Health Plan Administrative Services

Description

The City of Orlando (City) is soliciting proposals from qualified organizations to provide administrative services for its self-funded group medical and pharmacy benefit plans, effective January 1, 2027. Proposers may submit responses for one or more of the following service configurations. All proposed configurations must apply across all three plan options (HMO, POS, and Narrow Network), meaning the City will not consider proposals that “slice” administration by plan (e.g., one administrator for HMO/POS and a separate administrator for the Narrow Network).Service Configuration Options:Option 1: Medical Administrative Services Only (ASO)Option 2: Pharmacy Benefit Manager (PBM) AdministrationEach proposer may submit up to two distinct response options. As described in further detail below, one of the City’s three plan options will include a Narrow Network Plan (which may also be referred to as a High-Performance Network throughout this RFP) beginning in 2027, utilizing a high-performance network anchored by a Clinically Integrated Network (CIN), as defined by the Centers for Medicare & Medicaid Services (CMS) and the Federal Trade Commission (FTC) applicable standards, or a network with the underlying systems in place that mirror a CIN.  Therefore, proposals must include a high-performance network for this Narrow Network Plan.Note: The City is not requesting proposals for Medicare-eligible retiree plan options (e.g., fully-insured Part D plans, Medicare Supplement, or Medicare Advantage) or stop-loss insurance as part of this solicitation. These services should not be included in the proposal.The City of Orlando’s objectives of this solicitation are as follows: Identify a collaborative administrative partner(s) with experience supporting alternative care delivery models, including value-based contracting, clinical