This Solicitation opportunity from Utah was posted on September 26, 2024. The submission period has ended. Browse the details below for market research, or find similar active opportunities.

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Medical Stop Loss Partner

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JG25-09State & Local

Submission Closed10/17/2024, 12:00:00 AM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

Active Opportunities Like This One

NAICS: 524292

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712589: Third Party Liability Claims Administrator Services

Solicitation # 54879

Solicitation 54879 is a request for proposals from the City of Chicago Department of Law for Third Party Liability Claims Administrator Services. The selected contractor will provide general claims administration, inside claims specialist services, and outside claims adjuster services, with a focus on managing tort claims, conducting field investigations, and providing litigation support. The contract is structured as a Blanket Purchase Agreement with a base term of 60 months and an option for a single 24-month extension. Performance is measured by strict timelines, requiring routine claims to be processed within 70 days and complex claims within 182 days, with a required 80 percent adherence rate. On-site staffing is mandated from Monday through Friday, 8:00 am to 6:00 pm, and Saturdays from 8:00 am to 12:00 noon. The award process is weighted heavily toward professional and technical competence at 70 percent, followed by the implementation and management plan at 20 percent and the schedule of compensation at 10 percent. Several pass/fail requirements are in place, including financial stability, insurance compliance, and the submission of a sexual harassment policy affidavit. Contractors must adhere to strict data protection requirements for personally identifiable information and comply with MBE, WBE, and VBE participation goals. Payment is processed monthly with a 60-day term, and the City will provide a 100,000 dollar Claims Payment Fund to be maintained by the contractor. Proposals must be submitted electronically via the iSupplier portal by December 18, 2026.

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TRICARE Medicare Eligible Program Second Generation (TMEP2)

Solicitation # HT940226R0001

The TRICARE Medicare Eligible Program Second Generation (TMEP2) is a full and open competitive acquisition issued by the Defense Health Agency to provide health care claims processing, customer support, and administrative services for dual-eligible Medicare and TRICARE beneficiaries across the United States and its territories. This Firm Fixed-Price contract utilizes a best value trade-off source selection process, where technical approach and past performance are weighted as equal in importance and collectively significantly more important than price. The potential period of performance spans 8.5 years, consisting of a 12-month transition-in period, seven 1-year healthcare delivery periods, a 12-month transition-out period, and a possible 6-month extension of services. The scope of work includes the processing and payment of electronic and paper claims, management of beneficiary satisfaction through quarterly incentives, and adherence to strict quality standards outlined in a Quality Assurance Surveillance Plan. Key requirements include CMMC Level 2 certification as a condition of award and compliance with FedRAMP Moderate security standards for any cloud service providers used. Proposals must be submitted electronically via DoD SAFE in six separate volumes, with a specific focus on technical subfactors including claims processing, customer service, management functions, and transition management. Small business participation is evaluated on an acceptable or unacceptable basis and is required for award eligibility.

Defense Health Agency

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DAS Medical Plan Third-Party Administrator

Solicitation # SRC0000038100

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for one or more contractors to serve as Third-Party Administrators for its self-insured medical plans, known as Ohio Med. The scope includes the administration of three plan options: the Ohio Med PPO, Ohio Med Select, and the Ohio Med HDHP, covering approximately 103,000 lives. The selected contractor will be responsible for administering all claims incurred on or after July 1, 2027, and must ensure a seamless transition of care and eligibility verification. Key requirements include providing case, care, disease, and utilization management, while behavioral health remains a carved-out service. The contractor must also integrate with the state's data warehouse vendor, Merative, and adhere to strict IT security standards, including HIPAA compliance via a Business Associate Agreement and various recognized security certifications such as SOC 2 Type 2 or HITRUST. The contract term runs from the date of signature through June 30, 2030, with options for short-term monthly renewals and potential mutual extensions for up to four additional years. Performance is measured by specific Service Level Agreements, such as mailing ID cards within five days of enrollment and maintaining zero errors in initial eligibility files. Financial terms involve weekly claims billing paid via ACH, with a cost proposal structure based on per employee per month fees for core and disease management services. Award selection is based on a total score combining technical, cost, and presentation evaluations. Proposals must be submitted electronically through the OhioBuys portal, with technical and cost components submitted as separate, non-password-protected electronic envelopes.

Administrative Services

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Request for Proposal - Third Party Administrative and Actuarial Services

Solicitation # 2025-RFP-127

The City of Cleveland Department of Finance, Division of Risk Management, is soliciting competitive proposals under solicitation 2025-RFP-127 for a single qualified Third-Party Administrator (TPA) to provide comprehensive administrative and actuarial services. The primary objective is to manage Ohio Bureau of Workers' Compensation (BWC) claims and conduct detailed liability reviews to reduce premium costs and minimize organizational exposure. The scope of work includes full claims administration, subrogation identification and negotiation, and the establishment of claims reserves. The selected provider must integrate with the Ohio BWC TPA Portal, the Ohio Industrial Commission systems, and the City's Origami Risk Management Platform and Microsoft Teams, while adhering to strict AES-256 and TLS 1.3 encryption standards and providing annual SOC 1 and SOC 2 Type II reports. Proposals were due by October 29, 2026, for a contract start date of January 1, 2027. The City operates under an individual retro plan and evaluates bidders based on a two-phase process focusing on proposal quality, demonstrated ability, OEO compliance, key personnel credentials, and the proposed schedule, followed by potential interviews. Awardees must comply with the Cleveland Area Business Code and maintain specific insurance coverages, including $1,000,000 limits for Business Automobile Liability and Workers' Compensation employer's liability. The contract requires a 10 percent Cleveland Area Small Business participation goal and adherence to the City's Professional Services Contracts Reimbursables Policy for invoicing and billing.

Finance - Division of Risk Management

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State of South Dakota Account Based Plans (HRA, HSA and FSA)

Solicitation # 26RFP19879

The South Dakota Bureau of Human Resources and Administration is seeking a qualified vendor through solicitation 26RFP19879 to provide comprehensive administration services for the state's Account Based Plans. The scope of work includes the management of Health Reimbursement Accounts (HRA), Health Savings Accounts (HSA), and Medical and Dependent Care Flexible Spending Accounts (FSA) for both active employees and COBRA participants. The state aims to secure a partner capable of delivering innovative technology, exceptional service, regulatory compliance, and a positive experience for all participants. Proposals must be submitted electronically via email in MS Word or PDF format to [email hidden] by October 28, 2026, at 5:00 PM CDT, with a total email size limit of 20MB. All submissions must be signed by an authorized representative and reference the solicitation number. The state will not award contracts to entities in arrears on obligations to South Dakota or those deemed irresponsible. Additionally, all IT-related purchases are subject to approval by the Bureau of Information and Technology. An award decision and contract negotiations are anticipated by December 14, 2026.

South Dakota State Government

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TPA Workers' Compensation

Solicitation # 127-2026

The Southwest Ohio Regional Transit Authority (SORTA), also known as Cincinnati Metro, is soliciting proposals for a Third-Party Administrator (TPA) to manage its self-insured Workers' Compensation program. The scope of work includes comprehensive claims administration, medical management, cost containment, legal support, and regulatory compliance in accordance with Ohio Bureau of Workers' Compensation and Ohio Industrial Commission requirements. Additionally, the selected vendor will provide safety consulting, OSHA/VSSR review services, and various reporting deliverables, including quarterly claims reports and bi-weekly payment forecasts. The contract is intended to begin in March 2027 and utilizes a firm-fixed price structure for a five-year term. Proposals must be submitted electronically via the OpenGov portal by November 4, 2026, and must be divided into two volumes to keep pricing separate from technical and business qualifications. Evaluation will be based on a points-based system focusing on price, project approach, and firm and staffing qualifications, specifically looking for public-sector or transit-related experience. Award decisions will be made based on the most advantageous proposal to SORTA. The successful contractor must adhere to NET 30 payment terms and comply with various federal and state non-discrimination and equal employment opportunity regulations.

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Vehicle Assistance and Claims AdministratorThe Vehicle Assistance and Claims Administrator subcontract, issued by the US Embassy Paris for the Department of State, involves providing roadside assistance and third-party insurance claims management for prime contractors in France. The selected provider will manage assistance for 112 vehicles, settle third-party claims, and recover expenses related to personnel and equipment. Key deliverables include the resolution of claims, the recovery of funds, and detailed documentation of all roadside assistance events. To be eligible, the contractor must possess a Kbis registration and appoint a Project Manager who is fluent in both English and French. The work will be performed in Paris, France, under NAICS code 524292. Responses for this opportunity are due by November 6, 2026.

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Announcement of RFP for Retirement Plan Administration and Record Keeping Services

Solicitation # LC26028

Lane County is seeking proposals from qualified firms to provide comprehensive administration, record keeping, education, and investment-related services for its 457 Deferred Compensation Plans and 401(a) Defined Contribution Plan. The primary objectives of this solicitation are to enhance participant retirement outcomes, improve education and communication, and implement robust online transaction capabilities. Additionally, the County aims to reduce expenses, evaluate competitive pricing structures, and streamline administrative functions through automation and integrated reporting. Interested parties must request solicitation documents from the designated consultants by November 12, 2026, at 5:00 PM. The final deadline for proposal submissions is November 20, 2026. The selected firm will be expected to ensure an orderly transition of assets and services while maintaining a strong working relationship with the Deferred Compensation Advisory Committee.

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Nevada State Pharmacy Benefit Manager

Solicitation # 41NHA-S3992

The Nevada Health Authority Director's Office is seeking proposals for a Nevada State Pharmacy Benefit Manager under solicitation number 41NHA-S3992. This state-level procurement opportunity is managed by the Nevada Health Authority in Carson City and is open for responses until December 29, 2026. Interested parties should coordinate with the primary purchaser, Heather Moon, or the designated administration contact for further inquiries. All detailed requirements and submission guidelines are contained within the official solicitation attachments provided through the Nevada ePro portal.

410 - Nevada Health Authority Director's Office

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Solicitation # 2611-KP

The Sacramento Housing and Redevelopment Agency (SHRA) is soliciting proposals under RFP 2611-KP for a qualified actuarial services firm to manage its Other Post-Employment Benefits (OPEB) program. The selected contractor will be responsible for measuring liabilities, supporting funding decisions, and providing essential data for financial reporting and long-term planning. Key deliverables include GASB 75 reporting packages for fiscal year ends 2026 through 2030 and full actuarial valuations as of December 31 for 2026, 2027, and 2028. The scope also encompasses advisory services for prefunding strategies, scenario modeling, and the development of Actuarially Determined Contributions (ADCs) to ensure the fiscal sustainability of retiree medical and dental benefits. The contract is structured for an initial one-year term with options to extend for up to four additional periods, not to exceed five years in total. Proposals are due by October 29, 2026, via the OpenGov portal, with an anticipated start date of December 7, 2026. Evaluation follows a two-stage process where technical proposals must score at least 70% to be considered responsive before cost proposals are reviewed. Award criteria emphasize technical expertise in public-sector OPEB valuations, past performance with similar governmental agencies, and the qualifications of the project team. The agreement requires strict adherence to GASB 75 standards, the Federal Privacy Act of 1974, and applicable Actuarial Standards of Practice.

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Pharmacy Drug Benefits

Solicitation # HHS0017240

The Texas Department of State Health Services (DSHS) is soliciting proposals under solicitation number HHS0017240 for a Pharmacy Benefits Manager (PBM) to support the Texas HIV Medications Program (THMP). The selected PBM will act as a secondary payor to manage prescription drug benefits, premium payments, and copayments through three primary programs: the State Pharmacy Assistance Program (SPAP) for Medicare Part D costs, the Texas Insurance Assistance Program (TIAP) for medication copayments and COBRA premiums, and the Texas Insurance Assistance Program-PLUS (TIAP-PLUS) for private and federal marketplace plan assistance. The scope of work involves processing medication claims and monthly invoice premium payments, with historical data indicating the management of over 15,000 claims for approximately 2,764 participants. The contract features an initial one-year term with the possibility of four additional one-year extensions and one final option period at the discretion of DSHS. Award selection is based on best value, evaluated through a weighted scoring system consisting of the Project Workplan (45%), Cost Proposal (35%), and Qualifications and Experience (20%). Proposals must be submitted by November 19, 2026, via either USB drive or an online bid room. Requirements include a narrative proposal limited to 40 pages, a separate Excel-based cost proposal, and a VetHUB Subcontracting Plan. The contract is governed by Texas Government Code Section 2155.144 and incorporates various HHS uniform terms, additional provisions, and a Data Use Agreement.

Department of State Health Services

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DAS Behavioral Health Third-Party Administrator RFP

Solicitation # SRC0000040548

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for a Third-Party Administrator to manage its self-insured Behavioral Health Benefit Plan. Starting July 1, 2027, the selected contractor will provide administrative services for approximately 43,800 employees and 104,600 total lives. Key responsibilities include managing eligibility, claims history, prior authorizations, utilization management, and data integration with the State's data warehouse. The contract runs from the date of signature through June 30, 2030, with the possibility of a one-month discretionary renewal and further mutual renewals for up to four additional years. To be eligible, offerors must be NCQA accredited and comply with the Mental Health Parity and Addiction Equity Act. The evaluation process is based on a total score derived from technical requirements, cost, and presentations, with the highest-ranking responsible offeror recommended for award. Financial terms utilize a not-to-exceed unit cost fee structure, and the contractor must provide a Benefits Fund of at least 150,000 dollars. Strict compliance is required regarding HIPAA through a Business Associate Agreement, State IT policies, and secure data transfer protocols via SFTP. Proposals must be submitted electronically through the OhioBuys portal, consisting of separate technical and cost volumes.

Administrative Services

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7 days ago

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in 16 days

AI Contract Overview

The Granite School District has issued a solicitation for a Medical Stop Loss Partner, with the solicitation number JG25-09, posted on September 26, 2024. The contract aims to secure a partner to provide stop-loss insurance services, with a project budget ranging from $1,000,000 to $5,000,000. Interested vendors are encouraged to respond by October 17, 2024. The district, part of the State of Utah's education sector, is seeking proposals from qualified organizations to manage or provide stop-loss coverage, which helps mitigate high-cost medical claims for the district’s health plans. The primary point of contact for inquiries is Jared Gardner, a government official at the district, reachable via email at [email hidden]. More details and the opportunity to respond can be accessed through the provided link to the Utah State procurement portal.