Bid Solicitation #

25DPP01075

T3093 - State Health Benefits Program and School Employees Health Benefits Program Plans – Medicare Advantage Plans

Due Date For Electronic Questions Refer to Bid Solicitation Section 2.1 for more information.

Optional Pre-Quote Submission Conference Refer to Bid Solicitation Section 2.5 for more information.

Mandatory/Optional Site Visit Refer to Bid Solicitation Section 2.4 for more information.

N/A

N/A

Quote Opening Date Refer to Bid Solicitation Section 3 for more information.

Dates are subject to change. All times contained in the Bid Solicitation refer to Eastern Time.

All changes will be reflected in Bid Amendments to the Bid Solicitation posted on www.njstart.gov.

SET-ASIDES

Small Business Set-Aside For Goods and Services:

☐ I ☐ II ☐ III

For Construction:

☐ IV ☐ V ☐ VI

☒ Not Applicable ☐ Entire Contract ☐ Partial Contract ☐ Subcontracting Only ☐ Preference

☐ Entire Contract ☐ Partial Contract ☐ Subcontracting Only ☐ Preference

Bid Solicitation Issued By:

State of New Jersey Department of the Treasury Division of Purchase and Property Trenton, New Jersey 08625‑0230 On Behalf of:

State of New Jersey Department of the Treasury Division of Pensions and Benefits Trenton, NJ 08625-0295

Date: November 6, 2025

TABLE OF CONTENTS

Exhibit 1- Audit File Layout Exhibit 2A & 2B- Current Medicare Member Census file and Current Med Supplemental Member Census File Exhibit 3 -Eligibility File Layout (HIPAA 834) Exhibit 4 -Employer File Layout Exhibit 5 -Descriptions of Coverage Groups Exhibit 6 -Experience and Risk Score Data Exhibit 7 -Plan Design and Medicare Advantage Benefit Design Provisions

Attachment A1 - Provider Disruption Workbook Medicare Advantage (note: this workbook contains data for current MA Members only) Attachment A2 - Provider Disruption Workbook Medicare Supplement (note: this workbook contains data for current MA Members only) Attachment B - Performance Standards and Liquidated Damages Attachment C -Centers for Medicare & Medicaid Services (CMS) STAR rating for 2022-2026 Attachment D- PPO CMS ACCESS Match Attachment E- Service Area Match Attachment F- T3093 Confidentiality/Non-Disclosure Agreement Attachment G - Standard Procurement Forms Packet Attachment H – State-Supplied Price Sheet Attachment I - State of New Jersey Standard Terms and Conditions (6/3/25) Attachment J- State of New Jersey Third-Party Information Security Questionnaire

INTRODUCTION AND SUMMARY OF THE BID SOLICITATION

This Bid Solicitation is issued by the Department of the Treasury, Division of Purchase and Property (Division), Procurement Bureau, on behalf of the Department of the Treasury’s Division of Pensions and Benefits (DPB). Quotes submitted in response to this Bid Solicitation shall be through the State of New Jersey’s eProcurement system, NJSTART. Bidders are advised to thoroughly read all sections of this Bid Solicitation and follow all instructions.

Bidders are strongly encouraged to visit the NJSTART Vendor Support Page, which contains Quick Reference Guides (QRGs), supporting videos, a glossary of NJSTART terms, and helpdesk contact information. Bidders should utilize the QRGs before attempting to submit a Quote through NJSTART. It is the Bidder’s responsibility to ensure that the Quote and attachments have been properly submitted. Inquiries concerning the use of NJSTART may be directed to njstart@treas.nj.gov. The Division will not respond to substantive questions related to the Bid Solicitation or any other Contract via this email address.

PURPOSE AND INTENT

The purpose of this Bid Solicitation is to solicit Quotes from qualified Bidders to provide fully insured Medicare Advantage Preferred Provider Organization (PPO) Plan and Medicare Advantage Health Maintenance Organization (HMO) Plans and other services as specified in this Bid Solicitation for the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP).

N.J.S.A 52:14-17.27 and N.J.S.A 52:14-17.46.3 created the State Health Benefits Plan Design Committee and the School Employees’ Health Benefits Plan Design Committee (Plan Design Committees), which are responsible for reviewing the SHBP and SEHBP plan designs, respectively, and developing any changes therein that are determined to be cost effective and in the mutual best interests of the State, participating Local Employers, employees, retirees, and their Dependents.

Accordingly, the Plan Design Committees may make benefit design changes during the term of this Contract that are not contemplated by this Bid Solicitation. The State expects that such changes could include, but are not limited to, changes in deductibles, copays, out-of-pocket (OOP) maximums, innovative programs, new Plan options, and similar variables. In the event of any such change, appropriate changes to the Contract and/or Guaranteed Insured Premium Rates and premium rate funding agreement shall be made pursuant to Bid Solicitation, Section 5, General Contract Terms.

It is the intent of the State of New Jersey (State) to award a Contract to those responsible Bidders whose Quotes, conforming to this Bid Solicitation are most advantageous to the State, price and other factors considered. The State may award any or all price lines. The State, however, reserves the right to separately procure individual requirements that are the subject of the Contract during the Contract term, when deemed by the Director of the Division (Director) to be in the State’s best interest.

The State expects the Contracts resulting from this Bid Solicitation to be:

A. Focused on the success of the SHBP/SEHBP by delivering a superior level of service and attention during the implementation process, and on an ongoing basis;

B. Cost effective by demonstrating an interest in the SHBP/SEHBP and quoting competitive premiums, practicing effective care management, and agreeing to be held accountable through Performance and Financial Guarantees;

C. Quality-focused by demonstrating high levels of strong outcomes and Member satisfaction; and D. Able to provide comprehensive network access to the vast majority of current Retirees enrolled in Medicare Advantage (MA) plans.

The State anticipates multiple scenarios for the Contract. The State reserves the right to award to one (1) or multiple Contractors, based on the scenarios detailed below. The State does not guarantee any actual minimum/maximum enrollment. The following population counts are close approximations, whereas the Bidder’s best forecasting of Plan Year 2027 to Plan Year 2031 to estimate payment increases, growth rates, and other factors should be answered on the State-Supplied Price Sheet:

A. Potential award scenarios:

1. Scenario 1A (Sole MA Contractor):

(i) Contractor is awarded all current MA PPO and HMO plans with services beginning on the Contract Effective Date (199,389 Members);

2. Scenario 1B (Sole MA Contractor):

(i) Contractor is awarded all current MA PPO and Medicare Supplement PPO plans (217,072 PPO Members) and all current MA HMO Members and Medicare Supplement HMO plans (14,406 Members) with services beginning on the Contract Effective Date.

3. Scenario 2A (Two MA Contractors):

(i) Contractor A is awarded all current MA PPO plans (185,859 Members) with services beginning on the Contract Effective Date.

(ii) Contractor B is awarded all current MA HMO plans (13,530 Members) with services beginning on the Contract Effective Date.

4. Scenario 2B (Two MA Contractors):

(ii) Contractor A is awarded all current MA PPO and Medicare Supplement PPO plans (217,072 PPO Members) with services beginning on the Contract Effective Date.

(iii) Contractor B is awarded all current MA HMO Members and Medicare Supplement HMO plans (14,406 Members) with services beginning on the Contract Effective Date.

IMPORTANT NOTE: The current SHBP/SEHBP Self-Insured plans will be bid through a separate, standalone procurement process and are not covered by the scope of this Bid Solicitation, with the exception of the potential migration of the Medicare Supplement population noted in Scenarios 1B and 2B above.

The State of New Jersey Standard Terms and Conditions (SSTCs) included with this Bid Solicitation will apply to all Contracts made with the State. These terms are in addition to the terms and conditions set forth in this Bid Solicitation and should be read in conjunction with them unless the Bid Solicitation specifically indicates otherwise.

BACKGROUND

The SHBP was created in 1961 by the NJ State Health Benefits Program Act, N.J.S.A. 52:14-17.25 et seq., (the Act) to provide health insurance coverage to State Employees. The State Health Benefits Commission (SHBC) is charged with establishing health benefits programs for State and qualified Local Government Employees, Retirees, and eligible Dependents and promulgating regulations, as necessary, to administer the Act. The SHBC is comprised of representatives of the State Treasurer (Chairman), the Commissioner of the Department of Banking and Insurance, the Chairperson of the Civil Service Commission, a State Employees’ representative and a Local Government Employees’ representative, both chosen by the Public Employees’ Committee of the AFL-CIO. The SHBC has the authority to provide health benefits in accordance with the Act. The Division of Pensions and Benefits (DPB) administers the SHBP on behalf of the SHBC.

The SEHBP was established in 2007 by the School Employees’ Health Benefits Program Act, N.J.S.A. 52:14-17.46 et seq., to provide health coverage to qualified Local Education Employees, Retirees, and eligible Dependents. The School Employees’ Health Benefits Commission (SEHBC) is comprised of representatives of the State Treasurer, the Commissioner of the Department of Banking and Insurance, a member appointed by the Governor who is a New Jersey resident, a member representing the New Jersey School Boards’ Association, three members representing the New Jersey Education Association, a member representing the New Jersey State AFL-CIO, and a member appointed to be the chairperson.

The SHBC and SEHBC may be referred to herein, collectively, as the Commissions.

The DPB, specifically the Health Benefits Bureau and the Bureau of Policy and Planning, is responsible for the daily administrative activities of the SHBP and the SEHBP.

The SHBP/SEHBP covers State employees and Retirees, as well as employees and Retirees of Local Government and Education Employers who have elected to purchase coverage in the SHBP/SEHBP. Presently, the SHBP/SEHBP covers approximately 800,000 lives (including active, retired and Consolidated Omnibus Budget Reconciliation Act (COBRA) individuals and their Dependents). The MA population is approximately 195,000 lives of the 800,000 total lives.

Note: The non-Medicare Advantage plans, including all self-insured Medicare Supplement plans, with the exception of the potential migration of the Medicare Supplement population noted in Scenarios 1B and 2B above, are NOT included within the scope of this Bid Solicitation and will be procured through a separate bid process.

This is a reprocurement of the services under State Health Benefits Program & School Employees Health Benefits Program Plans. Bidders interested in reviewing the current Contract/Master Blanket Purchase Order specifications and pricing information may do so by following the instruction below. Bidders should not rely upon or use data or information from the contract when preparing a response to this Bid Solicitation as this Bid Solicitation addresses the State’s current requirements.

· Go to: www.njstart.gov

· In the search bar, select “Contracts” from the drop down menu

· Enter “T3093” and click “”

· The current Contract list will appear under “Results”

MEDICAL PLAN OVERVIEW

Public Law 2007, Chapter 103, approved June 28, 2007, requires a certain benefit level for certain Retiree Members.

There are a number of self-insured PPO, HMO, HDHP, and Tiered Network medical plans administered to SHBP/SEHBP Employees, Retirees, and their Dependents.

The current fully-insured Medicare Advantage levels of benefits and the administrators in place for Plan Year 2025 are described below. Please note that not all Plans are available to all Retiree groups.

Fully-Insured Medicare Advantage Plans - All Medicare-eligible Members in the SHBP and SEHBP enrolled with Aetna are in Medicare Advantage Plans – either the HMO, HMO1525, PPO10, or PPO15 plan.

A. Preferred Provider Organizations (PPOs). There are two National Open Access Medicare Advantage PPO Plans offered for the State and Local Government populations: PPO10, and PPO15. The Local Education population has two plan design offerings offered through Aetna only: PPO10 and PPO15. All Medicare Advantage PPO Plans are fully insured.

B. Health Maintenance Organizations (HMOs). The Commissions currently contract to offer two Medicare Advantage HMO Plans through Aetna: Aetna Legacy HMO and Aetna HMO1525. All Medicare Advantage HMO Plans are fully insured.

Prescription Drug Plans. The State allows Retirees participating in SHBP/SEHBP Plans have access to prescription drug coverage, unless their employer opted out. Retirees receive prescription drug coverage based on the SHBP/SEHBP medical plan that they have chosen. Prescription drug Plan design differs by medical plan. A Pharmacy Benefits Manager (PBM) administers all SHBP/SEHBP drug coverage, and all Medicare-eligible SHBP/SEHBP members are in an Employer Group Waiver Plan (EGWP). As noted above, this Bid Solicitation is not requesting bids for this prescription drug coverage.

Copies of the current Plan documents – Summary Program Description (SPD) and Member Handbooks for all Plans – are available at the Division of Pensions and Benefits website at: State of NJ - Department of the Treasury - NJDPB | Health Benefits Information for Retirees (https://www.nj.gov/treasury/pensions/hb-info-retired.shtml).

Since 2009, any Medicare plans offered by Aetna to State, Local Government, and Local Education (SEL) Medicare Retirees were offered to Retirees as MA plans. The Plans were offered alongside Medicare supplement plans, with nearly identical Plan designs. Retirees have a choice between enrolling in the MA plan or the Medicare supplement plan.

The State does not hold a traditional annual Open Enrollment for Retirees; however, Retirees are permitted to change Plans once in a 12-month period. As age-ins turn 65 outside of the annual change period, they will be automatically enrolled in the Medicare Advantage plan that correlates to the current coverage. As an example, a State Retiree age-in enrolled in the $10 PPO plan as an Early Retiree would automatically be enrolled in the $10 PPO Medicare Advantage plan when they turn 65. If the Plan option that the Early Retiree is enrolled in has both a Medicare supplement and a Medicare Advantage option (i.e., current Education $10 PPO plan with Medicare Supplement through Horizon and Medicare Advantage through Aetna), the Member will be automatically enrolled into the Medicare Advantage plan option.

The Medicare Retiree is permitted to switch every 12 months into any applicable Plan design option, including the Medicare Advantage PPO or HMO plans.

Many current Medicare-eligible Retirees are grandfathered in from the contribution requirements enacted under P.L. 2010 Chapter 2; P.L. 2011, Chapter 78: N.J.S.A. 52:14-17.28b; N.J.S.A.52:14-17.32f; N.J.S.A. 52:14-17.32f1; 52:14-17.32f2; N.J.S.A. 52:14-17.38; N.J.S.A.52:14-17.46.9; N.J.S.A. 52:14-17.28c; N.J.S.A. 52:14-17.28d; N.J.S.A. 40A:10-21.1; N.J.S.A. 40A:5A-11.1; and negotiated agreements. This is a significant factor in the static movement between the various plan options each year. The historical trends indicate that Members remain in a comparable plan option in which they were enrolled as an Active Employee in the SHBP or SEHBP. However, following the enactment of Chapter 2 and Chapter 78, future retirees are required to pay a portion of the cost for their health benefits. It is anticipated that these retirees will seek the most cost effective plan option when enrolling in their Medicare Retiree benefits. The successful Contractor(s) will be permitted to send communication materials to Medicare supplement Members regarding the benefits of enrolling in a Medicare Advantage Plan provided all communications are pre-approved by the State via email communication.

Chapter 78 required that Employees and Retirees of the SHBP and SEHBP contribute toward the cost of their health benefits through a salary/retirement allowance-based contribution structure. Retiree rates and contribution scales can be found here: State of NJ - Department of the Treasury - NJDPB | Rate Renewal Reports (https://www.nj.gov/treasury/pensions/rate-renewal.shtml).

RETIREE WELLNESS PROGRAM (RWP)

Pursuant to Public Law 2007, Chapter 103, the State offers a wellness program as an option to a small number of State Retirees. Since April 2008, State Retirees who retired after July 1, 2007 with 25 or more years of service and who had been required to contribute 1.5% toward their Retiree health care coverage have been eligible for participation in the Retiree Wellness Program (RWP) to reduce this contribution. Eligible Retirees who participate in the RWP have their entire health premium contribution waived.

The RWP began operation as of July 1, 2008, and provides for early detection and intervention to address health risks, encourages the development of healthy lifestyles designed to promote wellness and prevent disease, provides reminders of critical tests and screenings necessary to monitor Retiree health, and provides guidance to those now struggling with chronic disease.

Currently, there are 5,090 State Medicare Advantage Retirees eligible for this program. There are also approximately 9,000 current Active Employees and Retirees that are eligible to participate in the RWP as well; however, outside of those Members, the group is closed and will not add any additional eligible Members in the future.

In addition to submitting a pledge to renew their RWP eligibility annually, participating Retirees are required, each year, to complete a Health Assessment Test (HAT), have an annual medical check-up and submit the annual Physician Certification, obtain age and gender appropriate tests and screenings, and participate in Disease Management programs administered by the SHBP/SEHBP medical vendors.

The Medicare Advantage awarded Contractor(s) will administer the RWP and to provide innovative and strategic planning and support to help enhance the RWP.

Note: All anticipated charges associated with the administration of the RWP must be factored into insured premium rates and cannot be billed separately.

CONTRACT AMOUNT

The estimated amount of the Contract, if stated, shall not be construed as either the maximum or minimum amount which the State shall be obliged to order.

ORDER OF PRECEDENCE OF CONTRACTUAL TERMS

The Contract awarded, and the entire agreement between the parties, as a result of this Bid Solicitation shall consist of: (1) the final Bid Solicitation, (2) the State of New Jersey Standard Terms and Conditions, (3) the Quote, and if applicable (4) any Bidder responses to clarifications; (5) a Bidder’s Best and Final Offer, (6) other negotiated document, and/or (7) third party document. In the event of a conflict in the terms and conditions among the documents comprising this Contract, the order of precedence, for purposes of interpretation thereof, listed from highest ranking to lowest ranking as noted above.

Any other terms or conditions, not included with the Bidder’s Quote and accepted by the State, shall not be incorporated into the Contract awarded. Any references to external documentation, including those documents referenced by a URL, including without limitation, technical reference manuals, technical support policies, copyright notices, additional license terms, etc., are subject to the terms and conditions of the Bid Solicitation and the State of New Jersey Standard Terms and Conditions. In the event of any conflict between the terms of a document incorporated by reference, the terms and conditions of the Bid Solicitation and the State of New Jersey Standard Terms and Conditions shall prevail.

INTRASTATE COOPERATIVE PURCHASING

Not Applicable to this procurement.

PRE-QUOTE SUBMISSION INFORMATION

The Bidder assumes sole responsibility for the complete effort required in submitting a Quote and for reviewing the Quote submission requirements and the Scope of Work requirements.

ELECTRONIC QUESTION AND ANSWER PERIOD

The Division will electronically accept questions and inquiries from all potential Bidders via the “Q&A” Tab of the Bid Solicitation in NJSTART. Questions should be directly tied to a Bid Solicitation Section, the Price Sheet, Form or Attachment; and should reference the specific Bid Solicitation Section or document to which it relates.

The cut-off date for electronic questions and inquiries relating to this Bid Solicitation is indicated on the Bid Solicitation cover page. In the event that questions are posed by Bidders, answers to such questions will be issued by Bid Amendment.

A Bidder shall not contact the Using Agency and/or the Procurement Specialist directly, in person, by telephone or by e-mail, concerning this Bid Solicitation, prior to Contract award.

EXCEPTIONS TO THE STATE OF NJ STANDARD TERMS AND CONDITIONS (SSTC)

Questions regarding the State of New Jersey Standard Terms and Conditions and exceptions to mandatory requirements MUST be posed during the Electronic Question and Answer period and shall contain the Bidder’s suggested changes and the reason(s) for the suggested change(s).

BID AMENDMENTS

In the event that it becomes necessary to clarify or revise this Bid Solicitation, such clarification or revision will be by Bid Amendment. Any Bid Amendment will become part of this Bid Solicitation and part of any Contract awarded. Bid Amendments will be posted as a file attachment on the “Summary” page of the Bid Solicitation in NJSTART after the cut-off date.

There are no designated dates for release of Bid Amendments. Those Bidders who are on the bid holder list either through commodity code registration in NJSTART or by acknowledging the bid in NJSTART should receive notification of any Bid Amendment(s). If a Bidder is not on the bid holder list, Bid Amendments are still viewable on the “Summary” page of the Bid Solicitation in NJSTART.

It is the sole responsibility of the Bidder to be knowledgeable of all Bid Amendments related to this procurement. An interested Bidder should check the NJSTART “Open Bids” Tab on a daily basis to ensure review of the most updated information.

SITE VISIT

Not Applicable to this procurement.

OPTIONAL PRE-QUOTE CONFERENCE

The date and time of the Optional Pre-Quote Conference is indicated on the Bid Solicitation cover sheet. Attendees may attend the Optional Pre-Quote Conference with the following video conference and/or call-in details:

Phone Number: 1-856-338-7074 Access Code: 728 069 853# T3093 Pre-Quote Conference | Meeting-Join | Microsoft Teams

The Optional Pre-Quote Conference may be recorded.

The purpose of the Optional Pre-Quote Conference is to address procedural questions regarding the Bid Solicitation and Bidder Quote submission requirements only. No substantive questions regarding the Bid Solicitation Scope of Work will be accepted or answered during the pre-Quote conference. All questions are to be submitted during the Electronic Question and Answer Period.

PRE-QUOTE DOCUMENT REVIEW

Prior to receiving the documents outlined below, a Bidder must submit the Confidentiality/Non-Disclosure Agreement (See Attachment F - T3093 Confidentiality/Non-Disclosure Agreement) included with this Bid Solicitation. The Attachment F - T3093 Confidentiality/Non-Disclosure Agreement must be signed by an officer or other authorized representative of the Bidder. The Bidder shall not edit or revise the Attachment F - T3093 Confidentiality/Non-Disclosure Agreement prior to signing and submitting Attachment F.

Bidders shall email the signed Attachment F - Confidentiality/Non-Disclosure Agreement prior to the close of the Question and Answer Period to allow time to review information and submit questions, if necessary.

Note: Attachment F - T3093 Confidentiality/Non-Disclosure Agreement is a separate document not to be confused with the Confidentiality/Commitment to Defend Form referenced by Bid Solicitation Section 3.13.7, Confidentiality/Commitment to Defend, and the Confidentiality/Non-Disclosure Agreement attached to the State of New Jersey Security Due Diligence Third-Party Information Security Questionnaire as referenced by Bid Solicitation Section 3.13.11, State of New Jersey Security Due Diligence Third-Party Information Security Questionnaire.

Bidders will be provided all confidential Bid Solicitation documents as soon as practical via the State of New Jersey’s secure file transfer, MOVEIT, once the signed Confidentiality/Non-Disclosure Agreement is received, reviewed and approved by DPB. The Bidder shall email Attachment F - T3093 Confidentiality/Non-Disclosure Agreement to:

Olu Albert olu.albert@treas.nj.gov

Materials provided by Secure File Transfer to a Bidder upon receipt of a signed Attachment F - T3093 Confidentiality/Non-Disclosure Agreement will include the following:

A. Exhibit 1- Audit File Layout;

B. Exhibit 2A and 2B- Current Medicare Member Census file and Current Med Supplemental Member Census File;

C. Exhibit 3 -Eligibility File Layout (HIPAA 834);

D. Exhibit 4 -Employer File Layout;

E. Exhibit 5 -Descriptions of Coverage Groups;

F. Exhibit 6 -Experience and Risk Score Data;

G. Exhibit 7 - Plan Design and Medicare Advantage Benefit Design Provisions;

H. Attachment A1 - Provider Disruption Workbook Medicare Advantage (note: this workbook contains data for current MA Members only); and I. Attachment A2 - Provider Disruption Workbook Medicare Supplement (note: this workbook contains data for current MA Members only).

Note: All other attachments and exhibits listed in the Table of Contents but not in the list above are already made available under the ‘Attachments’ tab on the NJSTART page for this Bid Solicitation.

QUOTE SUBMISSION REQUIREMENTS

QUOTE SUBMISSION

In order to be considered for award, the Quote must be received electronically by the Division’s Proposal Review Unit, through NJSTART, by the required date and time.

The date and time of the Quote opening are indicated on the Bid Solicitation cover sheet and on the “Summary” Tab of the Bid Solicitation webpage within NJSTART. If the Quote opening deadline has been revised, the new Quote opening deadline will be shown on the posted Bid Amendment and on the “Summary” Tab of the Bid Solicitation webpage within NJSTART. Quotes not received prior to the Quote opening deadline shall be rejected.

Quotes will be publicly opened and announced by telephone conference on the date and time of the quote opening.

(Dial-in phone number: 888-204-5984 / Access code: 2602305)

When submitting a Quote through NJSTART, do not use any symbols (i.e., #, @, $, &, *) in the filename as this may prevent the Quote from being properly uploaded. Uploaded files must be compatible with Microsoft Office and/or Adobe software applications. DO NOT UPLOAD files with extensions such as .zip, .numbers, or .pages.

When uploading the documents to NJSTART, the Bidder should select the “Confidential” option in NJSTART for attachments on the “Attachments” Tab to request that the documents not be displayed publicly through NJSTART. Marking an attachment as "Confidential" in NJSTART shall not constitute the Bidder's designation of the attachment as exempt from public disclosure under the New Jersey Open Public Records Act (OPRA), N.J.S.A. 47:1A-1 et seq., or the common law right to know.

BIDDER RESPONSIBILITY

The Bidder assumes sole responsibility for the complete effort required in submitting a Quote in response to this Bid Solicitation. No special consideration will be given after Quotes are opened because of a Bidder’s failure to be knowledgeable as to all of the requirements of this Bid Solicitation. The State assumes no responsibility and bears no liability for costs incurred by a Bidder in the preparation and submittal of a Quote in response to this Bid Solicitation or any pre-contract award costs incurred.

ANNOUNCEMENT OF QUOTE INFORMATION

On the date and time Quotes are due under the Bid Solicitation, all information concerning the Quotes submitted may be publicly announced and shall be available for inspection and copying except otherwise noted:

A. Information appropriately designated as proprietary and/or confidential in a Bidder’s Quote shall not be available for inspection and copying; and B. Where negotiation is contemplated, only the names and addresses of the Bidders submitting Quotes will be announced, and the contents of the Quotes shall not be available for inspection and copying until the Notice of Intent to Award is issued by the Director.

QUOTE ERRORS

In accordance with N.J.A.C. 17:12-2.11 “Proposal errors,” a Bidder may withdraw its Quote as described below.

QUOTE WITHDRAWAL PRIOR TO QUOTE OPENING

A Bidder may withdraw its Quote submission in NJSTART prior to the Quote opening; however, Bidders should note that while withdrawn NJSTART Quotes remain viewable by the Bidder on its Vendor Profile Homepage, they are removed from the Division’s view and cannot be considered for Contract award. The Bidder may submit a revised Quote as long as the Quote is received prior to the announced date and time for Quote submission. Bidders may refer to the QRG “Submit a Quote” for additional instructions.

QUOTE WITHDRAWAL AFTER QUOTE OPENING, BUT PRIOR TO CONTRACT AWARD

If, after the Quote opening, but before Contract award, a Bidder discovers an error in its Quote, the Bidder may make a written request to the Procurement Bureau to withdraw its Quote, from consideration for award. If the Bidder’s request to withdraw is made in good faith, and the State will not be significantly prejudiced by granting the withdrawal of the Quote beyond the loss of the benefit of the bargain to the State of the withdrawing Bidder’s offer, the request shall be granted. Evidence of the Bidder’s good faith in making this request can be demonstrated by one (1) or more of the following factors: A mistake is so significant that to enforce the Contract resulting from the Quote would be unconscionable; that the mistake relates to a material feature or term of the Contract; and that the mistake occurred notwithstanding the Bidder’s exercise of reasonable care. After Quote opening, while pursuant to the provisions of this section a Bidder may request to withdraw its Quote and the Director may in his/her discretion allow said Bidder to withdraw it, the Division also may take notice of repeated or unusual requests to withdraw by a Bidder and take those prior requests to withdraw into consideration when evaluating the Bidder’s future Quotes.

The Quote withdrawal request must include the Bid Solicitation Number, Bid Solicitation Title, and the Quote submission date and should be sent to Procurement.Bureau@treas.nj.gov.

If, during a Quote evaluation process, an obvious pricing error made by a potential Contract awardee is found, the Director or his/her designee shall issue written notice to the Bidder. The Bidder will have up to five (5) Business Days after receipt of the notice to confirm its pricing. If the Bidder fails to respond, its Quote shall be considered withdrawn, and no further consideration shall be given to it.

JOINT VENTURE

If a Joint Venture is submitting a Quote, the agreement between the parties relating to such Joint Venture should be submitted with the Joint Venture’s Quote. Authorized signatories from each party comprising the Joint Venture must sign the Offer and Acceptance Page. Each party to the Joint Venture must individually complete and comply with all the forms and certification requirements in Bid Solicitation Section 3 – Quote Submission Requirements.

SMALL BUSINESS SET-ASIDE CONTRACTS

Not applicable to this procurement.

DISABLED VETERANS’ BUSINESS SET-ASIDE CONTRACT

Not applicable to this procurement.

BID SECURITY

Not applicable to this procurement.

BIDDER ADDITIONAL TERMS SUBMITTED WITH THE QUOTE

A Bidder may submit additional terms as part of its Quote. Additional terms are Bidder-proposed terms or conditions that do not conflict with the scope of work required in this Bid Solicitation, the terms and conditions of this Bid Solicitation, or the State of New Jersey Standard Terms and Conditions. Bidder proposed terms or conditions that conflict with those contained in the State of New Jersey Standard Terms and Conditions will render a Quote non-responsive. It is incumbent upon the Bidder to identify and remove its conflicting proposed terms and conditions prior to Quote submission.

Quotes including Bidder proposed additional terms may be accepted, rejected, or negotiated, in whole or in part, at the State’s sole discretion.

If Bidder intends to propose terms and conditions that conflict with the State of New Jersey Standard Terms and Conditions, those Bidder proposed terms and conditions shall only be considered if submitted and agreed to pursuant to the electronic question and answer procedure. Bidders shall not submit exceptions or modifications as part of the Quote or on the “Terms and Conditions” Tab through NJSTART.

QUOTE CONTENT

The Quote should be submitted with the attachments organized in following manner:

· Forms

· Technical Quote

· Management Overview

· Contract Management

· Mobilization Plan

· Organizational Experience

· Location

· Organization Charts

· Resumes

· Experience with Contracts Similar Size and Scope

· Sample Documents

· Premium Refund Agreement

· Attachment A1 and A2 Provider Disruption Workbooks

· Attachment B – Performance Standards and Liquidated Damages

· Attachment C – CMS Star Ratings for 2022-2026

· Attachment D – PPO CMS ACCESS Match

· Attachment E – Service Area Match

· Attachment G – Standard Procurement Forms Packet

· Attachment H – State-Supplied Price Sheet

· State of New Jersey Security Due Diligence Third Party Information Security Questionnaire

· Financial Capabilities of the Bidder

A Bidder should not password protect any submitted documents. Use of URLs in a Quote should be kept to a minimum and shall not be used to satisfy any material term of a Bid Solicitation. If a preprinted or other document included as part of the Quote contains a URL, a printed copy of the information should be provided and will be considered as part of the Quote.

FORMS, REGISTRATIONS AND CERTIFICATIONS TO BE SUBMITTED WITH QUOTE

A Bidder is required to complete and submit the following forms. As an alternative to uploading certain forms with the submitted Quote, a Bidder may complete several certifications electronically in NJSTART on the “Terms and Categories” Tab within the Vendor Profile. Those forms that may be completed on the NJSTART “Terms and Categories” Tab are noted below. Additionally, a Bidder may attach completed forms to the Vendor Profile. Refer to QRGs “Vendor Forms” and “Attaching Files” for additional instructions. VENDOR QUICK REFERENCE GUIDES (https://www.nj.gov/treasury/purchase/vendor.shtml).

OFFER AND ACCEPTANCE PAGE

The Bidder should complete and submit the Offer and Acceptance Page with the Quote. The Offer and Acceptance Page must be signed by an authorized representative of the Bidder. If a Bidder does not submit the form with the Quote, the Bidder must comply within seven (7) Business Days of the State’s request or the State may deem the Quote non-responsive.

OWNERSHIP DISCLOSURE FORM

Pursuant to N.J.S.A. 52:25-24.2, in the event the Bidder is a corporation, partnership or limited liability company, the Bidder must disclose all 10% or greater owners by (a) completing and submitting the Ownership Disclosure Form with the Quote; (b) if the Bidder has submitted a signed and accurate Ownership Disclosure Form dated and received no more than six (6) months prior to the Quote submission deadline for this procurement, the Division may rely upon that form; however, if there has been a change in ownership within the last six (6) months, a new Ownership Disclosure Form must be completed, signed and submitted with the Quote; or, (c) a Bidder with any direct or indirect parent entity which is publicly traded may submit the name and address of each publicly traded entity and the name and address of each person that holds a 10 percent or greater beneficial interest in the publicly traded entity as of the last annual filing with the federal Securities and Exchange Commission or the foreign equivalent, and, if there is any person that holds a 10 percent or greater beneficial interest, also shall submit links to the websites containing the last annual filings with the federal Securities and Exchange Commission or the foreign equivalent and the relevant page numbers of the filings that contain the information on each person that holds a 10 percent or greater beneficial interest. N.J.S.A. 52:25-24.2.

NOTE: In lieu of completing and submitting the paper-based form, the Bidder has the option to complete this form online in NJSTART on the “Terms and Categories” Tab.

A Bidder’s failure to submit the information required by N.J.S.A. 52:25-24.2 will result in the rejection of the Quote as non-responsive and preclude the award of a Contract to said Bidder.

DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN FORM

The Bidder should submit Disclosure of Investment Activities in Iran form to certify that, pursuant to N.J.S.A. 52:32-58, neither the Bidder, nor one (1) of its parents, subsidiaries, and/or affiliates (as defined in N.J.S.A. 52:32-56(e)(3)), is listed on the Department of the Treasury’s List of Persons or Entities Engaging in Prohibited Investment Activities in Iran and that neither the Bidder, nor one (1) of its parents, subsidiaries, and/or affiliates, is involved in any of the investment activities set forth in N.J.S.A. 52:32-56(f). If the Bidder is unable to so certify, the Bidder shall provide a detailed and precise description of such activities as directed on the form. If a Bidder does not submit the form with the Quote, the Bidder must comply within seven (7) Business Days of the State’s request or the State may deem the Quote non-responsive.

NOTE: In lieu of completing and submitting the paper-based form, the Bidder has the option to complete this certification online in NJSTART on the “Terms and Categories” Tab.

DISCLOSURE OF INVESTIGATIONS AND OTHER ACTIONS INVOLVING BIDDER FORM

The Bidder should submit the Disclosure of Investigations and Other Actions Involving Bidder Form, with its Quote, to provide a detailed description of any investigation, litigation, including administrative complaints or other administrative proceedings, involving any public sector clients during the past five (5) years, including the nature and status of the investigation, and, for any litigation, the caption of the action, a brief description of the action, the date of inception, current status, and, if applicable, disposition. If a Bidder does not submit the form with the Quote, the Bidder must comply within seven (7) Business Days of the State’s request or the State may deem the Quote non-responsive.

NOTE: In lieu of completing and submitting the paper-based form, the Bidder has the option to complete this certification online in NJSTART on the “Terms and Categories” Tab.

MACBRIDE PRINCIPLES FORM

The Bidder should submit the MacBride Principles Form. Pursuant to N.J.S.A. 52:34-12.2, a Bidder is required to certify that it either has no ongoing business activities in Northern Ireland and does not maintain a physical presence therein or that it will take lawful steps in good faith to conduct any business operations it has in Northern Ireland in accordance with the MacBride principles of nondiscrimination in employment as set forth in N.J.S.A. 52:18A-89.5 and in conformance with the United Kingdom’s Fair Employment (Northern Ireland) Act of 1989, and permit independent monitoring of their compliance with those principles. If a Bidder does not submit the form with the Quote, the Bidder must comply within seven (7) Business Days of the State’s request or the State may deem the Quote non-responsive.

NOTE: In lieu of completing and submitting the paper-based form, the Bidder has the option to complete this certification online in NJSTART on the “Terms and Categories” Tab.

SERVICE PERFORMANCE WITHIN THE UNITED STATES

The Bidder should submit a completed Source Disclosure Form. Pursuant to N.J.S.A. 52:34-13.2, all Contracts primarily for services shall be performed within the United States. If a Bidder does not submit the form with the Quote, the Bidder must comply within seven (7) Business Days of the State’s request or the State may deem the Quote non-responsive.

CONFIDENTIALITY/COMMITMENT TO DEFEND

Pursuant to the New Jersey Open Public Records Act (OPRA), N.J.S.A. 47:1A-1 et seq., or the common law right to know, Quotes can be released to the public in accordance with N.J.A.C. 17:12-1.2(b) and (c).

The Bidder should submit a completed and signed Confidentiality/Commitment to Defend Form with the Quote. In the event that the Bidder does not submit the Confidentiality form with the Quote, the State reserves the right to request that the Bidder submit the form after Quote submission.

After the opening of sealed Quotes, all information submitted by a Bidder in response to a Bid Solicitation is considered public information notwithstanding any disclaimers to the contrary submitted by a Bidder. Proprietary, financial, security and confidential information may be exempt from public disclosure by OPRA and/or the common law when the Bidder has a good faith, legal/factual basis for such assertion.

When the Bid Solicitation contains a negotiation component, the Quote will not be subject to public disclosure until a notice of intent to award a Contract is announced.

As part of its Quote, a Bidder may request that portions of the Quote be exempt from public disclosure under OPRA and/or the common law. The Bidder must provide a detailed statement clearly identifying those sections of the Quote that it claims are exempt from production, and the legal and factual basis that supports said exemption(s) as a matter of law. The State will not honor any attempts by a Bidder to designate its price sheet, price list/catalog, and/or the entire Quote as proprietary and/or confidential, and/or to claim copyright protection for its entire Quote. If the State does not agree with a Bidder’s designation of proprietary and/or confidential information, the State will use commercially reasonable efforts to advise the Bidder. Copyright law does not prohibit access to a record which is otherwise available under OPRA.

The State reserves the right to make the determination as to what to disclose in response to an OPRA request. Any information that the State determines to be exempt from disclosure under OPRA will be redacted.

In the event of any challenge to the Bidder’s assertion of confidentiality that is contrary to the State’s determination of confidentiality, the Bidder shall be solely responsible for defending its designation, but in doing so, all costs and expenses associated therewith shall be the responsibility of the Bidder. The State assumes no such responsibility or liability.

In order not to delay consideration of the Quote or the…