T3093 - State Health Benefits Program and School Employees Health Benefits Program Plans - Medicare

The State of New Jersey Department of the Treasury, Division of Purchase and Property, on behalf of the Division of Pensions and Benefits, is procuring fully insured Medicare Advantage Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans and related administrative services for the State Health Benefits Program (SHBP) and School Employees Health Benefits Program (SEHBP) covering approximately 199,389 Medicare Advantage members and 34,856 Medicare Supplement members across 2,156 distinct service areas. The solicitation encompasses comprehensive plan design, eligibility file processing, employer file management, claims administration, member services, ID card production and distribution, account management, and performance standards tracking with a five-year base term covering Plan Years 2027 through 2031, with options to extend up to two additional years at the same or more favorable terms. Bidders must submit guaranteed premium rates for the full contract term, propose budgets for claims administration, communications, audits, implementation, and integration services, complete CMS STAR ratings data, provide 2026 network access match percentages demonstrating CMS compliance, and furnish book-of-business data across their entire Medicare Advantage and Medicare Advantage Prescription Drug portfolio from 2022 through 2026. Evaluation will be based on technical criteria including personnel qualifications, firm experience, and ability to complete scope of work, as well as price evaluation of guaranteed premium rates and proposed budgets across multiple award scenarios ranging from sole contractor arrangements to split PPO and HMO arrangements. Bidders must carry professional liability insurance of at least $2,000,000 per occurrence and cyber breach insurance of at least $5,000,000 per occurrence, comply with comprehensive HIPAA and data security requirements aligned with NIST Cybersecurity Framework standards, and meet performance standards including ID card delivery within 15 days of eligibility confirmation, 30-day claims processing for 90 percent of transactions, member services speed of answer within 30 seconds, and 92 percent first call resolution rates. Critical deadlines include an optional pre-quote conference on November 17, 2025, electronic questions due by December 11, 2025 at 2:00 p.m. Eastern Time, and quote submissions due through the NJSTART eProcurement system on March 4, 2026 at 2:00 p.m. Eastern Time.

No set-asides are applicable to this procurement; however, bidders are encouraged to establish partnerships with small, woman-owned, minority-owned, veteran-owned, and disabled veteran-owned businesses and must identify subcontractor utilization plans for such entities where applicable. The State reserves the right to award to one or multiple contractors based on competitive evaluation with no guaranteed minimum or maximum enrollment. Bidders must place a minimum of 2 percent of their premiums at risk to guarantee performance across all metrics, with minimum liquidated damage percentages established at 0.20 percent for ID cards, 0.30 percent for claims administration and each member services metric, and 0.30 percent for account management and member satisfaction, though bidders may propose more stringent standards and greater damage amounts. All submitted information, including security questionnaires and proprietary data, must comply with New Jersey Standard Terms and Conditions, and bidders must execute the Confidentiality/Non-Disclosure Agreement (Attachment F) prior to accessing pre-quote documents through the MOVEit cloud portal. No incumbent contractor information, pricing terms, or specific budget allocations are disclosed in the solicitation materials, with award value dependent on the competitive evaluation of guaranteed premium rates and proposed administrative budgets submitted by qualified bidders meeting all technical and financial requirements.