Indiana Department of Administration #000700000088573

Indiana State Employee Health Plan administration, wellness, and COBRA services

Indiana is seeking a third-party administrator and wellness partner for its self-funded State Employee Health Plan. - Government buyer: State of Indiana; Indiana State Personnel Department, with procurement support from the Indiana Department of Administration (IDOA). - Services requested: Medical-plan administration and a statewide provider network; wellness and population health management; and COBRA administration. - Medical-plan scope: Claims processing and payment, utilization and disease management, case management, eligibility and billing, member support, appeals, reporting, network administration, and coordination with other plan vendors. Prescription drug benefits and pharmacy benefit management (PBM) are carved out. - Wellness scope: Rewards and wellness program administration, three full-time onsite health coaches, telephonic and virtual coaching, health risk assessments, member engagement tools, data integration, reporting, and electronic gift card fulfillment. - Notable requirements: The State aims to bring hospital facility prices, excluding physician and other professional fees, to or below the national commercial average. It also prioritizes Medicare-based payment limits, reference pricing for shoppable services, site-neutral payments, direct provider pricing, and expanded tiered-network options. - OEMs and vendors: No OEMs, specific commercial vendors, or branded products are named in the provided materials. PBM services are outside the requested scope. - Quantities and part numbers: No product line items, product quantities, or part numbers are specified. Service quantities are not specified except for three onsite health coaches.

Description

The State seeks third-party administrative services for its employee health plans. This outcomes-based procurement aims to bring aggregate hospital facility prices for the State Employee Health Plan, excluding physician and other professional fees, to or below the national commercial average. The sample contract identifies statewide medical-plan network services and wellness and population health management. The sample contract describes an initial one-year term beginning January 1, 2028, with three optional one-year renewals.

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