Self-Funded Medical Plan ASO

Marion County Public Schools (MCPS) in Ocala, Florida is conducting a Request for Proposal (RFP) #4115RC for a Third-Party Administrator (TPA) to manage their self-funded medical plan with Administrative Services Only (ASO) capabilities. The procurement seeks a qualified vendor to administer claims processing, provide exceptional customer service, and implement innovative cost management strategies for their employee health plan effective January 1, 2026. The RFP covers comprehensive medical plan administration for four existing plan designs currently serving 4,184 subscribers and 5,611 members. Proposals are due by 2:00 PM EST on March 6, 2025, with an anticipated board award date of June 24, 2025. The evaluation criteria will comprehensively assess proposers across multiple categories including network access, claims repricing, utilization management, administration, customer service, technology capabilities, reporting, wellness programs, and medical administrative fees, with a total possible score of 100 points. Proposers must submit a complete ASO RFP Questionnaire in Excel format through VendorLink, with any incomplete submissions deemed non-responsive. The contract term is initially set for three years (January 1, 2026 through December 31, 2028) with potential renewal options for up to three additional one-year periods.

The RFP does not explicitly indicate specific set-aside designations or restrictions limiting proposer eligibility, though vendors must meet standard government contracting requirements including proof of insurance, background screening compliance, and E-Verify regulations. The current medical administrative services organization is Florida Blue, and the RFP indicates a simultaneous Pharmacy Benefit Manager (PBM) procurement is also occurring for the 2026 plan year. While precise budget ranges are not explicitly stated, the RFP requires vendors to provide detailed per-employee-per-month (PEPM) pricing for medical administration fees, including options for broad and narrow network configurations. Performance guarantees will be critical, with potential financial penalties for non-compliance in areas such as claims processing accuracy, financial payment accuracy, turnaround times, and customer service metrics. Three vendors have previously submitted proposals in a tabulation document: Aetna Life Insurance Company, Blue Cross and Blue Shield of Florida, Inc., and United HealthCare Services, Inc., with Blue Cross and Blue Shield of Florida, Inc. receiving the highest evaluation score of 92.00 points in a previous assessment. The district emphasizes a desire for a cost-effective solution that can help manage healthcare spending while providing comprehensive employee health benefits.