Cape Girardeau County Ionwave #RFP #04-04NOV26 Addendum 2

Integrated TPA, stop-loss, and pharmacy services for Cape Girardeau County’s self-funded health plan

Cape Girardeau County is seeking one integrated administrator for its self-funded employee health benefits plan. - Government buyer: Cape Girardeau County, Missouri, through the County Commission and County Clerk’s Office; Addenda identify County Clerk Kara Clark Summers. - Plan population: Approximately 262 full-time employees and 315 covered plan members. - Requested services: One integrated proposal covering third-party administration (TPA), stop-loss reinsurance, and pharmacy benefit management (PBM). Work includes claims processing and any needed claims run-out; network, eligibility, enrollment, and coordination-of-benefits support; member and employer service; utilization and case management; prescription drug management; and detailed reporting. - Notable requirements: The TPA must reprice claims in-house for locally contracted health vendors using agreed rates and coordinate direct-contract arrangements. The provider is also expected to support plan analysis and transition, employee meetings and training, ongoing assistance, and recommendations to improve processes. Proposals should demonstrate public-sector self-funded plan experience, applicable-law compliance including HIPAA and the ACA, adequate technical and financial resources, dedicated customer service with toll-free support, a secure online portal, and suitable liability and errors-and-omissions coverage. - Named organizations in supporting materials: Express Scripts (pharmacy materials and agreement), Symetra (reinsurance quotes), and McGriff, a Marsh & McLennan Agency LLC (the County’s current benefits broker). These are references in the supporting documents, not named prospective TPA bidders or required OEMs. The broker agreement describes existing benefits brokerage and management services and does not change the TPA solicitation scope. - Products and quantities: No equipment, products, part numbers, or product quantities are specified; the procurement is for services. - Performance: The selected provider is expected to begin in early 2027. Contract duration, options, and renewal terms are not specified.

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 covers plan transition and ongoing support, claims run-out if needed, and in-house repricing for locally contracted health vendors. The RFP indicates the selected TPA is expected to enter into an agreement on or after January 1, 2027; Addendum #2 states that it does not modify the RFP scope.

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