Surgery Benefit for Health PPO Plan

The City of Long Beach is requesting proposals for a surgical and medical procedure carve-out benefit program for employees, retirees, and dependents enrolled in the City's Anthem Blue Cross PPO plan, with proposals due October 7, 2026 and questions due September 9, 2026.

Proposers must demonstrate at least three years of consecutive, verifiable experience managing specialized Center of Excellence networks and bundled payment models for large-scale government entities or public sector clients. HIPAA compliance and recent audited financial statements or corporate annual reports are required. The City's Equal Benefits Ordinance applies to contractors if the contract exceeds $100,000; proposers must certify compliance or provide written explanation of noncompliance. Proposers subject to the ordinance must provide equal benefits to employees with spouses and domestic partners, including health, bereavement, family medical leave, retirement, and travel benefits, with implementation permitted to delay until the first open enrollment or administrative deadline following contract start (not exceeding two years).

The program will offer pre- and post-care for knee, hip, orthopedic, shoulder, spine, heart, weight loss, and oncology procedures through vetted Centers of Excellence on a voluntary basis. The City has approximately 3,800 active employees and retirees enrolled in the Anthem PPO plan. The RFP does not include volume guarantees for member steerage, though the City is willing to develop steerage solutions post-award.

All-inclusive pricing proposals must describe pricing transparency, guarantees, and savings calculation methodologies. Evaluation weighting is organizational capacity and experience (30%), method of approach (40%), communications and reporting (20%), and cost reasonableness (10%). The initial contract term is two years with options to renew for three additional one-year periods, for a maximum five-year term. The City anticipates contractor selection and negotiation during January–March 2027, with contract execution and go-live targeted for April 1, 2027. The awarded contractor must maintain commercial general liability insurance of at least $1 million per occurrence and $2 million aggregate, professional liability insurance of at least $1 million per claim, and workers' compensation insurance as required by California law.