Test.docx

This is a Request for Proposal (RFP) document from the County of Orange Human Resource Services, Employee Benefits Department in California, soliciting comprehensive claims administration services for self-insured Preferred Provider Organization (PPO) health plans. The County seeks qualified firms to administer four existing self-insured PPO health plans (two for employees and two for retirees) with potential expansion to High Performance Network (HPN) self-insured PPO plans, serving approximately 5,600 employees and retirees. Primary deliverables include claims processing, customer service, provider network management, utilization review, and disease management. The RFP was released on February 15, 2024, with proposals due on March 15, 2024, by 4:00 PM Pacific Time. The initial contract term is three years, commencing January 1, 2025, with potential renewal for up to two additional consecutive one-year terms.

Evaluation criteria include administrative capability, cost, network capabilities, performance guarantees, plan design compatibility, qualifications and experience, and responsiveness to RFP requirements. The RFP does not specify explicit set-aside designations or restrictions on respondent types. Blue Shield of California currently serves as the claims administrator, and the County anticipates transitioning to a new vendor. Existing medical expenditures totaled approximately $52.7 million in 2022. Qualified vendors must demonstrate experience with public sector clients, maintain a broad provider network in California and nationally, and possess the ability to integrate with the existing OptumRx pharmacy benefits management system. Contractors must also demonstrate robust cybersecurity protocols and compliance with healthcare regulations, with performance standards subject to potential penalties for administrative and service metrics. The County may implement plan design changes including coverage for hearing aids, foot orthotics, fertility services, and abortions.