RFP for Claims Administration for the Self-Insured County of Orange Dental Plan

The County of Orange Human Resource Services, Employee Benefits Department is seeking proposals for claims administration services for their self-insured dental preferred provider organization (PPO) plan through a Request for Proposal (RFP) released on February 19, 2025. The procurement targets a third-party administrator to manage dental claims for approximately 5,800 county employees and their dependents, with services commencing January 1, 2025. Key deliverables include comprehensive claims processing, customer service, provider network management, eligibility tracking, and reporting services. The successful vendor must provide a California and national dental PPO network, maintain claims system functionality, and implement robust cybersecurity protections. Proposals are due on March 7, 2024, by 4:00 PM Pacific Time, with an initial contract term of three years and two optional one-year renewal periods. Evaluation criteria will encompass proposed cost, network capabilities, administrative functions, performance guarantees, experience with public entities, and overall responsiveness to RFP requirements. The county will assess vendors based on claims processing accuracy, turnaround times, customer service metrics, and member satisfaction.

The RFP does not explicitly indicate specific set-aside designations or restrictions for disadvantaged enterprises. The current claims administrator is Blue Shield of California, utilizing Dental Benefit Providers as a subcontractor, which will be replaced by the new vendor. The dental plan currently offers an annual maximum benefit of $2,000, with recent enhancements including implant and orthodontia coverage. Historical claims expenditures were $2.1 million in 2022 and $2.2 million in 2023, suggesting a potential contract value in a similar range. Full-time eligible county employees do not pay premiums for the dental plan, and the new administrator must maintain or improve the existing plan design. The county requires the selected vendor to demonstrate comprehensive administrative capabilities, including implementation planning, detailed reporting, and adherence to Information Technology Security Guidelines outlined in the RFP attachments. Proposing firms must provide detailed documentation of their technological infrastructure, claims processing systems, and ability to integrate with existing county technology platforms.