Employee Medical and Pharmacy Benefits
| Agency: | Sedgwick County |
|---|---|
| State: | Kansas |
| Type of Government: | State & Local |
| Category: |
|
| Posted: | Mar 7, 2024 |
| Due: | Mar 19, 2024 |
| Solicitation No: | 24-0019 |
| Publication URL: | To access bid details, please log in. |
| RFB/RFP | Due Date | Description | Document | Pre-bid Conference |
| 24-0019 | 3/19/2024 1:45:00 PM | Employee Medical and Pharmacy Benefits |
|
Attachment Preview
SEDGWICK COUNTY, KANSAS
DIVISION OF FINANCE DEPARTMENT
Purchasing Department
100 N. Broadway, Suite 610 ~ Wichita, KS 67202
Phone: 316 660-7255 Fax: 316 660-1839
https://www.sedgwickcounty.org/finance/purchasing/
requests-for-bid-and-proposal/
REQUEST FOR PROPOSAL
RFP #24-0019
EMPLOYEE MEDICAL AND PHARMACY BENEFITS
February 16, 2024
A. PURPOSE
Sedgwick County, Kansas (hereinafter referred to as “County”) is seeking to obtain proposals from medical and/or pharmacy
benefit administrators (hereinafter referred to as “Vendors”) to provide employee medical, and/or pharmacy coverage.
B. SUBMITTALS
Carefully review this document. If your firm is interested in participating in this selection process commensurate with the
specifications, conditions, mandatory requirements and instructions as contained herein, submit one (1) original, 12 copies
and a flash drive (Microsoft Word or PDF file format) of the entire document with any supplementary materials to:
Joseph Thomas
Sedgwick County Purchasing Department
100 N. Broadway, Suite 610
Wichita, KS 67202
SUBMITTALS are due NO LATER THAN 1:45 P.M. CST, March 19, 2024. Responses must be sealed and marked on
the lower left-hand corner with the firm name and address, proposal number, and proposal due date. Late or incomplete
responses will not be accepted and will not receive consideration for final award.
Proposal responses will be acknowledged and read into record at bid opening which will occur at 2:15 P.M., CDT on the
due date. No information other than the respondent’s name will be disclosed at bid opening.
The documents in this pdf formatted request for proposal are the official record in the event of conflicting language or
information in the pricing sheets or the excel spreadsheet.
C. QUESTIONS and CLARIFICATIONS
All requests for clarifications of the RFP process and document content should be directed to Joseph Thomas at e-mail
joseph.thomas@sedgwick.gov. All questions must be submitted in writing by 5:00 P.M. CST, February 28, 2024. Answers
will be provided in written form as an addendum and will be posted on the county website at
www.sedgwickcounty.org/finance/purchasing.asp/ by March 6, 2024. Vendors are responsible for checking the website
and acknowledging any addenda in their response.
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D. ABOUT THIS DOCUMENT
This document is a Request for Proposal. It differs from a Request for Bid or Quotation in that the county is seeking a
solution, as described on the cover page and in the following Background Information section, not a bid or quotation meeting
firm specifications for the lowest price. As such, the lowest price proposed will not guarantee an award recommendation.
As defined in Charter Resolution No. 68, Competitive Sealed Proposals will be evaluated based upon criteria formulated
around the most important features of the product(s) and/or service(s), of which quality, testing, references, service,
availability or capability may be overriding factors, and price may not be determinative in the issuance of a contract or
award. The proposal evaluation criteria should be viewed as standards that measure how well a vendor’s approach meets
the desired requirements and needs of the county. Criteria that will be used and considered in evaluation for award are set
forth in this document. The county will thoroughly review all proposals received. The county will utilize its best judgment
when determining whether to schedule a pre-proposal conference before proposals are accepted, or meetings with vendors
after receipt of all proposals. A Purchase Order/Contract will be awarded to a qualified vendor submitting the best proposal.
Sedgwick County reserves the right to select, and subsequently recommend for award, the proposed service(s) and/or
product(s) which best meets its required needs, quality levels and budget constraints.
The nature of this work is for a public entity and will require the expenditure of public funds and/or use of public facilities,
therefore the successful proposer will understand that portions (potentially all) of their proposal may become public record
at any time after receipt of proposals. Proposal responses, purchase orders and final contracts are subject to public disclosure
after award. All confidential or proprietary information should be clearly denoted in proposal responses and responders
should understand this information will be considered prior to release, however no guarantee is made that information will
be withheld from public view.
E. BACKGROUND INFORMATION
Sedgwick County, located in south-central Kansas, is one of the most populous of Kansas’ 105 counties with a population
estimated at more than 514,000 persons. It is the sixteenth largest in area, with 1,008 square miles, and reportedly has the
second highest per capita wealth among Kansas’ counties. Organizationally, the county is a Commission/Manager entity,
employs nearly 2,500 persons, and hosts or provides a full range of municipal services, e.g. – public safety, public works,
criminal justice, recreation, entertainment, cultural, human/social, and education.
GLOSSARY
•
Ad-hoc – Non-standard inquiry to obtain information as specific needs arise.
•
Administrative Services Only (ASO) – An arrangement in which an organization funds its own employee benefit
plan but hires an outside firm to perform specific administrative services to evaluate and process claims under its employee
health plan while maintaining the responsibility to pay the claims itself.
•
Disease Management – A system of coordinated interventions and communications for populations with conditions
in which patient self-care efforts are significant.
•
Health Risk Assessment (HRA) – Health questionnaire to collect information to provide individuals an evaluation
of their health risks.
•
Health Insurance Portability And Accountability Act (HIPAA) – Act that regulates the availability and breadth of
group health plans and certain individual health insurance policies. Defines policies, procedures and guidelines for
maintaining the privacy and security of individually identifiable health information as well as outlining offenses relating to
health care and sets civil and criminal penalties for violations.
•
Point of Service (POS) – Type of managed care health insurance system that combines aspects of a Health
Maintenance Organization or HMO and a Preferred Provider Organization or PPO.
•
Medical Case Management – is a collaborative process that facilitates recommended treatment plans to assure the
appropriate medical care is provided to disabled, ill or injured individuals.
•
Patient Protection Affordable Care Act (PPACA) – also referred to as the Affordable Care Act was enacted on
March 23, 2010.
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•
Prescription Benefit Manager (PBM) – will be responsible for processing and paying prescription drug claims.
•
Preferred Provider Organization (PPO) – A subscription-based medical care arrangement that provides a substantial
discount below the regularly charged rates of the designated professionals partnered with the organization.
•
Protected Health Information (PHI) - Also referred to as personal health information, generally refers
to demographic information, medical histories, test and laboratory results, mental health conditions, insurance information,
and other data that a healthcare professional collects to identify an individual and determine appropriate care.
•
Personally Identifiable Information (PII) - Personally identifiable information (PII) is any data that could potentially
identify a specific individual. Any information that can be used to distinguish one person from another and can be used
for de-anonymizing anonymous data can be considered PII.
•
Third Party Administrator (TPA) – A person or organization that processes claims and performs other administrative
services in accordance with a service contract. Plan administration responsibilities include processing, adjudication, and
negotiation of claims, record-keeping, and maintenance of the plan.
•
Utilization Review (UR) – Evaluation of the appropriateness, medical need and efficiency of health care services
procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health
benefits plan.
•
Utilization Review Accreditation Commission (URAC) – a nonprofit organization promoting healthcare quality by
accrediting healthcare organizations.
CURRENT MEDICAL & PHARMACY PLAN
These benefits are provided by Sedgwick County to the full-time active population of approximately 2,500 total eligible
employees. The Self-Insured Medical Preferred Provider Organization (PPO) plan has been selected by by 2,321 employees,
76 retired employees and 4 COBRA participants. Sedgwick County has four coverage tiers for health insurance coverage,
Employee Only, Employee and Spouse, Employee and 1 or more children, Employee Only. Sedgwick County Member
Counts by Plan Tier are listed below.
Active
EE + Family
EE + Spouse
EE +1 or more Children
Employee Only
TOTAL
759
374
298
890
2321
Cobra
EE + Family
EE + Spouse
EE +1 or more Children
Employee Only
TOTAL
Retiree
0 EE + Family
5
1 EE + Spouse
16
0
EE +1 or more Children
4
3 Employee Only
51
4 TOTAL
76
Sedgwick County’s Medical Benefits:
Plan is administered by United Healthcare. The Preferred Provider Organization (PPO) medical plan is offered to local
Sedgwick County employees.
There are three benefit options:
Plan
Deductible
Medical Out-of-Pocket
Maximum
Premier
$750 / $1,500
$1,500 / $3,000
Base
$1,250 / $2,500
$2,500 / $5,000
High Deductible (HDHP)
$3,200 / $6,400
$3,200 / $6,400
A third-party vendor currently provides the administrative services for COBRA/Retired employees. The COBRA/Retired
employees use the PPO plan at 102% of the monthly cost.
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Sedgwick County’s Pharmacy Benefits:
Optum Rx, a subsidiary of UHC, provides pharmacy benefits for both retail prescription and mail order drugs. The three
plans:
Plan
Premier
Base
High
Deductible
(HDHP)
Rx
Out-of-Pocket $3,000 / $6,000
$4,400 / $8,800
$3,200 / $6,400
Maximum
Tier 1 – Retail
$10
$10
100% After Deductible
Tier 2 – Retail
$40
$40
100% After Deductible
Tier 3 – Retail
$70
$70
100% After Deductible
Tier 1 – Mail-Order
$25
$25
100% After Deductible
Tier 2 – Mail-Order
$100
$100
100% After Deductible
Tier 3 – Mail-Order
$175
$175
100% After Deductible
Diabetic supplies will be dispensed, up to a 90 day supply, with no cost share to the member.
Current Rates and Contribution:
Contributions as of 1/1/2024
Single
Two-Person
Family
Base Plan
Sedgwick County
Monthly Premium Contribution Per
Equivalents
Month
$
637.08 $
597.36
$
1,274.14 $
1,194.72
$
1,847.50 $
1,732.38
Employee
Contributions per
Month
$
39.72
$
79.42
$
115.12
Single
Two-Person
Family
Premier Plan
Sedgwick County
Monthly Premium Contribution Per
Equivalents
Month
$
668.98 $
594.72
$
1,337.96 $
1,189.46
$
1,940.04 $
1,724.72
Employee
Contributions per
Month
$
74.26
$
148.50
$
215.32
Single
Two-Person
Family
HDHP Plan
Sedgwick County
Monthly Premium Contribution Per
Equivalents
Month
$
586.48 $
572.18
$
1,172.98 $
1,144.40
$
1,700.80 $
1,659.36
Employee
Contributions per
Month
$
14.30
$
28.58
$
41.44
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RFP #24-0019
Sedgwick County…Working for you
ELIGIBILITY & CURRENT ENROLLMENT INFORMATION
Eligible Employees (EE) are defined as any employee assigned to a permanent position of twenty (20) or more hours work
per week.
Census Information – Active, Retirees, & COBRA participants as of February 12, 2024, attached
Eligible dependents are defined by Sedgwick County as:
• “Spouse” by marriage contract.
• “Spouse Common-Law” by a Kansas Common-Law affidavit.
• “Child” by natural birth or adoption.
• “Child-Special Court Order” by any court order for financial responsibility of the medical care expenses of the
child.
• “Legal Guardianship” by court decree.
• “Stepchild” by present marriage.
• Each dependent child is eligible until the end of the month in which they turn 26.
Employee Benefit Eligibility policy of Sedgwick County is as follows: Employee is eligible the 1st of the month after they
have been hired. He/she is to complete the enrollment process by the 1st of the month after they have been hired. If the
employee did not complete the enrollment process before the 1st of the month after hire then the enrollment is effective the
1st of the next month. The employee has 30 days from hire date to enroll. This coverage ends the last day of the month the
employee separates from employment.
OPEN ENROLLMENT INFORMATION
The Sedgwick County Division of Human Resources coordinates an annual open enrollment period for county employees.
Annual enrollment takes place in October/November and has a plan year effective date of January 1st. Family status changes
are handled by Sedgwick County outside the annual enrollment process and passed on to the appropriate carrier
electronically on a weekly basis thereafter for eligibility maintenance. In addition, other outsource vendors are currently
responsible for the flexible spending account, and COBRA/Retirement administration. Electronic transfer of information
for all reports, billing, and enrollment is the preferred method.
Medical/Rx (PPO)
Avg.
Year
Monthly
Employee
Count
January 1 –
December 2,382
31, 2021
January 1 –
December 2,253
31, 2022
January 1 –
September 2,334
30, 2023
Avg.
Monthly
Dependent
Count
3,497
3,276
3,261
Gross Paid
Medical Claims
$20,306,082
$20,417,748
$$21,065,418
Gross Paid Rx
Claims
Total Net Claims
$10,722,538
$29,538,719
$11,413,131
$29,909,625
$12,668,029
$30,677,912
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RFP #24-0019
Sedgwick County…Working for you
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