Fully-Insured Medical Plans

The Washington State Health Care Authority is soliciting proposals for a professional services contract to provide a portfolio of up to three fully-insured medical plans for the Public Employees Benefits Board and School Employees Benefits Board. The contract is scheduled to run from January 1, 2029, through December 31, 2033, with an implementation period beginning no later than January 2028 and the possibility of year-to-year extensions for up to seven additional years. Eligible bidders must be licensed by the Washington State Office of the Insurance Commissioner and maintain at least 10,000 fully insured lives in their Washington book-of-business. The scope includes the design and administration of various plan types, such as HMO, PPO, EPO, or Alternative Payment Models, while adhering to strict statutory risk pool requirements and NCQA Health Outcomes Accreditation. The selection process consists of a two-phase evaluation. Phase 1 utilizes a point-based system focusing on performance standards, cost proposals based on risk-normalized rates, and the breadth of the proposed service area across Washington counties. Finalists proceed to Phase 2, which involves a consensus-based analysis of strengths, weaknesses, opportunities, and risks, incorporating written proposals on AI tools and eligibility systems, compliance with the Bree Collaborative for social determinants of health, contract redlines, and oral presentations. Awardees must comply with rigorous data security standards, including HIPAA, WaTech Category 4 confidentiality requirements, and the provision of SOC 2 Type 2 audits. Additionally, contractors must maintain comprehensive insurance coverage, including professional liability and data breach response insurance for the contract term and three years thereafter.