Pasco County School District Ionwave #26-046-DM

Administrator for Self-Funded Group Health Insurance – Pasco County Schools

This opportunity seeks an administrator for Pasco County Schools' self-funded group health insurance program. - Government Buyer: - School Board of Pasco County, Florida - OEMs and Vendors: - Current plan administrator: Florida Blue - Products/Services Requested: - Administrative Services Only (ASO) for Group Medical Plans - Medicare Advantage Plan administration - Integrated behavioral health, wellness programs, and innovative value-added services - Run-out claims administration for 12 months post-termination - Criteria for medical necessity and organ transplant approvals - Unique/Notable Requirements: - Proposers must be licensed by the State of Florida, Office of Insurance Regulation - Must own a medical provider network in Florida (ancillary networks outside Florida acceptable) - Must coordinate with District, vendors, and consultants (agent/broker services excluded) - Preference for direct contracts; full disclosure of agent fees if used - Compliance with HIPAA, PPACA, ADA, and other federal/state regulations - District may contract with carve-out vendors for specific services - Audits allowed up to 24 months after plan termination - Covers active employees, retirees, COBRA participants, and eligible dependents - Place of Performance: - Pasco County, Florida (School Board facilities) - Period of Performance: - Includes 12 months of run-out claims administration post-termination and audits up to 24 months after plan termination

Description

This Request for Proposal (RFP) issued by the School Board of Pasco County, Florida, seeks an administrator to provide management services for the District's self-funded group health insurance program. The contract aims to improve care management and reduce total cost of care per member without compromising quality. The program includes Health Plan Administrative Services Only (ASO) for Group Medical Plans and a Medicare Advantage Plan. The administrator must coordinate with the District and its vendors, excluding agent or broker services. Proposers must be licensed by the Florida Office of Insurance Regulation and own their medical provider network in Florida.

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