Cape Girardeau County Ionwave #RFP #04-04NOV26

Integrated TPA, Stop-Loss, and Pharmacy Benefit Management for Cape Girardeau County

Cape Girardeau County, Missouri, is seeking an integrated administrator for its self-funded employee health benefits plan. - Government buyer: Cape Girardeau County, Missouri (County of Cape Girardeau); County Commission and Office of the County Clerk are identified in the materials. - Scope: One integrated proposal for third-party administration (TPA), stop-loss reinsurance, and pharmacy benefit management (PBM) for about 262 full-time employees and 315 covered lives. - Requested services: Claims processing and prior-plan claims run-out; network management; eligibility and enrollment support; member and employer customer service; coordination of benefits; utilization and case management; detailed reporting; and prescription drug management. - Provider coordination: Reprice claims for locally contracted providers, apply agreed rates, support direct or employer-negotiated provider contracts, and perform claim edits. - Transition and advisory support: Analyze existing plans and systems, recommend improvements, support implementation and enrollment, conduct employee information meetings and training, provide ongoing assistance, and advise on healthcare reform compliance and wellness planning. - Notable requirements: Relevant public-sector self-funded plan experience, sufficient technical and financial capacity, compliance with applicable requirements including HIPAA and the ACA, a dedicated customer-service team with toll-free support and a secure online portal, and appropriate liability and errors-and-omissions insurance. - Named vendors in reference materials: Express Scripts (ESI) and Symetra are mentioned in supporting plan materials; neither is identified as the selected or required provider. No specific OEM, commercial product, part number, or product quantity is requested. - Timing: The anticipated start is in 2027; contract length and renewal options are not stated.

Description

Cape Girardeau County is seeking proposals from qualified third-party administrators to administer its self-funded employee health benefits program. The requested integrated services include claims processing, network management, eligibility and enrollment support, customer service, coordination of benefits, utilization and case management, data reporting, stop-loss reinsurance, and pharmacy benefit management. The scope also includes transition assistance, ongoing plan support, and administration of claims run-out where needed. Proposals are due November 4, 2026, at 10:30 a.m. CT; fax and email submissions will not be accepted, and electronic submission through the county bid portal is optional.

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