Third-Party Administrative Services for Medical Plan

Tazewell County, Illinois is seeking proposals for a Third-Party Administrator (TPA) to manage its self-funded employee medical plan through a Request for Proposals (RFP) released on October 2, 2023. The county is soliciting qualified TPA firms to provide comprehensive claims and administrative services for approximately 320 active and retired employees and their dependents. The selected administrator will be responsible for claims processing, eligibility management, customer service, prescription drug program coordination, case management, utilization review, and detailed reporting. Proposals are due by 3:30 p.m. CST on October 16, 2023, for an initial three-year contract term with potential one-year extensions. The county currently offers four medical plan options: Traditional PPO Plan, Mid-Level PPO Plan, Qualified HDHP Plan, and a Medical Reimbursement Plan, with varying deductibles, copayments, and out-of-pocket maximums. Evaluation criteria are not explicitly detailed in the provided documents, but the RFP suggests a comprehensive review of administrative capabilities, service offerings, and fee structures.

The RFP does not specify explicit set-aside designations or restrictions for respondents, indicating the opportunity is open to qualified TPA firms. The county currently has a reinsurance contract with a $125,000 specific deductible and is in the second year of a five-year network services contract with Carle Health Plus. The existing infrastructure includes four distinct medical plan options with graduated coverage levels and established prescription drug benefit structures. While specific budget ranges are not directly stated, the RFP includes a fee schedule template for bidders to complete, covering administrative fees such as medical administration, network access, pharmacy benefit management, and stop-loss fees. Potential respondents should be prepared to provide comprehensive administrative services with demonstrated expertise in managing self-funded medical plans for public sector employers, with a focus on efficient claims processing, network management, and responsive customer service.