Delaware My Market Place #DHR26009-MED_TPA

Delaware Medical Third-Party Administration (TPA) Services for State Employee Benefits

Delaware is seeking a vendor to administer its medical insurance benefits for state employees and retirees through Medical Third-Party Administration (TPA) services. - Government Buyer: - State of Delaware Department of Human Resources, Statewide Benefits Office - Delaware Department of Health and Social Services - Services Requested: - Medical TPA services for Group Health Insurance Plan (GHIP), covering approximately 124,780 active and retired employees and dependents - Administration of both non-Medicare and Medicare Supplement plans - Duplication of current and proposed medical plan designs for active, pre-65, and post-65 retirees (First State Basic, CDH Gold, HMO, Comprehensive PPO, Health Savings Account, State Special Medicfill Medicare Supplemental Plan) - Claims processing, enrollment, care management, provider network maintenance, member services, compliance reporting, and integration with Delaware Health Information Network (DHIN) - Comprehensive reporting services (invoices, enrollment, wellness, disease management, financial and clinical performance) - Unique/Notable Requirements: - Vendors must match current and proposed plan designs exactly, with no deviation - Emphasis on experience, compliance, and innovative cost-reduction solutions - Integration with DHIN and secure data handling (no storage or transfer of non-public State data outside the US) - Detailed reporting schedule with multiple state agencies and partners - OEMs and Vendors: - No specific OEMs named; Highmark Delaware referenced as current administrator - Opportunity open to qualified TPA service providers - Place of Performance: - Statewide Benefits Office, 841 Silver Lake Boulevard, Suite 200, Dover, DE 19904 - State of Delaware (statewide) - Period of Performance: - Three-year base term for non-Medicare plans (July 1, 2027 – June 30, 2030) - Medicare Supplement plan (January 1, 2028 – December 31, 2030) - Two optional one-year extensions

Description

The State of Delaware, Department of Human Resources, on behalf of the State Employee Benefits Committee, is soliciting professional services for Medical Third-Party Administration (TPA) services. The scope includes administering the State's medical insurance benefits. The solicitation outlines a schedule of events including a mandatory pre-proposal meeting and deadlines for proposal submission. The contract is anticipated to start on July 1, 2027.

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