Self-Funded and Medical and Pharmacy Services

The City of Greenville and Greenville Utilities Commission are requesting proposals for self-funded medical and pharmacy claims administration services covering employees and dependents across three plan options, with proposals due July 17, 2026 and anticipated selection by August 31, 2026. The City has established 4% Minority Business Enterprise (MBE) and 4% Women Business Enterprise (WBE) participation goals. Questions are due June 22, 2026, with answers provided by addendum on June 29, 2026.

The scope covers claims administration, member services, account management, implementation, and pharmacy services for approximately 2,812 members (1,513 employees and pre-65 retirees) enrolled across Core PPO, Enhanced PPO, and HSA plan designs. Detailed plan documents specify deductibles, copayment structures, out-of-pocket maximums, and coverage exclusions for each option. The administrator must maintain 99% claims accuracy, process claims within 10 business days, provide geoaccess and disruption-analysis reporting, and accept fiduciary responsibility. Pharmacy administration must include 100% pass-through of manufacturer revenue (access fees, rebates, administrative fees) with third-party audit transparency. The contract requires customized implementation and transition plans, quarterly meetings, annual vendor reviews, and an Employee Assistance Program with customizable options.

Pricing must be submitted on a per-employee-per-month (PEPM) basis net of commissions, with no fee adjustments based on actual enrollment fluctuations during the rate-guarantee period. Recent claims experience (January–April 2026) shows approximately $10.1 million in gross claims with $120,162 in stop-loss recoveries across combined accounts. The contract is for an initial three-year term with annual renewals thereafter, effective January 1, 2027. The incumbent carrier is Cigna. Proposals must be submitted directly by insurance carriers or claims administrators; submissions involving brokers, agents, or third parties will be rejected. Proposers must provide a minimum of three client references with services delivered within the past three years. The City and GUC have engaged Mercer Health & Benefits to evaluate proposals and provide recommendations. Proposals become public records unless specific North Carolina statutory exemptions are claimed.