Medicare Supplement and Part D Pharmacy Insurance

Volusia County, Florida is issuing a Request for Proposal for Medicare Supplement and Part D Pharmacy Insurance services to provide fully insured group coverage to eligible Medicare retirees and their spouses across the county and participating agencies, effective January 1, 2027. The Contractor must provide three Medicare Supplement plan options (Plans F, G, and N) and a comprehensive Medicare Part D Employer Group Waiver Plan (EGWP) with specific formulary requirements, maintaining separate eligibility and reporting capabilities for each participating agency. Deliverables include assignment of a dedicated client service manager with retiree health experience, telephonic and web-based customer service during business hours, monthly eligibility updates with discrepancy reporting, coordination of claim submissions with Medicare, on-site enrollment assistance including three annual half-day meetings, annual plan experience reports within 90 days of plan year end, and compliance with CMS and Florida Office of Insurance Regulation requirements. The Contractor must provide a minimum pharmacy network including major chains (CVS, Walgreens, Publix, Walmart, and others), classify approximately 100 listed medications into five tiers, and implement the specified $0 deductible with tiered copayments ($15 generic, $35 preferred brand, $55 non-preferred brand and specialty). Key evaluation criteria include firm and employee qualifications (10 percent), project methodology and approach (25 percent), functional performance and scope of services capability (30 percent), total cost (20 percent), experience and references (10 percent), and financial stability and litigation history (5 percent); respondents must provide four or more references with a minimum of five years of relevant experience in comparable governmental or educational entities with at least 2,500 subscribers. The deadline for submitting questions is April 27, 2026, with proposals due electronically through the County's eProcurement portal by May 11, 2026, at 3:01 p.m., and all costs must remain firm for 120 days from solicitation opening.

No specific set-aside designations or disadvantaged enterprise restrictions are identified in the solicitation documents. The incumbent vendor is UnitedHealthCare, currently providing coverage to approximately 500+ Medicare-eligible participants in the existing plan; census data indicates supplement plan premiums ranging from approximately $119 to $389 monthly and Part D premiums standardized at $340.98 monthly across all current participants. The County's existing Third Party Administrator, WEX, will continue to handle eligibility, enrollment, and billing functions and must coordinate with the selected contractor, requiring seamless integration with existing systems and infrastructure. Combined Medicare Supplement Plan N and Part D Pharmacy premiums must be lower than the County's current medical and pharmacy premium of $971 per month for single coverage. The contract term is five years with an optional five-year renewal contingent upon mutual written agreement and County Council approval, with compensation structured as monthly premiums paid through payroll deduction from Florida Retirement System (FRS) accounts or direct billing for members without FRS accounts. The Contractor must maintain Professional Liability insurance coverage of $1,000,000 per claim and $2,000,000 aggregate, and Cyber Insurance of $2,000,000 per claim and $2,000,000 aggregate, with all policies issued by insurers licensed in Florida with minimum A.M. Best ratings of A- and Financial category size VIII or greater.