HR Benefits - Medical, Dental, and Vision

Travis County Healthcare District d/b/a Central Health is requesting proposals for comprehensive medical administrative services only (ASO), prescription drug benefits, fully-insured dental coverage, and fully-insured vision insurance with proposals due June 11, 2026 at 2:00 PM Central Time under RFP 2605-004. Central Health permits vendors to quote on any or all lines of coverage and does not restrict bidding to a single incumbent or set-aside category, though the District encourages good-faith efforts to include certified minority, women, and veteran-owned businesses as subcontractors.

The scope spans medical plan administration (including Seton ACO, Texas Medical Neighborhood EPO, and HDHP options); pharmacy benefits management (carve-out or bundled); fully-insured dental coverage (Basic and Premium PPO tiers); and fully-insured vision coverage (Basic and Plus plans). Current medical networks operate through Aetna; dental and vision plans are also administered by Aetna. Central Health maintains approximately 2,000 eligible lives with enrollment across multiple family composition tiers. Medical claims experience from the rolling 12-month period (March 2025–February 2026) shows significant catastrophic claims, including 18 claimants exceeding $150,000 with aggregate catastrophic claims of $4.68 million. Dental claims (24 months through January 2026) total $2.62 million against $2.85 million in premiums (92% cost ratio) with 1,961 subscribers and 3,591 members at contract close. Vision claims (24 months through November 2025) totaled $273,767 against $363,687 in premiums (75% cost ratio).

The initial contract term runs one year with optional renewal for up to four additional one-year periods, effective January 1, 2027. Incumbent carriers are Aetna (medical, PBM via CVS Caremark, dental, and vision). Evaluation criteria include account management (10%), customer service (10%), claims administration (20%), technical and reporting capabilities (10%), implementation planning (10%), fee structure (20%), and underwriting processes (20%), with potential interviews of short-listed finalists worth up to 20 additional points. Proposals must be submitted via Bidnet (preferred) or sealed mail to Central Health's Purchasing Office in Austin. All vendors must execute Central Health's standard contract template, provide a Certificate of Interested Parties (Form 1295), complete a Conflict of Interest Questionnaire, and execute a HIPAA Business Associate Agreement. Central Health reserves the right to request Best and Final Offers, waive minor irregularities, reject any or all proposals, award multiple contracts, or terminate the RFP without obligation.