Medical Third-Party Administration (TPA) Services

The State of Delaware is seeking a qualified vendor to serve as the Medical Third‑Party Administrator (TPA) for its employee and retiree health‑benefit programs. The contractor will be responsible for full‑service administration of existing non‑Medicare plans and a Medicare Supplement plan, including enrollment, eligibility verification, claims processing, member communications, ID‑card production, data integration with state health‑information networks, and delivery of member‑facing technology (web portal, mobile app, 24/7 nurse line). The contract also requires participation in the Delaware Health Information Network (DHIN), provision of clinical and wellness programs, and adherence to extensive performance guarantees and reporting requirements. • Administer enrollment, eligibility, claims, and member services for multiple plan designs (PPO, HMO, Medicare Supplement, HSA). • Provide data feeds and reporting to DHIN, Merative, Lantern, and other state partners; submit historic claims and ongoing clinical data at no cost. • Deliver a secure self‑service portal, 24 × 7 nurse line, and support for wellness and disease‑management programs, with performance and financial guarantees tied to cost‑trend and quality metrics.