Self-Funded Medical Plan Administration, Pharmacy Benefit Management and Stop Loss Coverage

Westchester Medical Center Health Network (WMCHealth) is requesting proposals for self-funded medical plan administration, pharmacy benefit management, and stop loss coverage serving approximately 13,500 employees across eight acute care hospital locations and affiliated facilities, with proposals due September 25, 2026 at 4:00 p.m. Eastern Standard Time. Direct submissions from carriers and vendors are required; proposals submitted through brokers or consultants will not be accepted.

WMCHealth seeks comprehensive administrative services across five distinct subgroups: WMC Westchester, WMC NYSNA Grandfathered, MidHudson, HealthAlliance, and Charity entities. The scope includes medical plan administration, pharmacy benefit management, and stop loss insurance coverage (current stop loss is at a $1 million specific level for domestic claims only). All ASO fees must be guaranteed for three years with no automatic escalators. The vendor must provide year-one allowances to offset incumbent termination penalties and credits or allowances to offset implementation costs. Implementation is expected to run concurrently with contract finalization.

The current service provider is Aetna/CVS for medical and pharmacy services, with Aetna providing stop loss coverage. The estimated contract value is not stated. The initial contract term runs from January 1, 2027 through December 31, 2029. Place of performance is Westchester County, New York.

Evaluation will apply best-value criteria emphasizing quality, cost, efficiency, cultural fit, service guarantees, implementation capabilities, and communication support. A Letter of Intent and signed Confidentiality Agreement are due by September 8, 2026 to access complete appendices. Questions must be submitted by September 14, 2026, with responses distributed by September 18, 2026. All proposals must remain valid for acceptance through December 31, 2026. Vendors must complete Medical RFP Questionnaire, Medical Provider Disruption Workbook, Medical Claim Repricing Workbook, Pharmacy RFP Questionnaire, and compliance documentation including M/WBE participation and diversity practices attestation.