Health Plan Administrative Services

The City of Orlando (City) is soliciting proposals from qualified organizations to provide administrative services for its self-funded group medical and pharmacy benefit plans, effective January 1, 2027. Proposers may submit responses for one or more of the following service configurations. All proposed configurations must apply across all three plan options (HMO, POS, and Narrow Network), meaning the City will not consider proposals that “slice” administration by plan (e.g., one administrator for HMO/POS and a separate administrator for the Narrow Network).

Service Configuration Options:

1. Option 1: Medical Administrative Services Only (ASO)
2. Option 2: Pharmacy Benefit Manager (PBM) Administration

Each proposer may submit up to two distinct response options. As described in further detail below, one of the City’s three plan options will include a Narrow Network Plan (which may also be referred to as a High-Performance Network throughout this RFP) beginning in 2027, utilizing a high-performance network anchored by a Clinically Integrated Network (CIN), as defined by the Centers for Medicare & Medicaid Services (CMS) and the Federal Trade Commission (FTC) applicable standards, or a network with the underlying systems in place that mirror a CIN. Therefore, proposals must include a high-performance network for this Narrow Network Plan.

Note: The City is not requesting proposals for Medicare-eligible retiree plan options (e.g., fully-insured Part D plans, Medicare Supplement, or Medicare Advantage) or stop-loss insurance as part of this solicitation. These services should not be included in the proposal.

The City of Orlando’s objectives of this solicitation are as follows:

1. Identify a collaborative administrative partner(s) with experience supporting alternative care delivery models, including value-based contracting, clinical data integration, and population health management.
2. Engage administrator(s) with demonstrated success working together to deliver integrated care and comprehensive plan management—even when operating under a carve-out structure.
3. Maintain high-quality medical and pharmacy coverage through continuation of the current open-access Health Maintenance Organization (HMO/Choice) and Point-of-Service (POS/Choice Plus) plan offerings.
4. Expand access to affordable care through the implementation of a third plan, high-performance Narrow Network plan, which is expected to include reduced premiums and/or cost-sharing.
5. Leverage transparent, data-driven partnerships to support continuous improvement in quality, utilization, and cost control across all plan options.
6. Align the City’s benefits strategy with evidence-based care and emerging value-based healthcare models, while upholding fiscal responsibility to employees, retirees, and taxpayers.

The City of Orlando currently offers two self-funded medical plan options to eligible full-time employees, retirees, and dependents: an open-access Health Maintenance Organization (HMO/Choice) and a Point-of-Service (POS/Choice Plus) plan. These plans are administered by UnitedHealthcare (UHC), which has served as the City’s medical and pharmacy benefits administrator since 2001. The City transitioned from fully insured coverage to a self-funded model effective January 1, 2012. The current administrative services agreement with UHC will expire on December 31, 2026.

For the plan year beginning January 1, 2027, the City will continue to offer both the HMO and POS plans, maintaining existing provider access, plan design structure, and cost-sharing arrangements, subject to annual adjustments. While it is acknowledged that future network changes can occur, it is expected that members enrolled in these plans will continue to have similar access to medical providers, including both of the Greater Orlando region’s major hospital systems (AdventHealth and Orlando Health).

To enhance the value and affordability of its healthcare offerings, the City intends to introduce a third plan option in 2027 built on a high-performance network. The high-performance network must either (1) meet the formal criteria of a CIN, or (2) demonstrate equivalent systems and capabilities. Specifically, the network must show the ability to:

1. Manage population health across covered members
2. Reduce variation in care delivery
3. Implement evidence-based clinical protocols
4. Operate under coordinated governance with supporting infrastructure

The selected Proposer must demonstrate the ability to contract with and support the administration of a high-performance network. The City seeks a flexible, innovative partner capable of supporting evolving delivery models and plan designs. The City desires administrators with demonstrated success working together to deliver integrated medical and pharmaceutical care—even when operating under a carve-out structure. Proposers must have the flexibility to administer client specific strategies, including but not limited to wellness programs and incentives, formulary strategies, and plan design structures that encourage use of cost containment programs and quality providers.

The City currently provides coverage to approximately 9,000 total covered lives, of which includes 5,500 active employee and retiree subscribers. Projected gross annual healthcare claims total $85 million, with an approximate distribution of 65% medical and 35% pharmacy claims.

Regardless of the plan selection, the City currently funds 95% of employee-only premiums and 73% of dependent-tier premiums of the Choice HMO Plan (Employee + Spouse, Employee + Child(ren), and Employee + Family). Employees who select the Choice Plus POS Plan pay the additional premium between the Choice and Choice Plus plans. Funding for the Narrow Network Plan is to be determined. Retiree premium contributions are based on years of service and the employee’s retirement date. For Medicare-eligible retirees, the City provides secondary medical coverage, and enrollment in Medicare Part B is mandatory. The City currently provides primary prescription drug coverage and participates in the CMS Retiree Drug Subsidy (RDS) program. The City maintains individual-specific stop-loss coverage with a $1,000,000 deductible and a $420,000 aggregating specific corridor. The current stop-loss policy includes an individual laser provision with a $1,600,000 specific deductible.

The City has implemented a comprehensive suite of health and wellness programs and seeks to partner with an administrator that can support these initiatives, track outcomes, and make strategic recommendations to improve employee health and well-being. The City employs a full-time Wellness Coordinator to oversee program implementation. Key initiatives include the annual multi-day Employee Fitness Challenge and gender-specific health seminars.

UHC currently provides the following integrated wellness and disease management programs:

1. Level 2 Assured Value Diabetes Management Program (implemented 1/1/2025)
2. Chronic Condition Management (Asthma, Diabetes, Coronary Artery Disease, Congestive Heart Failure)
3. Complex Care Programs (Cancer, Transplant, Maternity, Kidney Disease, Neonatal Care)
4. Wellness Platform & Incentive Administration via myUHCRewards (health assessments, coaching, personal health records) including up to $200 for employees completing various wellness activities and preventive screenings
5. Full-time onsite nurse (employed by UHC) supporting education, outreach, and closure of care gaps
6. $25,000 annual communication fund
7. $104,750 annual wellness fund

Additional services such as COBRA administration and retiree direct billing are managed by a third-party vendor.

The ASO agreement with UHC has been in place since January 1, 2012, when the City transitioned to a self-funded health plan. Following RFP16-0077, UHC was re-awarded the contract effective January 1, 2017. ASO fee history is as follows:

1. 2017–2019: $33.43 PSPM (Per Subscriber Per Month)
2. 2020: $34.43 PSPM
3. 2021–2024: $35.79 PSPM
4. 2025: $36.51 PSPM + $13 PSPM Rx Admin Fee**
5. 2026: $37.24 PSPM + $13 PSPM Rx Admin Fee**

**transitioned to 100% pass-through rebate arrangement effective 1/1/2025

For Proposers’ information in preparing their Proposals, Summary Plan Descriptions for the HMO and POS plans are included with this RFP in Exhibit “1”. The City’s Claims Experience, Census, a Claims File Layout, Stop Loss information, and United Health Plan Summary Booklet have also been included with this RFP as Exhibits “2”, “3”, “4”, “5”, and “6” respectively.

The following Attachments are included in this RFP and must be completed and returned with your submission in the format specified based on the self-funded health plan administrative services proposed: