Description
The Washington State Health Care Authority (HCA) is seeking proposals from qualified health‑insurance carriers to provide up to three fully‑insured medical plans for the Public Employees Benefits Board (PEBB) and the School Employees Benefits Board (SEBB). The contractor will be responsible for designing the plan benefits, administering enrollment, processing claims, maintaining a secure member portal, handling daily HIPAA‑compliant 834 eligibility files, meeting Washington‑state network adequacy and NCQA accreditation requirements, and participating in value‑based purchasing and health‑equity initiatives. The contract runs from January 1 2029 through December 31 2033 with a possible extension to 2040, and includes extensive reporting, performance‑based penalties, and mandatory data‑security safeguards.
• Design up to six fully‑insured health plans (max 3 for each board) meeting actuarial‑value guidelines.
• Operate all plan‑admin functions in‑nation, including claims processing, enrollment via daily 834 files, and a secure multi‑factor‑auth member portal.
• Deliver quarterly and annual performance reports (claims quality, CAHPS, HEDIS, VBP, health‑equity) and maintain NCQA Health‑Outcomes accreditation.
• Provide Disaster‑Recovery and Business‑Continuity plans, health‑equity director and community advisory council, and free trauma‑informed‑care training for providers.