SELF-FUNDED PLAN, CARRIER/THIRD PARTY ADMINISTRATOR (TPA), PREFERRED PROVIDER ORGANIZATION (PPO) NETWORK, PHARMACY BENEFIT MANAGEMENT (PBM) SERVICES, TRANSPARENT MODELING AND OR PASS-THROUGH MODELING, INTERNATIONAL RX OPTION AND STOP LOSS COVERAGE

The Edinburg Consolidated Independent School District is seeking proposals for a self-funded plan, carrier/third-party administrator (TPA), preferred provider organization (PPO) network, pharmacy benefit management (PBM) services, transparent modeling and/or pass-through modeling, international Rx option, and stop loss coverage. The district is looking for a vendor to provide these services for a primary term of one year with the option to renew for five additional one-year terms. The vendor must be licensed by the Texas Department of Insurance and be permitted to contract with the state or any of its subdivisions. The vendor must also be rated A- or better by AM Best Company. Some key requirements include: • Providing a self-funded plan, carrier/TPA, PPO network, PBM services, transparent modeling and/or pass-through modeling, international Rx option, and stop loss coverage • Being licensed by the Texas Department of Insurance and permitted to contract with the state or any of its subdivisions • Being rated A- or better by AM Best Company • Providing fiduciary claims responsibility • Agreeing to hold the district harmless in the event of any IRS penalties or fines imposed as a result of the vendor's failure to comply with ACA Public Law • Not receiving any revenue or compensation for any other third party related to the services provided under the agreement except for the revenue and compensation expressly described in the proposal response form • Providing all materials necessary to effectively communicate and administer the program at the vendor's own expense Some key evaluation criteria include: • Responses to Excel workbooks (20 points) • Responses to RFP questionnaire (5 points) • Experiences with school districts (5 points) • Software capabilities (20 points) • Experience with direct providers (10 points) • Network providers (10 points) • Overall cost (30 points) The district is looking for a vendor that can provide high-quality services, meet the requirements outlined in the RFP, and offer competitive pricing.