OEIBA Program Commercial HMO, MSP, and MAPD Plans

The Oklahoma Office of Management and Enterprise Services (OMES), on behalf of the Oklahoma Health Care Authority Employees Group Insurance Division (EGID), is soliciting proposals for comprehensive health insurance plans for the OEIBA Program for Plan Year 2026. The procurement seeks qualified Health Maintenance Organizations (HMOs), Medicare Supplements (MSP), and Medicare Advantage Prescription Drug (MAPD) health plans to provide managed care benefits to approximately 216,190 total lives, including 34,570 Medicare participants, 176,142 current employees, and 5,478 pre-Medicare former employees. Bidders must submit detailed proposals including premium quotes, benefit summaries, network reports, utilization data, and comprehensive documentation such as organizational charts, licensing information, and actuarial certifications. Key deliverables include monthly and quarterly reporting on network changes, member services, claims utilization, satisfaction surveys, and compliance with specific performance metrics like 80% call answer rates within 30 seconds and call abandonment rates under 5%. The solicitation (Event #EV00000681) requires bid responses to be received by 3:00 p.m. Central Standard Time on May 2, 2025, with the last day to submit questions being April 17, 2025. Proposals must be submitted exclusively through the Oklahoma Supplier Portal, with bids remaining valid for a minimum of 120 days after the response due date.

The procurement does not explicitly outline specific set-aside designations or restrictions for disadvantaged enterprises. The administrative assessment for Plan Year 2026 is $4.477 Per Member Per Month (PMPM), which will be collected by EGID to reimburse administrative activities. Bidders can offer one of four bid combinations: HMO and Medicare Supplement, HMO and MAPD, HMO and Medicare Supplement and MAPD, or a standalone national MAPD plan, with only one plan per supplier to be accepted for the 2026 plan year. While specific incumbent vendors are not detailed, the solicitation indicates an intent to solicit a standalone national MAPD plan exclusively for retired OEIBA Program members living outside Oklahoma. The state reserves the right to determine a bidder's financial responsibility and may withhold award from bidders not deemed financially sound. Although precise award values are not specified, the comprehensive nature of the solicitation covering over 216,000 lives suggests a significant potential contract value, with the state providing usage estimates that are not guaranteed purchase quantities.