Greenville Civic Plus #25-26-50

RFP for Self-Funded Medical and Pharmacy Claims Administration for City of Greenville and GUC Employees

The City of Greenville and Greenville Utilities Commission (GUC) in North Carolina are seeking proposals for the administration of self-funded medical and pharmacy claims for their employee and dependent healthcare plans. - Government Buyer: - City of Greenville and Greenville Utilities Commission (GUC), North Carolina - Scope of Services: - Administration of self-funded medical claims for approximately 2,812 members (1,513 employees and pre-65 retirees) - Pharmacy claims administration with carved-in pharmacy benefit management - Management of Core PPO, Enhanced PPO, and HSA health plans - Employee Assistance Program (EAP) services, including 3 face-to-face visits per issue, management consultation, and critical incident response - Key Requirements: - Full pass-through of all medical pharmacy rebates and revenue from pharmaceutical manufacturers to the City/GUC - Full disclosure and third-party audit rights of manufacturer contracts - Compliance with ACA and all regulatory requirements - Competitive pricing, comprehensive claims administration, clinical programs, and robust data reporting - Performance guarantees and multi-year rate guarantees if applicable - Incumbent Vendor: - Cigna (current plan administrator) - No specific OEMs or manufacturers are named in the solicitation - Proposals must be submitted electronically and include all required information in the provided workbook

Description

The City of Greenville and Greenville Utilities Commission are accepting proposals for Self-Funded Medical and Pharmacy Claims Administration Services for the healthcare plans covering COG and GUC employees and dependents. The solicitation seeks a medical/pharmacy plan administrator for COG/GUC's self-funded medical plans effective January 1, 2027, covering approximately 2,812 members. The selected vendor is expected to provide innovative services including cost trend management, clinical programs, competitive pricing, and best-in-class claims administration. Proposals must be submitted electronically by July 17, 2026.

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