Self Insured HMO

The Illinois Department of Central Management Services (CMS) is soliciting proposals through a Request for Proposals (RFP) for organizations to administer self-insured HMO plans serving approximately 62,200 lives across four state employee benefit programs: the State Employees Group Insurance Program (SEGIP), Local Government Health Plan (LGHP), Teachers Retirement Insurance Program (TRIP), and College Insurance Program (CIP). The procurement covers medical, facility, and professional behavioral health services administration, excluding pharmacy benefits, with implementation required by March 1, 2027, prior to the May 1-31 Benefit Choice Period and contract commencement on July 1, 2027. The RFP was posted March 27, 2026, with proposals due April 29, 2026, and technical evaluation scheduled for June 2026, with anticipated award in July 2026 and contract execution in December 2026. Qualified vendors must demonstrate established provider networks across all Illinois counties, the ability to negotiate and maintain specified average discounted rates with in-network providers, and compliance with comprehensive operational requirements including provider credentialing, claims processing, disease management, customer service, utilization management, and 340B drug program compliance. The State will evaluate proposals based on three independently scored components: Technical Requirements (1,475 points), Commitment to Diversity (295 points), and Price (1,000 points), for a maximum of 2,770 points, with pricing submitted using Agency-provided templates. The contract will have an initial three-year term from July 1, 2027, through June 30, 2030, with the State retaining the right to make multiple awards within specific service areas and renew the contract for up to seven additional years through one or more renewal periods, not to exceed a total contract term of ten years.

The procurement includes a 5% Business Enterprise Program (BEP) participation goal requiring vendors to submit a Utilization Plan demonstrating compliance or documenting good faith efforts to meet diversity targets. The Commitment to Diversity evaluation factor represents 20 percent of the technical score and encourages vendors to increase investment in businesses owned by women, minorities, and persons with disabilities (WMD), with evaluation across six factors: BEP Goal Compliance, subcontracting with WMDB entities, diversity equity and inclusion spending, DEI promotion hours, written DEI policies, and diversity representation in staffing. All vendors responding to this procurement must complete and submit multiple disclosure and compliance forms, including the Vendor Disclosure form, IPG Active Registered Vendor Disclosure form, Business Enterprise Program Utilization Plan, and Commitment to Diversity Vendor Answer Form with required supporting documentation. Offerors must also provide detailed information utilizing Agency-provided census data covering enrollment demographics segmented by program, geographic region, age groups, and salary bands, and submit pricing through a comprehensive pricing worksheet addressing ASO fees, network discounts by county, detailed network discount schedules, medical discount guarantees, expected claims and expenses, and stop loss pricing. While the RFP does not identify incumbent vendors or current contractors in the provided documentation, vendors must disclose any existing affiliations with Deloitte Consulting, which is assisting with RFP preparation and evaluation. Estimated contract value or budget ranges are not specified in the available documentation, though the scope encompassing approximately 62,200 covered lives across four major state employee programs indicates a significant procurement with substantial annual administrative and claims management costs.