North Carolina eVP #311-25-26-50

Self-Funded Medical and Pharmacy Claims Administration Services for City of Greenville Employee Healthcare Plans

The City of Greenville, North Carolina, together with the Greenville Utilities Commission, is seeking a vendor to administer self-funded medical and pharmacy claims for its employee healthcare plans. - Government Buyer: - City of Greenville, North Carolina - Greenville Utilities Commission - Office of Human Resources (Director: Mrs. Leah Futrell) - Products/Services Requested: - Administration of self-funded medical and pharmacy claims for approximately 1,513 employees, pre-65 retirees, and their dependents (total covered lives estimated at 2,812) - Medical plan options: Core PPO, Enhanced PPO, and HSA plans, each with carved-in pharmacy benefits - Employee Assistance Program (EAP) with specified service levels (e.g., 3 face-to-face visits per issue, management consultation, critical incident response) - Notable Requirements: - 100% pass-through of all medical pharmacy rebates and all revenue from pharmaceutical manufacturers to the City/Commission - Full disclosure and auditability of contracts with pharmaceutical manufacturers - Demonstrated ability to deliver innovative, cost-effective healthcare solutions - Performance guarantees required - MWBE participation goals (4% MBE and 4% WBE) - Compliance with nondiscrimination laws - Proposals must be submitted electronically and include detailed client references - OEMs and Vendors: - No specific OEMs are mandated - Cigna is the incumbent administrator - Mercer Health & Benefits is managing the evaluation process

Description

The City of Greenville and Greenville Utilities Commission are soliciting proposals for Self-Funded Medical and Pharmacy Claims Administration Services for healthcare plans covering their employees and dependents. The solicitation aims to select a medical/pharmacy plan administrator effective January 1, 2027, for approximately 2,812 members. The services include claims administration, cost trend management, and pharmacy benefit administration. Proposals must be submitted electronically by July 17, 2026, and vendors must be registered with the North Carolina Electronic Vendor Portal.

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