HMO Services for MPSERS

The State of Michigan Department of Technology, Management and Budget issued Request for Proposal No. 190000002803 on July 18, 2019, seeking qualified Health Maintenance Organizations to provide comprehensive HMO services for the Michigan Public School Employees' Retirement System (MPSERS), serving approximately 32,500 members comprising 10,400 non-Medicare eligible and 22,100 Medicare eligible participants. The primary deliverables include administration of both Non-Medicare and Medicare HMO products with integrated pharmacy coverage, claim processing, and health care plan administration commencing January 1, 2020. Mandatory qualifications require current HMO licensure in Michigan with National Council for Quality Assurance (NCQA) accreditation, authorization to operate in all Michigan locations where approved by the Michigan Department of Insurance and Financial Services, and capability to provide comprehensive benefits meeting actuarial equivalency standards to the MPSERS Master Health Care Plan. Key operational requirements include maintaining a Michigan-based customer service call center available Monday through Friday from 8:00 AM to 5:00 PM Eastern Time, conducting annual SSAE 16 SOC 2 Type 2 audits, ensuring 100% accurate eligibility record processing within one business day, and achieving a minimum Plan Sponsor satisfaction survey score of 4.00 on a five-point scale with service credits of $1,000 assessed for non-compliance. Additional deliverables encompass quarterly and annual performance review reports, benefit comparison attestations due by September 1 annually, disaster recovery plans, and HEDIS metrics reporting. The proposal deadline was August 7, 2019 at 1:50 p.m. Eastern, with bidder questions due July 25, 2019, anticipated answers posted July 29, 2019, and an anticipated contract commencement date of October 23, 2019 for implementation through December 31, 2019, followed by service delivery through December 31, 2020, with four optional one-year renewal periods at the State's sole discretion. Evaluation criteria included Pass/Fail assessment of mandatory minimum requirements including completion of Schedule A and the Vendor Questions Worksheet, agreement with Standard Contract Terms, actuarial equivalency demonstration, and compliance with applicable certifications and labor standards.

The RFP documentation does not identify explicit set-aside designations for disadvantaged enterprises, minority-owned businesses, or other restricted procurement categories. No incumbent vendors or current contractors are identified in the solicitation materials, though the RFP references existing MPSERS plan design specifications administered through Blue Cross Blue Shield of Michigan with specialty pharmacy services provided by BriovaRx and hearing services through TruHearing, which bidders must accommodate within their proposed benefit structures. Premium rates for the initial contract year 2020 are specified in Schedule B, with non-Medicare self-only rates ranging from $682.32 to $686.00 depending on ACA health insurer fee status, spouse rates from $566.04 to $569.10, and per-child rates from $171.04 to $171.97, while Medicare participant rates range from $131.21 to $143.94 for self-only, $113.68 to $126.22 for spouse, and $128.04 to $140.59 per child. Contracts valued at $500,000 or greater require approval by the State Administrative Board, and payment will be made exclusively by electronic funds transfer based on Plan Sponsor enrollment records with undisputed invoices due within 45 days of State receipt. The contractor must maintain comprehensive insurance coverage including Commercial General Liability of $1,000,000 per occurrence, Professional Liability of $3,000,000 per occurrence, and Cyber Liability of $1,000,000, with all policies naming the State as additional insured. The State reserves the right to conduct on-site facility visits, require oral presentations, conduct reference checks, and award multiple contracts to responsive and responsible bidders meeting evaluation criteria.