Schedule B - Pricing Matrix Final.xlsx

This is a Pricing Matrix schedule for Request for Proposal No. 180000001030, establishing administrative and claims pricing for a three-year health plan contract commencing October 1, 2018, and ending September 30, 2021. Contractors must provide pricing proposals using the designated Excel template with calculations based on current membership of 198,835 total members across four coverage categories: Contract Holder Only (42,138 members), Contract Holder & Spouse (67,728 members), Contract Holder & Children (17,283 members), and Full Family (71,122 members). The proposal requires contractors to complete annual Per Contract Per Month (PCPM) administrative service fees and claims costs for all three plan years, with claims costs derived from the average of repriced claims data from fiscal years 2016 and 2017 submitted in Schedule F.

Pricing proposals must be comprehensive and include all costs associated with service delivery, including one-time setup charges and potential provider fees. Contractors must certify that prices were developed independently and provide pass-through pricing to the Plan Sponsor at rates not exceeding amounts paid to providers under the contract. Contractors are encouraged to offer quick payment discount terms, specifying the percentage discount and number of days for payment. Proposals must be submitted in modifiable format (Microsoft Word or Excel) with optional supplemental non-modifiable PDF submissions, and incomplete pricing schedules may result in proposal disqualification. The contract operates on an annual-rate pricing structure with firm pricing for each October 1 through September 30 period.