Group Employee Medical Insurance FY 2026-2027

The City of Edinburg, Texas is requesting proposals for group employee medical insurance coverage for fiscal year 2026–2027 under RFP 2026-018, with proposals due August 4, 2026 at 3:00 pm through the OpenGov portal and questions due July 24, 2026. The City seeks both fully-funded and self-funded options to cover approximately 1,200 full-time employees, 60 part-time employees, and 110 retirees.

Vendors must provide at minimum one PPO network option and one HMO network option for both fully-insured and self-funded plans, along with detailed pharmacy disruption and network access reports for seven specified counties in the service area. Pricing submissions must include fully-insured high and low plans, self-insured administrative services only (ASO) fees with per-employee-per-month administrative costs, stop-loss carrier fees, EAP services, wellness programs, and virtual visit services. The City's current coverage is provided by Blue Cross Blue Shield on a self-insured basis with pharmacy through Prime Therapeutics and stop-loss through Liberty Mutual.

Historical claims data shows significant cost escalation. For the period October 2024 through September 2025, total paid claims reached $9,574,959 on an annual premium of $9,632,072, yielding a 99.4% loss ratio. Enrollment averaged 1,709 members with paid per-employee-per-month costs of $725.93, up 22.6% year-over-year. High-cost claimants (expenses exceeding $50,000) numbered 26 members accounting for 49.7% of total paid expenses, with the highest individual claim at $920,378.79. Inpatient facility costs increased dramatically, with complex newborn admissions more than doubling. Neoplasms represented the largest diagnostic category at 19.0% of costs with 86.6% year-over-year growth.

Evaluation criteria are qualifications and experience (10 points), plan design and contract language (20 points), questionnaire responses (10 points), rates and fees (30 points), references from similar governmental agencies (10 points), and reporting system capability (20 points). All vendors must comply with HIPAA, ADA, and FMLA and submit conflict-of-interest disclosures, non-collusion affidavits, and verification of compliance with Texas bills HB 89, SB 13, and SB 19. Public proposal opening occurs August 4, 2026 at 3:00 pm in City Hall Community Room. The City reserves the right to hold proposals for 90 days without action or to reject any or all proposals.