Network, Claims Administration & Medical Management Serv for LSU First

REQUEST FOR PROPOSAL BID DUE DATE AND TIME
BOARD OF SUPERVISORS OF 04/16/2026 02:00 PM CT
LOUISIANA STATE UNIVERSITY
AND AGRICULTURAL & MECHANICAL COLLEGE
SOLICITATION RFQ-0000002721 RETURN BID TO
SUPPLIER # Louisiana State University and Agricultural and
Mechanical College
SUPPLIER NAME AND ADDRESS
Procurement
213 Thomas Boyd Hall
Baton Rouge, LA 70803
Buyer Jene Troxclair Ledet
Buyer Phone
Buyer Email jeneledet@lsu.edu
Issue Date 03/09/2026
TITLE: Network, Claims Administration and Medical Management Services for LSU First
This area left intentionally blank.
LSU IS AN EQUAL OPPORTUNITY/ACCESS UNIVERSITY Rev. 2/25

Table of Contents
SECTION 1: INTRODUCTION AND BACKGROUND ................................................................................................................ 5
1.1 University Information ........................................................................................................................................... 5
1.2 Purpose ................................................................................................................................................................... 5
1.3 Goals and Objectives .............................................................................................................................................. 6
1.4 Key Challenges and Concerns ................................................................................................................................ 6
SECTION 2: ADMINISTRATIVE INFORMATION ..................................................................................................................... 8
2.1 Definitions .............................................................................................................................................................. 8
2.2 Schedule of Events ............................................................................................................................................... 13
2.3 Proposal Submittal (Mailed) ................................................................................................................................ 13
2.4 Proposal Response Format .................................................................................................................................. 15
2.4.1 Collateral Information .................................................................................................................................. 15
2.5 Confidential Information, Trade Secrets, and Proprietary Information............................................................. 15
2.6 Proposal Clarifications Prior to Proposal Due Date ............................................................................................ 16
2.6.1 Inquiry Periods.............................................................................................................................................. 16
2.6.2 Blackout Period ............................................................................................................................................ 17
2.7 Errors and Omissions in Proposal ........................................................................................................................ 17
2.8 Changes or Addenda ............................................................................................................................................ 17
2.9 Withdrawal of Proposal ....................................................................................................................................... 18
2.10 Waiver of Administrative Informalities ............................................................................................................... 18
2.11 Cost of Proposal Preparation ............................................................................................................................... 18
2.12 Ownership of Proposal ......................................................................................................................................... 18
2.13 Right to Reject ...................................................................................................................................................... 18
2.14 Proposal Validity .................................................................................................................................................. 18
2.15 Acknowledgement of Supplier Responsibility..................................................................................................... 18
2.16 Written Clarification /Presentations ................................................................................................................... 19
2.16.1 Demonstration Guidelines ........................................................................................................................... 19
2.17 Best and Final Offer (BAFO) ................................................................................................................................. 19
2.18 Notice of Intent to Award .................................................................................................................................... 19
2.19 Debriefings ............................................................................................................................................................ 19
2.20 Right to Protest..................................................................................................................................................... 19
2.21 Protest Bond and Security.................................................................................................................................... 20
2.22 Contract Negotiations .......................................................................................................................................... 20
2.23 Contract Award and Execution ............................................................................................................................ 20
2.24 Commencement of Work ..................................................................................................................................... 20

2.25 Non-Negotiable Contract Terms .......................................................................................................................... 21
SECTION 3: SCOPE OF WORK ............................................................................................................................................. 22
3.1 Minimum Requirements and Qualifications ....................................................................................................... 23
3.2 Proposed Goods/Services ................................................................................................................................... 24
SECTION 4: EVALUATION ................................................................................................................................................... 30
4.1 Evaluation and Selection ...................................................................................................................................... 30
4.1.1 Evaluation Team ........................................................................................................................................... 30
4.1.2 Review and Evaluation (Points based on current RFP requirements) ........................................................ 31
SECTION 5: RESPONDENT QUALIFICATIONS AND EXPERIENCE ......................................................................................... 32
5.1 Management Proposal ......................................................................................................................................... 32
5.2 Respondent Financial Information ...................................................................................................................... 32
5.3 Subcontractor Information .................................................................................................................................. 32
5.4 Respondent Qualifications ................................................................................................................................... 32
5.5 Respondent Experience ........................................................................................................................................ 33
5.6 Personnel Qualifications ...................................................................................................................................... 33
SECTION 6: TECHNICAL PROPOSAL .................................................................................................................................... 35
SECTION 8: VETERAN AND HUDSON INITIATIVE ................................................................................................................ 51
SECTION 9: GENERAL INFORMATION ................................................................................................................................ 53
9.1 Data Security ........................................................................................................................................................ 53
9.2 Use of Subcontractors .......................................................................................................................................... 53
9.3 Prohibition of Discriminatory Boycotts of Israel ................................................................................................. 53
9.4 Campus Participation ........................................................................................................................................... 54
9.5 Insurance Requirements ...................................................................................................................................... 54
9.6 Subcontractor Insurance ...................................................................................................................................... 56
9.7 Indemnification and Limitation of Liability ......................................................................................................... 56
9.8 Compliance with Applicable Law ......................................................................................................................... 56
9.9 Term ...................................................................................................................................................................... 56
9.10 Payment ............................................................................................................................................................... 56
9.10.1 Claims ............................................................................................................................................................ 57
9.10.2 Administrative Monthly Fees ....................................................................................................................... 57
9.10.3 Late Payments .............................................................................................................................................. 57
9.11 Taxes ..................................................................................................................................................................... 57
9.12 Assignment ........................................................................................................................................................... 57
9.13 Audit/Retention of Records ................................................................................................................................. 58
9.13.1 Audit of Persons Submitting Cost or Pricing Data ....................................................................................... 58

9.13.2 Contract Audit .............................................................................................................................................. 58
9.14 Content of Contract/Order of Precedence .......................................................................................................... 58
9.15 Contract Changes .................................................................................................................................................. 58
9.16 Governing Law ...................................................................................................................................................... 58
9.17 Termination .......................................................................................................................................................... 58
9.17.1 Termination of the Contract for Cause ........................................................................................................ 58
9.17.2 Termination of the Contract for Convenience ............................................................................................ 59
9.17.3 Termination for Non-Appropriation of Funds ............................................................................................. 59
9.18 Anti-Kickback Clause ............................................................................................................................................ 59
9.19 Substitution of Personnel .................................................................................................................................... 59
9.20 Clean Air Act ......................................................................................................................................................... 59
9.21 Energy Policy and Conservation Act .................................................................................................................... 59
9.22 Clean Water Act .................................................................................................................................................... 60
9.23 Anti-Lobbying and Debarment Act ...................................................................................................................... 60
9.24 Fund Use ............................................................................................................................................................... 60
9.25 Warranties ............................................................................................................................................................ 60
9.26 Accessibility .......................................................................................................................................................... 61
9.27 Licenses and Permits ............................................................................................................................................ 61
9.28 Severability ........................................................................................................................................................... 61
9.29 Code of Ethics ....................................................................................................................................................... 61
9.30 Security ................................................................................................................................................................. 61
9.31 Personnel and Background Checks ...................................................................................................................... 61
9.32 Parking and Transportation ................................................................................................................................. 62
ATTACHMENT A - CERTIFICATION STATEMENT................................................................................................................ 63
ATTACHMENT B -BUSINESS ASSOCIATE AGREEMENT ..................................................................................................... 64
ATTACHMENT C - VETERAN/HUDSON INITIATIVE VERIFICATION ................................................................................... 70
ATTACHMENT D - SAMPLE CONTRACT ............................................................................................................................ 72
ATTACHMENT E - CENSUS DATA AND 1095 REPORTING ................................................................................................ 83
ATTACHMENT F-BARIATRIC PROGRAM ............................................................................................................................ 84
ATTACHMENT G - COMPREHENSIVE CARE CLINIC (CCC) ................................................................................................. 85
ATTACHMENT H
- GEO ACCESS AND NETWORK ADEQUACY REQUIREMENTS ......................................................................................... 86
EXHIBIT I: SUMMARY PLAN DOCUMENT .......................................................................................................................... 87
EXHIBIT II: FLEXIBLE SPENDING SUMMARY PLAN DESCRIPTION ..................................................................................... 88
EXHIBIT III: LSU FIRST PRORATION GUIDE ........................................................................................................................ 89

EXHIBIT IV: FINANCIAL PROPOSAL WORKSHEET-CLAIMS REPRICING ............................................................................. 90
EXHIBIT V: FINANCIAL PROPOSAL WORKSHEET-ADMINISTRATIVE FEE .......................................................................... 91
EXHIBIT VI: CERTIFI BILLING FILE FORMAT ....................................................................................................................... 92

SECTION 1: INTRODUCTION AND BACKGROUND
1.1 University Information
Louisiana State University and Agricultural & Mechanical College (hereinafter referred to as the
"University" or "LSU") is the state's comprehensive research University. The University is classified by the
Carnegie Foundation as a Doctorate-granting University, with very high research activity - one of only 27
public and 23 private universities in the nation. The University's instructional programs include 194
undergraduate and graduate/professional degrees. The University is accredited by the Commission on
Colleges of the Southern Association of Colleges and Schools (SACSCOC) to award bachelors, masters,
doctoral, and professional degrees.
As the premier University of the state, the mission of the University is the generation, preservation,
dissemination, and application of knowledge and cultivation of the arts for the benefit of the people of
the state, the nation, and the global community. The University offers challenging undergraduate,
graduate, and professional education programs for outstanding students from Louisiana, the nation, and
other countries. The University's libraries and museums preserve the rich cultural heritage of the state,
and scholars and artists at the University contribute to the literature, history, science, technology, and
arts of our culturally diverse community.
The student body consists of over 35,000 students from 50 states and more than 110 foreign countries.
The University employs approximately 5,000 faculty and staff. LSU Alumni total more than 250,000. The
University is located on more than 2,000 acres in the southern part of Baton Rouge, Louisiana. The campus
is bordered on the west by the Mississippi River. The University's more than 250 principal buildings are
grouped on a 650-acre plateau that constitutes the main part of the campus.
The LSU First Health plan was created by a Memorandum of Understanding (MOU) with the Louisiana
Division of Administration, Office of Group Benefits, and LSU in 2002, in order to create a health plan that
meets the unique needs of higher education employees. The MOU allows employees who meet eligibility
and non-Medicare primary retirees and surviving dependents to participate in the LSU First Health plan
from the following campuses/agencies: LSU System campuses and hospitals; House or Representatives,
Senate, Office of the Legislative Auditor, Legislative Fiscal Office, Louisiana Budget Control Council, and
agencies covered under a Successor Agreement.
1.2 Purpose
The purpose of the Request for Proposal ("RFP") is to obtain competitive Proposals as allowed by the
Higher Education Procurement Code (LAC34.XIII.501.A.2) from bona fide, qualified Respondents who are
interested in providing administrative, network, claims administration, medical management, and
COBRA Services for a self-funded health plan offered by LSU in accordance with the specifications and
conditions specified in this RFP.
The Supplier will be responsible for all facets of the day-to-day operational administration of LSU's self-
funded health plan including, but not limited to, implementation and delivery of third party
administration of health claims; including creation and maintenance of a client specific network
(currently known as First Choice Provider Program), national network services; population health
management, including but not limited to disease management; a wellness program, call center
operations, and general and advisory services regarding health plan design; support of current
programs, and COBRA services. LSU is looking to partner with an administrator that will provide advisory
or "best in class" health plan design and administration practices (pre-authorizations, standard

exclusions, etc.). The Supplier shall administer and pay all claims on LSU's behalf for the LSU First Health
Plan. The Supplier will provide innovative solutions for self-funded health program management,
including efficient claims processing, network management and population health management. The
Supplier is expected to drive health risk improvement and mitigation of rising costs of healthcare in
order for LSU to continue to provide the best value to its Plan Participants. The Respondent will match
current Plan design outlined in the current Summary Plan Document (SPD) and Summary of Material
Modification (SMM). LSU reserves the right to change and add to its health plan options at any time
during the period of the resulting Contract. LSU will not provide advance funding for payment of claim
expenses. Also included in this proposal is day-to-day administrative services for the LSU Flexible
Spending plan ("FSA") which includes the processing of flexible spending health care and dependent
care claims for enrolled participants, substantiation of claims, administration of COBRA for terminated
employees, and debit card administration.
The intent of this RFP is to assess the depth, value, and quality of each Respondent's network, and to
ultimately utilize a Respondent's network; however, LSU reserves the right to request special
involvement with network maintenance and final decision on any value-based health agreements or
programs. It is expected that all LSU Suppliers will be able to support program offerings and initiatives,
as well as be able to support changes to these offerings and initiatives. Upon request, Supplier will need
to work with other LSU Suppliers, the appointed LSU actuary, LSU's Pharmacy Benefit Manager (PBM),
and employees from LSU, which is responsible for managing the self-funded health Plan.
The general information contained in this RFP is complete and accurate to the best knowledge of LSU
and based upon circumstances existing at the time the RFP was prepared. However, any such data and
information released with the RFP are representations and not warranties by LSU. Each Respondent
submitting a Proposal assumes sole responsibility for reliance upon information included in this RFP.
1.3 Goals and Objectives
LSU's objective is to secure the services of a qualified Respondent to administer the LSU First Health Plan
and the FSA in accordance with Exhibit I: Summary Plan Document and Exhibit II: Flexible Spending
Summary Plan Description. LSU expects to pay competitive administrative fees and have minimal
disruption to the enrolled members of the LSU First Health Plan and FSA. LSU expects the Supplier to
provide excellent customer service to members as well as timely, thorough consultation with LSU and
partner Suppliers to develop a cost-effective, high-value benefit program.
1.4 Key Challenges and Concerns
LSU First is a consumer-directed, self-insured Plan administered by LSU for its employees and other
eligible participants that encourage Plan Participant(s) to be informed purchasers of health care
services. The Plan is generally divided into three (3) segments: (i) a health reimbursement account
("HRA"), which is fully funded by LSU; (ii) a deductible requiring 100% payment by the employee; and
(iii)medical and pharmacy coinsurance that is subject to an out-of-pocket maximum. The LSU First
Health Plan utilizes a multi-tier network approach with a local healthcare network (called First Choice
providers Tier 1) that offers aggressive contracting to steer utilization and rewards employees by waving
the deductible and co-pay for services. The Plan also has some direct contracts with providers in which
the deductible and coinsurance may also be waived and treated as Tier 1. The Supplier must have the
ability to prorate the HRA, Deductible, and Out of pocket accumulators based on the employee effective
date of coverage. The supplier must be able to send and receive direct eligibility file feeds daily with the
PBM (Pharmacy Benefit Manager) and have the ability to send and receive data to track individual or
combined medical and prescription out of pocket maximums. In addition, the Supplier must be able to
administer an HRA that covers half the deductible that applies to medical claims; the HRA for the current
year and rollover HRA from previous years may be housed in two distinct data fields by the Third-Party

Administrator ("TPA"). In addition to the local First Choice network, the Supplier must offer a national
network of providers with aggressive contracts, and negotiate out of network claims, as appropriate.
The FSA allows employees the opportunity to set aside pre-tax dollars for out of
pocket health care or dependent care expenses incurred by the employee or eligible dependents.
Employees of the LSU System campuses may participate in the FSA. The FSA should be administered
based on the Summary Plan Document in Exhibit II: Flexible Spending Summary Plan Description.
Background and Challenges:
As Louisiana's leading public system of higher education, LSU's objective in establishing the LSU First
Health Plan was to address specific needs and obstacles in competing for the best faculty and staff. LSU
accomplished its goals by providing the Plan as an alternative to its employees: (i) providing greater
choice in the level and type of medical benefits offered; (ii) without sacrificing choice, containing
healthcare costs, particularly for lower paid employees; (iii) addressing the concerns of those who live in
communities with limited access to health care; (iv) improving the services provided to Plan Members;
(v) building a health plan design and support tools around the needs of employees; (vi) giving faculty and
staff more control over their health care dollars; and (vii) establishing cooperative and productive
relationships with Providers.
Beginning in 2003, the eligibility provisions of the Plan were amended to allow the members, staff,
officers, and retirees of the Louisiana Legislative Branch, comprised of but not limited to, the House of
Representatives, the Senate, the Office of the Legislative Auditor, the Legislative Fiscal Office, and the
Louisiana Budgetary Control Council to participate in the Plan. Thus, members enrolled in the Plan come
from multiple LSU campuses as well as several state agencies, each of which may have its own Human
Resources Management Department and Payroll/Billing Department. Retirees are required to enroll in
Medicare Part A and Part B if eligible; once a retiree and any and all dependents are enrolled in
Medicare Part A and Part B, those families are no longer eligible to remain on LSU First Health Plan but
are eligible for other health plans offered by the University. LSU, pursuant to applicable Louisiana
statutory and regulatory procurement provisions, contracts with entities to provide claim
administration, provider network access, medical management, and pharmacy benefit management.
In addition, approximately half of LSU employees are managed using Workday and half by PeopleSoft.
Various other participating agencies such as the House or Senate are in various payroll systems. Annual
enrollment meetings are held on multiple campuses throughout the month of October, and the Supplier
will be expected to participate in each meeting and/or benefit fair. Thus, although the contract will not
begin until January 1, 2027, the Supplier will be expected to provide annual enrollment services during
onsite annual enrollment meetings in October/November 2026.
LSU First Enrollment
Enrollment Type 2026 2025 2024
Employee 8,655 8,487 8,323
Dependents 8,005 7,918 8,012
Total Participants 16,660 16,405 16,335
Retiree Medicare plan
Count (Services for Retirees 4,078 3,883 3,681
are not in this bid)

Total LSU First Enrollment 20,738 20,288 20,016
The current plan provider network hierarchy is as follows: (i) LSU First Choice Network (Tier 1); (ii) Verity HealthNet local
network (Tier 2); (iii) Aetna ASA national network (Tier 2); and (iv) Out-of-Network.
LSU First Claims Expense by Network Type
Network 2025 2024 2023
Tier 1 First Choice $69,598,616.88 $68,439,502.20 $67,969,451.83
Tier 2: Local-Verity $6,341,173.30 $7,476,371.98 $6,438,485.66
Tier 2: National-Aetna $18,017,022.46 $19,145,196.66 $17,476,234.64
Out of Network $682,101.02 $530,466.88 $775,658.79
Total Claims Expense $94,638,913.66 $95,591,537.72 $92,659,830.92
Physician Totals by Place of Service
Plan Paid 2025 2024 2023
Emergency $1,289,401.11 $1,274,295.84 $1,132,758.61
Primary Care Physician $7,121,511.90 $6,983,443.50 $6,846,586.49
Specialist $14,708,055.17 $15,181,691.86 $14,547,125.99
Urgent Care $955,715.50 $1,052,502.05 $1,110,185.46
Facility Totals by Type
Plan Paid 2025 2024 2023
Outpatient $35,030,565.66 $32,184,956.75 $33,526,124.64
Inpatient $14,955,551.54 $18,169,331.87 $15,837,117.75
Emergency $4,637,287.22 $4,516,371.40 $3,787,949.23
Flexible Spending Enrollment
Year 2026 2025 2024
Healthcare Flexible 1122 1235 1151
Spending
Dependent Care Flexible 207 251 238
Spending
Total Enrollment 1329 1486 1389
SECTION 2: ADMINISTRATIVE INFORMATION
2.1 Definitions
Administrative Fee (Admin Fee): Per Employee Per Month (PEPM) Fee paid for the performance of
administrative services under this agreement.

Agreement or Contract: The written Agreement, if any, executed by the authorized representatives of the
University and the Supplier that formalizes the terms, provisions, covenants, and obligations, including but not
limited to those contained in this RFP, of the respective parties to the arrangement for provision of services.
Aggrieved Party: A person who files a written protest in connection with the solicitation or award or the issuance
of a written Notice of Intent to Award a contract under the Higher Education Procurement Code and has or may
have a pecuniary or other property interest in the award of the contract.
Award: The acceptance of a bid or Proposal; the presentation of a purchase order or contract to a Supplier.
Benefit Plan or LSU First Health Plan or Plan: The LSU System self-funded, employer sponsored medical benefit
plan offered to eligible employees, retirees, and their eligible dependents, under which Covered Benefits and
services are provided to eligible Plan Participants in accordance with the terms of the Plan and applicable eligibility
data.
Best and Final Offer (BAFO): In a competitive negotiation, the final Proposal submitted by a respondent after
negotiations have been completed and which contains the respondent's most favorable terms in response to the
solicitation.
Business Associate Agreement (BAA): a privacy agreement amongst parties.
Campus: Louisiana State University and Agricultural & Mechanical College (LSU), a component of the Board of
Supervisors of Louisiana State University System under the management of the Louisiana State University and
Agricultural & Mechanical College located in Baton Rouge.
Chief Procurement Officer (CPO): As used in this RFP is the Assistant Vice President for Procurement and Property
Management for LSU.
Claim(s): the Covered Benefits Claims processed through an online Claims adjudication system or otherwise sent
and processed by Supplier.
CMS: the Centers for Medicare and Medicaid Services.
COB: the Coordination of Benefits.
Covered Benefit(s): health care services, products, or supplies made available as a covered benefit to Plan
Participants as set forth in the respective Plan.
Dependent Care Flexible Spending: permits a participant to set aside pre-tax money to pay for dependent care
expenses for young children underage thirteen (13) in daycare and elderly or disabled dependents, who cannot
care for themselves.
Discussions: For the purposes of this RFP, a formal, structured means of conducting written or oral
communications/presentations with responsible Respondents who submit Proposals in response to this RFP.
DRG: diagnosis-related group.
Entity: -An association, corporation, partnership, limited liability company, or any other legal entity individual that
has legal standing under State Law.
EOB: an Explanation of Benefits.