Medicare Supplemental Plans and Medicare Part D Employer Group Waiver Plans

Orange County, Florida is soliciting sealed proposals for Medicare Supplemental Plans and Medicare Part D Employer Group Waiver Plans (Y26-151) through a Request for Proposals released March 26, 2026. The procurement seeks qualified insurers to provide fully insured group coverage for county retirees and Medicare-eligible dependents, including individuals under age 65, across five Florida counties: Orange, Brevard, Osceola, Seminole, and Volusia. Proposers must offer a minimum of three Medicare Supplement plan options (Plans F, G, and N) and Medicare Part D EGWP plans at both low and high coverage levels, with specific formulary requirements covering 100 pharmaceutical drugs across generic, preferred brand, non-preferred brand, and specialty categories. Key deliverables include comprehensive plan administration with dedicated personnel possessing minimum five years of retiree benefits experience, nationwide pharmacy networks with specific chain participation (including CVS, Walgreens, Publix, and others) and documented independent pharmacy counts by county, disease management and case management programs, and guaranteed issue provisions with no pre-existing condition limitations. Proposers must maintain an A.M. Best financial strength rating of A or above (Class X or higher), obtain Florida Office of Insurance Regulation approvals, provide five references with at least three from governmental entities with 5,000+ employees, and demonstrate current enrollment capability in the Orange County area. The contract term is three years commencing January 1, 2027, with two optional one-year renewal periods. Evaluation criteria allocate 40 points for plan administration and staff qualifications, 15 points for technical approach to plan design and network services, and 45 points for the fee schedule, with bonus points available for hiring dislocated workers (up to 5 points), registered Service-Disabled Veteran subcontractors (up to 10 points), and registered SDV prime contractors (5 points). Electronic proposal submission through the OpenGov e-Procurement Platform is required by 4:00 PM EST on May 7, 2026, with a question submission deadline of April 9, 2026, at 5:00 PM EST, and public proposal opening at the next Wednesday or Friday procurement meeting following the deadline at 9:30 AM.

No specific set-asides for disadvantaged enterprises or restricted vendor categories are identified in the solicitation documents; however, the County encourages participation from dislocated worker programs, registered Service-Disabled Veteran-owned subcontractors and prime contractors through bonus point allocations. The County's current Third Party Administrator is Wex Health, Inc., which manages eligibility, enrollment, and billing integration, and proposers must be capable of interfacing with this existing infrastructure while accepting monthly premium payments on a group billing basis. The incumbent carriers appear to be Cigna-HealthSpring for prescription drug plans and Medicare Surround Cigna for supplemental coverage based on census data showing 400+ existing retirees enrolled as of January 1, 2026. Proposers must comply with comprehensive insurance requirements including $1,000,000 commercial general liability, $500,000 business auto liability, statutory workers' compensation, and $1,000,000 professional liability coverage, along with E-Verify employment verification and Business Associate Agreements for HIPAA compliance. The solicitation does not specify an overall budget or award value; pricing is evaluated competitively through the fee schedule submission requiring monthly premium rates for individual retirees across multiple age ranges (65, 66-69, 70-74, 75-79, and 80+) with reference plan proposals at $214.97 (Low Plan) and $377.00 (High Plan) for current proposed rates. The County reserves the right to make multiple awards and may conduct up to three on-site enrollment meetings and require bidders' training.