26PP-128 Managed Care Service for Group Medical Plans

New Castle County
Purchasing Division
87 Reads Way
New Castle, DE 19720
(302) 395-5250
Bid # 26PP-128
Administrative Managed Services for Groups Medical Plans
ATTACHMENT A - SCOPE OF WORK/SPECIFICATIONS
New Castle County ("County") is seeking sealed priced proposals for Administrative Managed
Services for Groups Medical Plans.
Objective
The objective of this RFP is to provide Administrative Managed Services for Groups Medical Plans.
We want to provide options for the employees and provide sustainable health care and rates.
Background
The County offers one Preferred Provider Organization (PPO), one Indemnity (Comp 80), and two
In Network Only plans (currently administered by both TPA's) to our active employees and pre-
65 retirees. The Active and Under 65 Retiree Indemnity/In Network Plan (EPO)/PPO/QHDHP
plans are currently administered by Highmark of Delaware and the In Network Plan (Open Access
and QHDHP) administered by Aetna on a self-insured basis. The County is seeking bids on behalf
of all active and pre-65 retiree medical participants at this time. The Indemnity/In Network Only
Plans/QHDHP/PPO plans may be placed with one or more Third Party Administrators. Highmark
of Delaware and Aetna. The Pharmacy Benefits Manager for the In Network Only, QHDHP and
PPO plans is administered by RxBenefits/Express Scripts
The County's objectives in seeking:
* Third Party Administration for Medical for the active and pre-65 retirees.
* Theone Indemnity Plan (Comp 80) has their pharmacy bundled with the Medical and
are not carved out on a standalone basis.
*
Important Note:
Please review the requests and information contained within and please provide responses to all
sections indicated within the RFP instructions.
September 28, 2025 Bid# 26PP-128 Page 1

New Castle County
Purchasing Division
87 Reads Way
New Castle, DE 19720
(302) 395-5250
Bid # 26PP-128
Administrative Managed Services for Groups Medical Plans
SCOPE OF WORK/SPECIFICATIONS
Section 1 - Introduction
1. Required Response: Your response must address all requested information as outlined in #'s
3 and 4 below.
2. Coverages Marketed:
* Third Party Administration for Medical only for the active and pre-65 retirees.
* Third Party Administration for Medical/Rx for the one Indemnity Plan (Comp 80) that
have their pharmacy bundled with the Medical and are not carved out to
RxBenefits/Express Scripts You are welcome to create a PPO to mimic the Indemnity
program where the out of network benefits match, if doing so, pharmacy should not be
included as it would then be carved out.
3. Attachments & Corresponding Appendix
Worksheet Name Instructions
Quote Instructions
Client Background Information
Client background and back-up
Current Fully Insured Equivalent Premiums
data needed to process the RFP
Monthly Enrollment & Claims (Dec 2024- Nov 2025)
Census
Current and Quoted Medical and Rx Benefits Indicate any plan deviations,
anything not identified will be
assumed to match the current
Proposed ASO Fees (all network access fees must be
on a PEPM basis and identified) Answer all questions in each
General capabilities worksheet and return the
Electronic capabilities completed spreadsheet with
Processing capabilities your RFP response. Please feel
Networks free to provide any additional
Utilization capabilities documentation you feel
Case Management capabilities necessary
Wellness capabilities
September 28, 2025 Bid# 26PP-128 Page 2

New Castle County
Purchasing Division
87 Reads Way
New Castle, DE 19720
(302) 395-5250
Bid # 26PP-128
Administrative Managed Services for Groups Medical Plans
Audit capabilities
Claims Funding
Guarantees
Network Discount Analysis
Instructions for requested GEO
GEO Access Report Request
Access Reports
4. Please fill-out, sign and return the following pages from this document:
* Takeover Issues
* One electronic copy emailed to Michelle Lindsay at michelle.lindsay@usi.com
September 28, 2025 Bid# 26PP-128 Page 3

New Castle County
Purchasing Division
87 Reads Way
New Castle, DE 19720
(302) 395-5250
Bid # 26PP-128
Administrative Managed Services for Groups Medical Plans
Section 2 - Takeover Issues
An authorized representative of your Company must sign this Exhibit on the last page. Any
exceptions to these requirements must be made on the last page of this Exhibit in addition to the
standard wording in your proposal (attach additional pages as necessary). It is very important
that we be notified of any exceptions to these requirements so that we can address these
concerns prior to awarding the business.
1. Include transition of care.
2. All benefits will apply to all employees and their dependents under the following
conditions:
a. Waive the actively-at-work rule for all employees as of the effective date whether
or not the employee is totally or partially disabled or temporarily absent from
work;
b. Waive the dependents non-confinement rule for all eligible dependents on the
effective date whether the dependent is disabled;
c. Include in your coverage all current COBRA participants whether or not they are
disabled;
d. Extend coverage to all current retirees if they are covered under the current
program whether or not they are disabled;
e. Extend coverage to all employees currently covered by the employer due to lay-off
or leave of absence whether or not they are currently disabled.
f. If you do not agree to any of the above, specify what terms will apply and as of
what date individuals not initially covered will become covered. If you distinguish
between "not-actively-at-work" and "disabled" individuals, clarify any differences
in eligibility, waiver, premium amounts that apply to these two groups.
3. No evidence of insurability is required for those currently enrolled.
Carrier accepts the above terms and conditions for Medical/Rx coverage:
( __ ) with exceptions noted below and on following pages.
( __ ) without exceptions.
September 28, 2025 Bid# 26PP-128 Page 4

New Castle County
Purchasing Division
87 Reads Way
New Castle, DE 19720
(302) 395-5250
Bid # 26PP-128
Administrative Managed Services for Groups Medical Plans
By:
Signature Date
Title
For:
Vendor/Carrier Name
Section 2 - Takeover Issues - Exceptions
List any exceptions to the form above within:
Please note: Please complete and return the Non-Disclosure Agreement to Robin Allen
(robin.allen@newcastlede.gov). Once the Non-Disclosure form has been completed
and return, the Census Data can be sent to the bidder. This form can be found on the
New Castle County Website with the other bid documents.
September 28, 2025 Bid# 26PP-128 Page 5