MEDICARE ADVANTAGE BENEFIT ADMINISTRATION

THIS IS ONLY A PDF COPY OF THE RFP DOCUMENT.
BIDDERS MUST RESPOND TO THE ELECTRONIC RFP (eRFP)
LOCATED ON PROPOSALTECH.
TO ACCESS THE eRFP, REGISTER ON PROPOSALTECH AT:
http://www.proposaltech.com/home/app.php/register
State of New Hampshire
REQUEST FOR PROPOSAL
For
MEDICARE ADVANTAGE BENEFIT ADMINISTRATION
RFP # 485-26
RESPONSE DUE BY:
April 8, 2026 at 2:00 PM Eastern Time (ET)
Department of Administrative Services
Division of Risk and Benefits

TABLE OF CONTENTS
1 Introduction
A. Background
B. Objective
C. Contract Length & Specifics
2 Bidding Instructions and Conditions
2.1 Proposal Conditions
2.2 Estimated RFP Timetable
2.3-2.7 Evaluation Process
2.8 Bidder Contacts
3 Required Plan Designs, Services and Programs
3.1.A MAPD Plan Design
3.1.B General Services
3.1.C Implementation
4 Network Match and Access
4.1 Network Match
4.2 Network Access
5 Performance Guarantees
6 Technical Questionnaire
6.1 Administrative, Member, & Claim Paying Services
6.2 Data Reporting
6.3 Star Rating Maximization
6.4 Enrollment, Implementation, & Communication
6.5 Medical Management & Member Case Management
6.6 Rx Formulary and Clinical Program Management
7 Financial
7.1 Fully Insured Premium Rates
7.2 Financial Questions
7.3 Allowances
8 Client References
9 Appendices - Group Information

State of New Hampshire
APPENDICES
APPENDICES - GROUP INFORMATION
Appendix A REQUESTED PLAN DESIGNS
Appendix B REQUESTED PLAN DESIGNS FORM
Appendix C DEFINITION OF TERMS
Appendix D SONH RFP DATA AND ATTACHMENTS
Appendix E STATE OF NH TRANSMITTAL LETTER
Appendix F P-37 FORM CONTRACT
Appendix G BUSINESS ASSOCIATE AGREEMENT
Appendix H REQUIRED PROTECTION OF CONFIDENTIAL INFORMATION AND DATA SECURITY
Appendix I PARTICIPATING BIDDER AGREEMENT

State of New Hampshire RFP for Administration of Medicare Advantage
(with Prescription Drug Option) #485- 26
1 INTRODUCTION
1.1 This Request for Proposal ("RFP") is issued by the Department of Administrative Services (DAS), acting
through the Division of Risk and Benefits, for a contract for the administration of fully insured Medicare
Advantage and Prescription Drug (MAPD) benefits as described herein.
A. Background
The State of New Hampshire ("State") currently provides medical and prescription drug benefits to
approximately 11,000 Medicare eligible retirees and Medicare-eligible dependents ("participants") of retirees
located throughout the country. The coverage is through a fully insured Medicare Advantage with Part D plan,
and it is provided by Anthem BCBS.
Medicare participants born on or after January 1, 1949 currently contribute 10% of the monthly Medicare
medical/Rx working rate. Medicare participants born before January 1, 1949 currently do not contribute to the
monthly working rate. The State collects applicable contributions from participants and pays the carrier 100%
of the Medicare Advantage premium.
B. Objective
The State seeks to provide high quality, cost-effective benefits to its Medicare-eligible retirees and their
families. The State is soliciting offers on a fully insured, national MAPD passive PPO plan with the same
benefits for services rendered in or out-of-network. The State is also soliciting offers for a carrier to provide a
fully insured Medicare Advantage (MA) medical plan alongside a fully insured Prescription Drug Plan (PDP). The
proposed plan, whether combined (MAPD) or separate (MA / PDP), should mirror the requested plan designs
and copays (see Appendix A) for Medicare-eligible State retirees within CMS guidelines.
The State will select either the combined (MAPD) option or the separate (MA / PDP) option. If the State
selects the separate option, both the standalone MA and PDP components will be selected and only one (1)
vendor will be selected to provide both components. Bidders submitting a separate quote must ensure
integration/compatibility between their standalone MA and PDP products.
Bidders are encouraged to identify and offer features or enhancements that provide additional value without
adding cost as well as any creative solutions that will achieve the State's goals. Of particular interest are
programs that focus on maximization of CMS Star Ratings, proven risk adjustment strategies and minimization
of medical and pharmaceutical claims cost, which ultimately lower the premium rates.
The State requires that Bidders duplicate the requested retiree health benefit plans due to current
legislative authorization. (See Appendix A for the requested MAPD plan design.) Additionally, the State's
contract with a vendor requires the vendor to implement any changes in plan design or coverage resulting
from legislative authorization throughout the term of the contract. In addition, the Vendor shall provide
financial modeling to assist the State with consideration of plan changes. The State reserves the right within
any contract awarded under this RFP to re-negotiate elements of the contract as required by legislative
changes.
C. Contract Length & Specifics
The contract shall commence upon approval of the Governor and Executive Council (the "effective date"),
through December 31, 2029, with the option to extend for up to three (3) additional one year extensions,
exercised individually or combined, as mutually agreed by the parties and approved by the Governor and
Executive Council (G&C). The implementation period shall commence within seven days of Governor and
Executive Council approval but in no event earlier than June 1, 2026. The services outlined in this RFP shall
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commence on January 1, 2027. Payments for contractual services shall commence January 1, 2027, and shall
not be made during the implementation period.
2 BIDDING INSTRUCTIONS AND CONDITIONS
2.1 PROPOSAL CONDITIONS
2.1.1 Mandatory Instructions for Bidders
Interested bidders must read the entire RFP, complete all sections of the RFP and submit the required
documents in the manner specified in the RFP by the stated proposal submission deadline. Electronic
responses must be completed and submitted through ProposalTech. Bidders are responsible for reviewing the
most updated information related to this RFP before submitting proposals.
Each bidder is required to provide an electronic copy of the State of New Hampshire's Transmittal Letter (see
Appendix E), signed by a person authorized to bind the company to all commitments made in the RFP
response.
The legal entity that would be entering into a resulting contract with the State must be the same legal entity
submitting a proposal and signing the Transmittal Letter (e.g., no trade names).
Failure to follow these instructions may be grounds for rejection of your RFP response.
2.1.2. Bidder Requests for Plan Data
Appendix I is a Participating Bidder Agreement (PBA) which must be filled out and sent to Jennifer Slutzky
through the messaging feature in Proposal Tech to obtain data and attachments referred to in Appendix D.
Upon receipt of a Bidder's signed PBA (Appendix I), Segal will review its files for a current Global or Bid-Related
Non-Disclosure Agreement (NDA) on file with Segal. If there is no NDA on file with Segal, an NDA document
will be issued to the Bidder for signature. Verbiage is non-negotiable.
No data will be issued without first having a signed NDA on file.
Upon receipt of the newly signed NDA, or confirmation of an existing NDA on file, Segal will establish a secure
workspace and upload the data files. A system-generated email with instructions for accessing the workspace
will be sent to the Bidder's designated data recipient.
2.1.3. RFP Inquiries
Any questions regarding how to use ProposalTech should be directed to Proposal Tech Support at 877-211-
8316 x84.
All other questions regarding this RFP, including questions related to the form contract P-37, must be
submitted to Ryan Fuller, the State's point of contact, at Christopher.R.Fuller@das.nh.gov. All questions
must be submitted in writing prior to the deadline for Bidder Inquiries and/or Requests for Clarification (March
24, 2026 at 3:00 ET). The questions will be consolidated and/or paraphrased and responded to via a written
addendum, or addenda that will be posted on the State's website on or before March 30, 2026. Note that this
date is subject to change at the State's discretion. In addition, the bidder inquiry addenda will be visible in
ProposalTech.
In response to requested exceptions to the P-37, the State will review requested exceptions and accept, reject
or note that it is open to discussion of the proposed exception at its sole discretion. Questions about or
requested exceptions to the RFP, P-37, and/or any relevant attachments not raised during the inquiry period
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are waived. Oral statements, representations, clarifications, or modifications concerning the RFP shall not be
binding upon the State.
The State may, at its discretion, amend this RFP on its own initiative or in response to issues raised by inquiries
as it deems appropriate. Bidders are responsible for reviewing the most updated information related to this
RFP as outlined in the Addenda section below, including State responses to Bidder inquiries, before submitting
a proposal.
RFP inquiries must be submitted by an individual authorized to commit the organization to provide the services
necessary to meet the requirements of this RFP. Inquiries should be submitted as questions, and not as
redlines to the RFP or any attachments. The Bidder must include complete contact information including the
Bidder's name, telephone number, and e-mail address.
2.1.4. Addenda
In the event it becomes necessary to add to or revise any part of this RFP prior to the scheduled proposal
submittal deadline, the Division of Risk and Benefits shall post any Addenda on ProposalTech and the State's
Bidder website. In the event of an addendum/addenda to this RFP, the State, at its sole discretion, may extend
the proposal submission deadline, as it deems appropriate. Before submission and periodically prior to the RFP
closing, check the ProposalTech platform and the State website for any addenda or other materials that may
have been issued affecting the RFP. The website address is
https://www.das.nh.gov/purchasing/vendorresources.aspx.
2.1.5. Bidder Certifications
All Bidders must be duly registered as a Bidder authorized to conduct business in the State of New Hampshire.
Bidders shall comply with the certifications below at the time of submission and through the term of any
resulting contract. Failure to comply shall be grounds for disqualification of proposal and/or the termination of
any resultant contract.
o STATE OF NEW HAMPSHIRE VENDOR APPLICATION: Prior to bid award, Bidders must have a
completed Bidder Application Package on file with the NH Bureau of Purchase and Property.
See the following website for information on obtaining and filing the required forms (no fee):
https://DAS.NH.Gov/Purchasing.
o NEW HAMPSHIRE SECRETARY OF STATE REGISTRATION: A bid award, in the form of a
contract(s), will ONLY be awarded to a Bidder who is registered to do business AND is in good
standing with the State of New Hampshire. The Certificate of Good Standing submitted during
the contract approval process must be dated on or after April 1st of the contracting year.
Please visit the following website to find out more about the requirements for registration
with the NH Secretary of State: https://sos.nh.gov/corporation-division/.
2.1.6. PUBLIC DISCLOSURE
The identification of confidential responses has been turned on for this RFP. If you feel that a response to a
question contains proprietary/confidential information, click the "Disclosure" tab located underneath the
question and check the box for "Exemption from Disclosure." Provide a reason for the exemption in the text
field provided. If you do not provide a reason for exemption, the question will not be considered answered. DO
NOT make every response confidential. If you have any questions regarding this process, please contact
ProposalTech Support at 877-211-8316 x84. See also the additional Public Disclosure information below.
A. DISCLOSURE OF INFORMATION SUBMITTED IN RESPONSE TO RFP
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State of New Hampshire RFP for Administration of Medicare Advantage
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Information submitted in response to this RFP (including all materials submitted in connection with it, such as
attachments, exhibits, addenda, etc.), any resulting contract, and information provided during the contractual
relationship may be subject to public disclosure under the Right-to-Know, RSA 91-A.
Confidential, commercial or financial information may be exempt from public disclosure under RSA 91-A:5, IV.
If you believe any information submitted in response to this RFP should be kept confidential, you must
specifically identify such information for the State by following the redaction designation instructions in
ProposalTech. Marking or designating an entire proposal, attachment or section as confidential shall neither
be accepted nor honored by the State.
A Bidder that does not believe any information in its proposal to be exempt from disclosure must also provide
a letter indicating as such to the State's Point of Contact indicated herein.
Submissions which do not conform to these instructions by failing to include redactions and related reasons for
redaction, or a letter indicating the proposal does not include any confidential information, or by including
redactions which are contrary to these instructions or operative law may be rejected by the State as not
conforming to the requirements of the proposal.
Pricing, which includes but is not limited to premium rates, administrative costs and performance guarantees,
in your proposal or any subsequently awarded contract shall be subject to public disclosure regardless of
whether it is marked as confidential.
Notwithstanding a Bidder's designations, the State is obligated by the Right-to-Know law to conduct an
independent analysis of the confidentiality of the information submitted in a proposal. If a request is made to
the State by any person or entity to view or receive copies of any portion of your proposal, or if the State
otherwise wishes to make your proposal public, the State shall first assess what information it is obligated to
release. If you have not provided redactions in your proposal the State will release the proposal in its entirety
with only the redactions the State deems necessary (if any). If you have provided redactions in your proposal,
the State will notify you that a request has been made or that the State wishes to make your proposal public.
The State will indicate what, if any, information it has assessed is confidential and will not be released, and
specify the planned release date of the remaining portions of the proposal. To halt the release of information
by the State, a Bidder must obtain and provide to the State, prior to the date specified in the notice, a court
order valid and enforceable in the State of New Hampshire, at its sole expense, enjoining the release of the
requested information.
By submitting a proposal, you acknowledge and agree that:
o The State may disclose any and all portions of the proposal or related materials which are not
marked as confidential and/or which have not been specifically explained in the letter to the
person identified as the point of contact for this RFP;
o The State is not obligated to comply with your designations regarding confidentiality and must
conduct an independent analysis to assess the confidentiality of the information submitted in
your proposal; and
o The State may, unless otherwise prohibited by court order, release the information on the
date specified in the notice described above without any liability to you.
B. ELECTRONIC POSTING OF RFP RESULTS AND RESULTING CONTRACT
Pursuant to RSA 21-G:37, all responses to this RFP shall be considered confidential until the award of a
contract. At the time of receipt of proposals, the State will post the number of responses received with no
further information. No later than five (5) business days prior to submission of a contract to the Department of
Administrative Services, the State will post the name and rank or score of each Bidder.
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State of New Hampshire RFP for Administration of Medicare Advantage
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Pursuant to RSA 91-A and RSA 9-F:1, the Secretary of State will post to the public any document submitted to
G&C for approval, including any resulting contract, on its website
(https://sos.nh.gov/administration/miscellaneous/governor-executive-council/). By submitting a proposal,
Bidder acknowledges and agrees that, in accordance with the above-mentioned statutes and policies, (and
regardless of whether any specific request is made to view any document relating to this RFP), any contract
resulting from this RFP that is submitted to G&C for approval will be made accessible to the public online.
2.1.7. TERMS OF SUBMISSION
The State assumes no responsibility for understandings or representations made by its officers or employees
prior to and in the event of the execution of a contract, unless such understandings or representations are
specifically incorporated into this RFP. Verbal discussions pertaining to modifications or clarifications of this
RFP shall not be considered part of this RFP unless confirmed in writing. Any information provided by the
Bidder verbally shall not be considered part of that Bidder's response. By submitting a proposal, a Bidder
agrees that in no event shall the State be either responsible for or held liable for any costs incurred by a Bidder
in the preparation of or in connection with the proposal, or for work performed prior to the effective date of a
resulting contract. Proposals must be valid until the effective date of any resulting contract.
2.1.8. SUBMISSION FORMAT
Instructions, formats, and approaches for the development of RFP information contained within the RFP are
designed to ensure that the submission of data essential to the understanding of the Bidder's response is
received in a consistent and comparable format.
Bidder RFP response must be submitted using the ProposalTech platform. Paper submissions, or submissions
in any other format, will not be accepted.
Detailed instructions for the completion and submission of your proposal will be found in the electronic RFP
(eRFP) on ProposalTech. ProposalTech will be available to assist you with technical aspects of utilizing the
system.
All sections must be answered completely and as outlined in the RFP, using ProposalTech. It is not acceptable
to use the term "See Attached" as a response to any of the questions, fee quotation forms, plan or network
comparisons. Such a response may jeopardize your chances for consideration.
The State reserves the right to ask Bidders followup clarifying questions through ProposalTech as may be
necessary to fully evaluate bidder capabilities.
2.1.9. PROPOSAL SUBMISSION DEADLINE
All RFP submissions must be submitted electronically, using the ProposalTech platform no later than 2:00
PM ET on Wednesday, April 8, 2026. A complete RFP submission will include responses to all sections of the
RFP, including a complete response to the financial section. Incomplete submissions or submissions received
after the date and time specified will be marked as late and will not be considered.
Bidders will be notified if their proposals are compliant by April 13, 2026. Bidders with compliant proposals
may participate in the Financial Proposal Confirmation Period (April 14 to 17, 2026). The Financial Proposal
Confirmation Period will provide an opportunity for Bidders to consider the CMS Final Rate Announcement
(anticipated in early April) in their proposals. During this period, Bidders will be asked to either confirm their
initial Financial Proposal or submit an updated Financial Proposal. All Technical Proposals are final on the initial
submission deadline and may not be altered during the Financial Proposal Confirmation Period.
Confirmed Financial Proposals must be submitted electronically, using the ProposalTech platform no later
than 2:00 PM ET on April 17, 2026. Submissions received after the date and time specified will be marked as
late and will not be considered and the Bidder's response submitted prior to the April 8, 2026 deadline will
stand and be deemed the Bidder's "Confirmed Financial Proposal".
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State of New Hampshire RFP for Administration of Medicare Advantage
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A Bidder's disclosure or distribution of proposals other than to the Department of Administrative Services,
Bureau of Purchase and Property, or ProposalTech shall be grounds for disqualification. No more than one (1)
proposal per respondent shall be submitted.
2.1.10. RFP DELIVERY
This RFP is being conducted electronically using the ProposalTech platform. A Bidder will not be able to submit
their proposal until all required sections have been completed in their entirety. ProposalTech provides Bidders
with a status of their proposal listed at the top of the page. Once a Bidder submits their proposal, the
submission will be confirmed by the status changing to "Posted". Bidders must submit (or "post") their
proposal by the specified deadlines indicated in Section 2.1.9.
The State shall not be held liable for any costs incurred by the Bidder in preparing or submitting an RFP
response.
2.1.11. ADDITIONAL INFORMATION
The State reserves the right to:
o Make a written request for additional information from a Bidder to assist in understanding or
clarifying a proposal response;
o Waive minor or immaterial deviations from the RFP requirements, if determined to be in the
best interest of the State;
o Omit any planned evaluation step if, in the State's view, the step is not needed;
o Reject any and all proposals, or any part thereof. Note that participating in this RFP process in
no way obligates the State to pursue a contract with any of the Bidders participating in the
RFP;
o Make independent investigation in evaluating a proposal.
o Consider available information regarding the Bidder, whether gained from the Bidder's
proposal, question and answer conferences, references, or any other source during the
evaluation process. This may include, but is not limited to, information from the New
Hampshire Department of Insurance, as well as any other state or federal regulatory entity.
2.1.12. RESTRICTION OF CONTACT WITH STATE EMPLOYEES
From the release date of this RFP, all contact with the State regarding this RFP, except the State's point of
contact specifically mentioned in Section 2.1.3 of this RFP, is prohibited. This prohibited contact includes
personnel employed by or under contract with the State. Improper contact is grounds for rejection of your
response.
2.1.13. CANCELLATION
Notwithstanding any other provision of this RFP, this RFP does not commit the State to award a contract. The
State reserves the right, at its sole discretion, to reject any and all proposals, or any portions thereof; to cancel
all or any part of this RFP at any time. Cancellation of this RFP, in whole or in part, shall not bar the State from
issuing an RFP for the same services or from purchasing the same services through other means.
2.1.14. ETHICAL REQUIREMENTS
From the time this RFP is published until a contract is awarded, no Bidder shall offer or give, directly or
indirectly, any gift, expense reimbursement, or honorarium, as defined by RSA 15-B, to any elected official,
public official, public employee, constitutional official, or family member of any such official or employee who
will or has selected, evaluated, or awarded an RFP, or similar submission. Any Bidder that violates RSA 21-G:38
shall be subject to prosecution for an offense under RSA 640:2. Any Bidder who has been convicted of an
offense based on conduct in violation of this section, which has not been annulled, or who is subject to a
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State of New Hampshire RFP for Administration of Medicare Advantage
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pending criminal charge for such an offense, shall be disqualified from bidding on the RFP, or similar request
for submission and every such Bidder shall be disqualified from bidding on any RFP or similar request for
submission issued by any state agency.
2.1.15. SUBCONTRACTING
Contractor may perform certain services hereunder through one or more of its subsidiaries or affiliates.
However, pursuant to Section 12 of the form contract P-37, subcontracting of services shall require prior
approval by the State. If Bidder plans to utilize subcontractors, subsidiaries, or affiliates, for any portion of the
services identified in this RFP, please include the subcontractor information, to include an outline of the
services or functions in which Bidder would plan to subcontract, the length of your relationship with the
subcontractor, and a brief company profile. A list of these subcontractors shall be attached to the contract
with the selected Contractor and shall constitute prior approval by the State (of those subcontractors)
consistent with Section 12 of the form contract P-37.
Contractor must also notify the State of any service provider or system change that differs from what is
outlined in the RFP response, whether the new provider is, or the new system is run by, a subcontractor,
subsidiary, affiliate, the Contractor itself, or another entity. Such notification shall be required during
implementation and throughout the term of the Agreement.
Contractor may, without prior written approval, contract with third-party vendors to provide ancillary services,
which are not medical benefit administration services hereunder, but rather are services that support
Contractor's conduct of its business operations.
Contractor shall be accountable for the performance of all subsidiaries, affiliates, partner networks and
subcontractors and shall be responsible for all performance guarantee penalties that may result from
underperformance of the subsidiary, affiliate and/or subcontractor.
2.1.16. REQUIRED CONTRACT TERMS AND CONDITIONS
a. The form contract P-37 (attached hereto as Appendix F) shall form the basis for any resulting contract. The
successful Bidder and the State, following notification of award, shall promptly execute the P-37 contract, as
amended by the parties, to include Exhibits A, B and C, and consistent with issues raised during the inquiry
period, to incorporate the service requirements of this RFP, price conditions established by the Bidder's offer,
and any other reasonable administrative practices and services. In no event is a Bidder to submit its own
standard contract terms and conditions as a replacement for one or all of the State's terms in response to this
RFP.
In addition to the insurance requirements outlined in the P-37, Contractor will be required to obtain and
maintain in force data security and cyber-liability insurance in an amount not less than $10 million as
referenced in Appendix H, Required Protection of Confidential Information and Data Security.
The terms of this RFP and the selected Bidder's response will be used to form the terms of any resulting
contract. References in the P-37 to Exhibits A, B, and C are references to the required structure of any
resulting contract (Exhibit A - Special Provisions/Amendments to the P-37, Exhibit B - Scope of Services, and
Exhibit C - Payment Terms) and are not references to sections of this RFP.
b. The Business Associate Agreement (attached hereto as Appendix G), is required to comply with the Health
Insurance Portability and Accountability Act, Public Law 104-191 and with the Standards for Privacy and
Security of Individually Identifiable Health Information, 45 CFR Parts 160 and 164 and those parts of the
HITECH Act applicable to business associates, shall be promptly executed by the successful Bidder and the
State, following notification of contract award.
c. In addition to the Business Associate Agreement, the Bidder will be required to comply with the Required
Protection of Confidential Information and Data Security (attached hereto as Appendix H).
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