Third-Party Medical Plan Administration and Solutions

Summit County Government is seeking sealed proposals for a comprehensive Third-Party Medical Plan Administration and Solutions contract through a Request for Proposal (RFP) released on March 24, 2025. The procurement targets qualified contractors to provide an extensive range of medical plan services, including self-funded medical plan administration, claims re-pricing, claims payment, direct contracting, network development, PPO network access, healthcare management, member advocacy, telemedicine, and integrated cost-saving solutions. The county is specifically looking for a third-party administrator to manage its self-funded health plan covering approximately 497 enrolled employees and 946 total members. Key deliverables include managing a "Tier 1" narrow network through Peak Health Alliance and a "Tier II" wrap-around network with Aetna Signature, integrating with existing pharmacy benefits through Prime Therapeutics, and maintaining stop-loss coverage with Aetna and Skyward. Proposal questions are due by April 11, 2025, at 3:00 PM Mountain Time, with final proposals required by May 9, 2025, at 3:00 PM Mountain Time, submitted through BidNet Direct. The anticipated contract effective date ranges between October 1, 2025, and January 1, 2026, with an initial three-year term potentially renewable for an additional three years based on performance.

The RFP does not specify explicit set-aside designations or restrictions for disadvantaged enterprises. The current infrastructure includes an existing telehealth service through CirrusMD, a Consumer-Driven Health Plan with a Health Reimbursement Arrangement, and integration capabilities with an analytics warehouse. Potential contractors must demonstrate a dedicated customer service model, compliance with federal healthcare regulations, and the ability to manage direct provider contracts. Administrative fees will be structured on a per-employee per-month (capitated) basis, with increases limited to the Consumer Price Index (CPI-U). The county expects vendors to meet specific performance metrics, including 97% call answer rates, 90% clean claims processed within 20 business days, 99% claims accuracy, and 99% system availability. While specific budget ranges are not explicitly stated, the comprehensive nature of the services and the size of the covered population suggest a substantial contract value. The county will require transparent pricing information, including all revenue streams, fees, and compensation arrangements to be presented on a per-employee per-month basis.