Virginia James City Civic Plus #20261035

James City County Seeks Administration of Group Medical, Prescription Drug, Dental, HSA, and Stop Loss Plans

James City County, Virginia, is seeking proposals for the administration of its self-insured group medical, prescription drug, dental, HSA, and stop loss (reinsurance) plans for approximately 1,050 full-time employees and pre-65 retirees. - Government Buyer: - James City County Purchasing Office - OEMs and Vendors Mentioned: - Sentara Health Plans (current medical and pharmacy administrator) - Delta Dental of Virginia (current dental administrator) - Products/Services Requested: - Administration of two medical plan options (PPO and CDHP with HSA) - Prescription drug plan administration (pharmacy benefit management) - Dental plan administration (three options: two PPO, one EPO) - Health Savings Account (HSA) administration - Stop loss (reinsurance) coverage with options for $250,000, $275,000, and $300,000 limits - Customer service and member support - Cost containment services (pre-certification, utilization review, case management) - Disease management programs - Claims appeal process - Transition of care management - Unique or Notable Requirements: - Proposals may be for any combination of services; contracts may be awarded separately - Administrative fees capped at 3% annual increase or CPI-U, whichever is less - Detailed pricing exhibits and questionnaires required - Performance guarantees and annual renewal packages required - Emphasis on HIPAA compliance, audit standards, and robust reporting - Support for wellness programs and flexibility to carve out pharmacy or stop loss services - Dedicated customer service line and transition of care manager - Formal claims appeal process compliant with regulations

Description

James City County is soliciting proposals for the administration of its group medical and prescription drug plan for full-time employees and pre-65 retirees. The self-insured program includes two medical options with prescription drug coverage and reinsurance protection, currently administered by Sentara Health Plans. Dental coverage is provided by Delta Dental of Virginia with three plan options. The county reserves the right to award contracts separately for medical and prescription drug services. Offerors may submit proposals for various combinations of medical, prescription drug, dental, HSA, and stop loss services, with proposals requested to be quoted net of commissions.

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