New York State Contract Reporter #WFE109D

WMCHealth seeks self-funded medical plan administration, pharmacy benefit management, and stop loss coverage

Westchester Medical Center Health Network (WMCHealth) is seeking proposals for self-funded medical plan administration, pharmacy benefit management (PBM), and stop loss coverage across its network of hospitals and care sites in New York. - Government Buyer: - Westchester Medical Center Health Network (WMCHealth) - Executive Offices at Taylor Pavilion, Office of Legal Affairs - OEMs and Vendors: - Aetna/CVS (current provider for medical and pharmacy administration and stop loss coverage) - Products/Services Requested: - Self-Funded Medical Plan Administration - Includes plan setup, data integration, employee communication, training, compliance, and timeline management - Pharmacy Benefit Management (PBM) - Includes claims processing, member support, preventive care programs, and reporting - Stop Loss Coverage - $1M specific level, domestic claims only, rate cap for Year 2, no individual lasers - Unique/Notable Requirements: - Direct submissions from carriers/vendors only; brokers and consultants are excluded - Strict confidentiality and compliance with HIPAA and New York State privacy laws - Guaranteed fees and performance guarantees for three years - Implementation expected to begin October 2025 - Contract period is three years, with potential for negotiated fee caps beyond initial term

Description

The WMCHealth Network is issuing a Request for Proposals (RFP) to qualified firms for medical plan administration, pharmacy benefit management, and stop loss coverage services throughout the WMCHealth network. The contract term is 12 months with optional 12-month renewals. Proposals must be submitted directly by qualified carriers or vendors; submissions through brokers or consultants will not be accepted. The services will cover locations including Dutchess, Orange, Rockland, Sullivan, Ulster, and Westchester counties in New York.

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