-two-page executive summary is to briefly describe the offeror's proposal. This summary should highlight the major features of the proposal. It must indicate any requirements that cannot be met by the offeror. The reader should be able to determine the essence of the proposal by reading the executive summary. Proprietary information requests should be identified in this section.

6.2.3 Detailed Response. This section should constitute the major portion of the proposal and must contain at least the following information:

6.2.3.1 A complete narrative of the offeror's assessment of the work to be performed, the offeror’s ability and approach, and the resources necessary to fulfill the requirements.

This should demonstrate the offeror's understanding of the desired overall performance expectations.

6.2.3.2 A specific point-by-point response, in the order listed, to each requirement in the RFP.

The response should identify each requirement being addressed as enumerated in the

6.2.3.3 A clear description of any options or alternatives proposed.

6.2.4 Cost Proposal. Cost will be evaluated independently from the technical proposal. Offerors may submit multiple cost proposals. All costs related to the provision of the required services must be included in each cost proposal offered.

6.2.4.1 A per hour rate for consulting services is desirable for the primary consultant.

6.2.4.2 It is expected that the firm will provide the Scope of Services as described in Section 3.0-

3.4 for an all-inclusive not to exceed lump sum price which shall include labor, mileage, insurance, travel expenses, lodging, office supplies, office equipment, photocopying, overhead and profit and all other expenses necessary to complete the referenced project according to “normal” industry standards per the specifications, exclusive of all taxes.

Overhead shall include all costs associated with project management, corporate accounting, invoice preparation, and all other expenses indirectly associated with the project. Include this all-inclusive lump sum in the proposal. The State requests the services in 3.5 be provided as an individual item so the state may review it separately.

6.2.4.3 The State recognizes that at times various projects and services may develop that are not part of the proposed Scope of Services. State the current hourly billing rates and position title for each level of employee that may be involved in conducting additional services. The hourly rates are to be all inclusive of labor, mileage, insurance, travel expenses, lodging, office supplies, office equipment, photocopying, overhead and profit and all other expenses necessary to complete the referenced project according to “normal” industry standards per the specifications, exclusive of all taxes. Overhead shall include all costs associated with project management, corporate accounting, invoice preparation, and all other expenses indirectly associated with the project.

6.2.4.4 Describe additional costs, if any, which may be charged for minor requests/questions that require minimal research time.

6.2.4.5 See section 8.0 for more information related to the cost proposal.

7.0 PROPOSAL EVALUATION AND AWARD PROCESS

7.1 After determining that a proposal satisfies the mandatory requirements stated in the Request for Proposal, the evaluator(s) shall use subjective judgment in conducting a comparative assessment of the proposal by considering each of the following criteria:

7.1.1 Specialized expertise, capabilities, and technical competence as demonstrated by the proposed approach and methodology to meet the project requirements (150 points);

7.1.2 Resources available to perform the work, including any specialized services, within the specified time limits for the project (100 points);

7.1.3 Record of past performance, including price and cost data from previous projects, quality of work, ability to meet schedules, cost control, and contract administration (50 points);

7.1.4 Availability to the project locale (150 points);

7.1.5 Familiarity with the project locale (150 points);