Contract: administration of medical benefits

The State of New Hampshire's Department of Administrative Services (DAS), specifically the Division of Risk and Benefits, is seeking a third-party administrator for its Employee and Retiree Health Benefit Plan through Request for Proposal (RFP) #3015-25. The procurement aims to secure comprehensive medical benefits administration services for approximately 27,300 lives, including active employees, dependents, and a "Special Group" of 510 subscribers from other organizations. The State self-funds its health benefit plan, covering active employees and non-Medicare retirees located throughout New Hampshire and surrounding New England states, with non-Medicare retiree dependents covered nationwide. Evaluation criteria will include minimum qualifications, technical scoring, performance guarantees, and financial scoring. The proposal response is due by April 17, 2025, at 2:00 PM Eastern Time, with key requirements including plan design, network access, value-based purchasing services, wellness programs, and compliance with federal regulations such as Mental Health Parity and Transparency in Coverage rules. The RFP emphasizes preferred outpatient surgery and lab locations, claims processing capabilities, and detailed technical and administrative performance metrics.

While the RFP does not explicitly mention specific set-aside designations or restrictions for disadvantaged enterprises, it provides comprehensive guidelines for potential bidders. The procurement appears open to qualified third-party administrators with demonstrated expertise in managing large-scale, self-funded health benefit plans. Although no incumbent vendor is specifically identified in the provided documentation, the RFP suggests a robust evaluation process that will carefully assess vendors' capabilities to manage a complex healthcare administration contract. The current infrastructure appears to support a comprehensive health benefits program covering employees across New Hampshire and surrounding New England states. While an exact award value is not specified in the available documents, the scale of the program covering 27,300 lives indicates a significant potential contract value. Prospective bidders should be prepared to demonstrate extensive experience in healthcare benefits administration, strong technological infrastructure, comprehensive claims processing capabilities, and the ability to meet stringent performance and compliance standards.