This Government Contract opportunity from Department Of Health And Human Services was posted on September 25, 2024. The submission period has ended. Browse the details below for market research, or find similar active opportunities.

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RFI and draft PWS - World Trade Center Health Program Third-Party Administrator

Closed

75D301-24-RFI-WTCHP-TPAFederal

Submission Closed10/25/2024, 08:30:00 PM 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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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

POSTED

DEADLINE

Employee Benefits- Life/STD/FSA/HSA/COBRA

Solicitation # 27-011CH-32RFP

The Tempe Union High School District is soliciting proposals under solicitation number 27-011CH-32RFP to secure a provider for the administration of employee benefits, including Basic and Voluntary Life and Accidental Death and Dismemberment, Short-Term Disability, Flexible Spending Account, Health Spending Account, and COBRA administration. The intended contract period runs from July 1, 2027, through June 30, 2032. Key requirements include the waiver of pre-existing condition limitations for initially enrolled employees and dependents, the elimination of active-at-work restrictions, and a guarantee that no employee suffers a loss of benefits during a carrier change. The selected vendor must provide a designated account management team, bilingual educational materials, and attendance at four days of annual open enrollment meetings in Tempe, Arizona. The award process utilizes a point formula system across three phases: initial evaluation, vendor interviews, and a best and final offer. Evaluation factors include responsiveness, cost, and past performance, with a minimum of 500 technical points required to proceed to price evaluation. The District intends to award the least number of vendors necessary, with contracts potentially awarded by individual product lines. Proposals must be submitted via the OpenGov portal by November 19, 2026. The contract is subject to Arizona Revised Statutes and School District Procurement Rules, featuring a zero-tolerance gift policy and net 30-day payment terms. Implementation must be completed 60 days prior to open enrollment, with a required 45-day support period following the July 1 effective date.

POSTED

DEADLINE

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

POSTED

DEADLINE

RFP-2026-21 Voluntary Benefits, Section 125 Flexible Benefit Plan, Enrollment and Related Employee Services

Solicitation # RFP-2026-21

Harnett County Schools is soliciting proposals under RFP-2026-21 for a qualified partner to provide voluntary employee benefits, Section 125 Flexible Benefit Plan administration, and related enrollment and support services. The scope of work includes the coordination of voluntary insurance benefits such as dental, vision, disability, and life insurance, as well as the administration of medical and dependent care flexible spending accounts. The selected provider will be responsible for open enrollment delivery, employee education, telemedicine services, and critical administrative tasks including payroll deduction files, billing reconciliation, and IRS-compliant nondiscrimination testing and tax filings. The contract will be awarded to the lowest responsible and responsive bidder based on the total base bid, though the agency may also consider overall value, service quality, and employee impact. Proposers must submit three signed physical copies and one electronic PDF copy via thumb drive by November 13, 2026. Required documentation includes a detailed pricing schedule, implementation and transition plans, North Carolina licenses, and various certifications regarding non-collusion, conflict of interest, E-Verify compliance, and the Iran Divestment Act. Vendors must also provide evidence of cybersecurity and privacy controls and adhere to North Carolina Department of Labor safety standards. Payment terms are set at net 30 days following the receipt of a correct invoice.

Harnett County Board of Education

POSTED

DEADLINE

Provision of flexible Benefits Administration Services and Platform

Solicitation # COM00163

Ofcom is seeking a provider for an end-to-end flexible benefits administration service and platform for an initial five-year term starting July 1, 2027, with the possibility of two 12-month extensions through June 30, 2034. The estimated contract value is 350,000 GBP excluding VAT. This open procedure solicitation, identified as COM00163, is particularly suitable for small and medium-sized enterprises and voluntary, community, and social enterprises. The award will be based on a weighted scoring system, with 20 percent of the evaluation focused on the quality of administration, reconciliation processes, helpdesk support, and colleague communication. The required service is divided into three core areas: scheme administration, platform management, and customer services. Administration duties include managing annual and open enrolment, monthly payroll and provider reporting, and pension re-enrolment on a three-year cycle. The provider must maintain a secure cloud-based platform featuring Single Sign On capability, Total Reward Statements, and the ability to model the cost effects of benefits, including tax and National Insurance implications. Additionally, the supplier must provide a responsive customer support service with a telephone helpdesk and detailed analytics reporting. All technical specifications must align with Ofcom Security Requirements and the Government Procurement Agreement.

POSTED

DEADLINE

Stop Loss - Healthcare & Medical

Solicitation # RFP-2027-394

The Board of Regents of The University of Oklahoma, through the Oklahoma University Health Sciences Center, is seeking a qualified vendor for the administration of its Stop Loss program under solicitation RFP-2027-394. The objective is to secure a provider capable of delivering high-quality, cost-effective program management to maximize value for the University and its partners. While the University prefers to award the contract to a single supplier, it maintains the right to award to multiple suppliers if it serves the institution's best interests. Interested vendors must adhere to a strict submission timeline, with the proposal deadline set for November 16, 2026, at 2:00 PM CST. A critical preliminary step requires vendors to sign and return a Non-Disclosure Agreement to Melody Carder by October 27, 2026, which serves as the formal Intent to Bid and is mandatory to receive the necessary census data and vendor questionnaire. Proposals must include a company overview, a signed Business Associate Agreement, and at least three references from projects of similar scope and complexity completed within the last five years, preferably within the public sector or higher education. Additionally, bidders must provide certifications regarding the absence of conflicts of interest and confirmation that they are not currently debarred or suspended from receiving federal funds.

Oklahoma University Health Sciences Center

POSTED

DEADLINE

DAS TELEHEALTH ADMINISTRATION

Solicitation # SRC0000042016

The State of Ohio, through the Department of Administrative Services, is soliciting proposals for a contractor to administer telehealth benefits for state employees and their dependents. The selected contractor will manage the delivery of telehealth services across three plan options: Ohio Med PPO, Ohio Med Select, and Ohio Med HDHP. The scope of work includes providing a provider network, proactive account management, and comprehensive claims management with accurate coding and timely submission to medical third-party administrators. Key operational requirements include maintaining 99.9% availability for the mobile app and web portal, achieving at least a 60% member satisfaction rating per visit, and implementing a written satisfaction improvement plan by the second contract year. The contractor must also ensure ADA compliance, maintain closed-loop referral tracking, and adhere to strict HIPAA and HITECH privacy standards. The contract will be awarded based on the highest total score, combining technical, cost, and presentation evaluations. Financial terms are structured as Administrative Services Only fees charged per enrolled employee per month, with payment terms set at Net 30. The contractor must be prepared for open enrollment activities by May 1, 2027. Proposals must be submitted via the OhioBuys Supplier Portal in two distinct volumes: a technical proposal and a cost proposal. Mandatory documentation includes a wide array of certification forms, a Business Associate Agreement, and evidence of security controls such as HITRUST or CMMC certification. Performance is monitored through a formal inspection and acceptance process where deliverables must be approved by an Agency Representative.

Administrative Services

POSTED

DEADLINE

Preferred Drug Program / Pharmacy Benefits Management C020463 X-12

Solicitation # 2139982

The New York State Department of Health, specifically the Office of Health Insurance Programs, intends to award a single-source contract to Prime Therapeutics State Government Solutions LLC for the provision of Preferred Drug Program and Pharmacy Benefit Management Services. This procurement is exempt from competitive advertising because a competitive process was not feasible within the required timeframe, as this extension represents the minimum period necessary to complete a new competitive procurement for these services. The contract is scheduled for a period of performance from December 1, 2026, through November 30, 2027, with the services being performed statewide across New York. Administrative oversight for the contract is managed by Health Program Administrator Kevin Noonan, based in Albany, New York. The solicitation is identified by number 2139982 and was posted on October 16, 2026.

NYS Department of Health

POSTED

DEADLINE

South Dakota State TPA Workers' Compensation

Solicitation # 26RFP19880

The State of South Dakota, through the Bureau of Human Resources and Administration, is soliciting proposals for a licensed business partner to provide Third Party Claims Administration for its Workers' Compensation Program. The selected vendor will be responsible for core services including medical case management, medical bill review, and MMSEA reporting. Key objectives include implementing cost-containment strategies, providing risk mitigation guidance, and delivering real-time analytics and benchmarking to improve claim outcomes and employee return-to-work efforts. The contract is structured over three twelve-month periods, beginning July 1, 2027, and ending June 30, 2030. Proposals will be evaluated on a 500-point scale, with the highest-ranked offeror invited to negotiate terms and compensation. Technical approval from the Bureau of Information and Technology is required, and vendors must meet strict IT standards, including Web Content Accessibility Guidelines 2.1 Level AA and compatibility with major web browsers. Security is a critical component, requiring the disclosure of third-party software libraries and the maintenance of cyber liability insurance for three years post-completion. The State will utilize User Acceptance Testing and performance load testing to ensure system effectiveness. Proposals must be submitted electronically to Peggy Canter by November 25, 2026, and must not be solely generated by artificial intelligence.

South Dakota State Government

POSTED

DEADLINE

Workers' Compensation & General Liability Claim AdministrationThis subcontract for the Maryland Office of Risk Management involves providing comprehensive end-to-end claim administration for prime contractors working on County insurance projects. The selected provider will manage Workers Compensation, Auto Liability, General Liability, and First Party Property Damage claims utilizing online internet-based reporting systems. Key deliverables include the management of claim files, the processing of settlements, and the delivery of regular claim status reports. To be eligible, providers must hold the necessary state and federal licenses for insurance adjusting and administration. The opportunity is categorized under NAICS code 524292, with a response deadline set for December 1, 2026.

Office of Risk Management

POSTED

DEADLINE

Third Party Administrative Services

Solicitation # 27-186

Frederick County, Maryland, through its Office of Risk Management, is seeking a third-party claim administrator to manage its self-insured workers compensation program and other lines of coverage. The selected contractor will provide comprehensive claim administration services, including specialized OSHA and MOSH reporting support, the calculation of lost and restricted duty days, and the provision of updated OSHA 300, 300A, and 301 reports. Key requirements include the ability to offer Medicare Set-aside services, interface with the County's risk management and safety systems, and maintain a rigorous information security program to protect confidential data. The contract is scheduled to commence on or about July 1, 2027, for an initial one-year term with the option for four additional one-year renewals at the County's discretion. Award selection is based on a points-weighted evaluation of the work proposal, provider qualifications, and the transition schedule. Successful bidders must provide evidence of general liability insurance and adhere to Net30 payment terms via electronic funds transfer. The procurement process is managed electronically through the OpenGov portal, with a response deadline of December 1, 2026.

Office of Risk Management

POSTED

DEADLINE

Q517--36C25527Q0015 | Pharmacy Benefits Services | Wichita |

Solicitation # 36C25527Q0015

The Department of Veterans Affairs Network Contracting Office 15 intends to award a single-award, Indefinite Delivery/Indefinite Quantity (IDIQ) contract for third-party pharmacy benefit services to support the First Fill Prescription Voucher Program. This program serves eligible Veterans assigned to the Robert J. Dole VA Medical Center in Wichita, Kansas, as well as associated Community Based Outpatient Clinics and Home-Based Primary Care programs. The contractor will provide the personnel, systems, and pharmacy network necessary to dispense new or urgent prescriptions when VA pharmacies are impractical, such as during telehealth appointments or after-hours emergency room visits. Services are limited to a maximum day supply of 10 days for most medications and 14 days for antibiotics, with a requirement for 24-hour network availability including weekends and federal holidays. This procurement is designated as a VOSB/SDVOSB set-aside under NAICS code 524292, with a size standard of 4.5 million dollars. The anticipated period of performance includes a base year from January 4, 2027, to January 3, 2028, with two subsequent one-year options. The contractor must maintain strict compliance with HIPAA, the Privacy Act of 1974, and Joint Commission standards, and will be subject to a Quality Assurance Surveillance Plan monitoring network availability and dispensing accuracy. The formal solicitation is expected to be publicized on or about November 1, 2026, via SAM.gov. All interested vendors must be active in the System for Award Management and, if applicable, registered in the SBA VetCert database.

255-NETWORK Contract Office 15 (36C255)

POSTED

7 days ago

DEADLINE

in 26 days

General Info

Agency

Department Of Health And Human Services → CDC Office Of Acquisition Services

NAICS

524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

Place of Performance

GA, USA

Set-Aside

NONE

Documents

TPA Summary Volume Data Shell

specifications

High

WTC Health Program End-to-End Certification Process

specifications

High

WTC Health Program Third-Party Administrator PWS

sow

High

ATT015_TPA_ProcessFlow_Transfer

other

Low

Questions and Answers Template

q-and-a

Low

TPA Glossary

supporting-documents

Low

TPA Process Flow Enrollment

other

Low

AI Contract Breakdown

Uniform Contract Format

Contract not broken down yet

CLEATUS splits the solicitation into Uniform Contract Format (UCF) sections: scope, pricing, deliverables, and evaluation criteria.

Timeline

PhaseClosed

PostedSep 25

special-notice

Response DeadlineOct 25

Deadline has passed

Submission Closed

10/25/2024, 08:30:00 PM UTC

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Organization & Contact Information

AgencyDepartment Of Health And Human Services → CDC Office Of Acquisition Services

Contacts1 person available

OfficeATLANTA, GA, 30333, USA

Organization / AgencyDepartment Of Health And Human Services → CDC Office Of Acquisition Services

Office AddressATLANTA, GA, 30333, USA

Contacts

Joshua Houston

contact@example.gov

Full Description

The purpose of this request for information (RFI) and draft performance work statement (PWS) is to solicit feedback from industry on an upcoming planned solicitation for a third-party administrator (TPA) for the World Trade Center (WTC) Health Program. The WTC Health Program is a limited benefit federal health care program that provides high-quality, compassionate medical monitoring and treatment for WTC-related conditions to those directly affected by the September 11th attacks in New York, at the Pentagon, and in Shanksville, Pennsylvania. The Program is administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), a component of the U.S. Department of Health and Human Services (HHS). The WTC Health Program TPA receives and processes enrollment applications and certification requests for NIOSH decision-making; maintains member demographic information; manages a call center; manages and maintains provider networks on behalf of the WTC Health Program; administers WTC Health Program benefits; and processes medical claims. Attached, please find: 1. The draft PWS for this acquisition. 2. Attachment 001, a glossary of terms and acronyms used in the PWS. 3. Attachments 012, 013, and 015, process flow charts for the current enrollment, certification, and transfer processes, respectively. 4. Attachment 101, a shell of summary volume data. This spreadsheet describes the data from all operational areas of the WTC Health Program that CDC/NIOSH intends to provide with the solicitation to inform prospective offerors of the historical volume of member enrollment, claims, and other data. Please note that all other attachments referenced in the PWS are intended to be provided once a solicitation is issued. Interested parties are encouraged to review the PWS and provide feedback to CDC/NIOSH. Responses may be in the form of redlines/tracked changes/comments in the Word document itself, and/or in a separate, stand-alone document. Interested parties may also use the attached questions and answers template to submit questions about this PWS to CDC/NIOSH. In addition to feedback on the draft PWS, CDC/NIOSH is interested in industry feedback on the following questions: 1. What information about the WTC Health Program would you need, beyond (a) what is included in the PWS and (b) the data that is to be provided in the shell of summary volume data spreadsheet, to develop a proposal in response to this PWS? 2. What, if any, monetary or non-monetary incentives to motivate contractor performance would you like to see considered for this contract? 3. Would you like to see any particular contract structure (e.g., structure of the contract line items) and compensation arrangement for the various tasks in the PWS? 4. What evaluation factors would you recommend CDC/NIOSH consider to facilitate CDC/NIOSH selecting the contractor and proposal that is the best value to the WTC Health Program? Please submit all responses to Contract Specialist Joshua Houston at jhouston@cdc.gov. Responses are requested by October 25, 2024. In addition to submitting written responses, CDC/NIOSH is offering the opportunity for a limited number of firms to share their feedback on the draft PWS and this acquisition in a one-on-one Microsoft Teams call with CDC/NIOSH. These calls are planned to take place between October 21, 2024, through October 25, 2024. If your firm is interested in participating in one of these calls, please contact Contract Specialist Joshua Houston at jhouston@cdc.gov. Please note that there is a limited number of calls that CDC/NIOSH intends to hold; these calls will be scheduled with firms at the discretion of CDC/NIOSH, and the opportunity for a call is not guaranteed. Further, CDC/NIOSH will not use these calls to provide feedback on a firm's proposed approach to perform this work, nor will CDC/NIOSH use these calls as an opportunity to share information outside that which is already included in this posting and the attached files. Following receipt and consideration of industry feedback, CDC/NIOSH intends to release a solicitation on or about mid-January 2025, with award of a contract expected in September 2025. Please note these dates are subject to change and are provided for informational purposes only. This RFI and draft PWS is issued solely for informational and planning purposes and is not a solicitation for proposals, proposal abstracts, or quotations. Release of this RFI and draft PWS shall not be construed as a commitment to procure items or services. Responses are not offers and cannot be accepted by the Government to form a binding contract. The Government will not pay for any cost incurred in response to this RFI and draft PWS; all associated costs with responding to this RFI are solely at the respondent's expense. Respondents should indicate which information in their response they consider to be proprietary. Responses will assist the Government in the development of this future planned acquisition.