Self Insured HMO

The Illinois Department of Central Management Services (CMS) is seeking proposals from organizations to administer self-insured HMO plans for enrollees in the State Employees Group Insurance Program (SEGIP), Local Government Health Plan (LGHP), Teachers' Retirement Insurance Program (TRIP), and College Insurance Program (CIP). The selected vendor will be responsible for administering medical, facility/professional, and behavioral health services, excluding pharmacy. The contract will have an initial term of three years, from July 1, 2027, to June 30, 2030, with the option to renew for up to seven years. The vendor must have the capability to pass deductible and claims information to the Prescription Benefit Manager and interface with the plan administrator for vision and dental benefits. Some key points to consider: • The combined current HMO plan enrollment in these four programs is approximately 62,200 lives. • The State may award to the most responsive and responsible offeror(s) whose offer best meets the specified criteria. • The contract may be renewed for up to seven years, and the State reserves the right to make multiple awards within specific service areas. • The vendor must comply with the terms and conditions outlined in the solicitation, including the Trading Partner Agreement and the HIPAA Transaction and Code Set regulations. • The vendor must establish four bank accounts to administer the health benefit accounts, one for each of the four plans (SEGIP, LGHP, TRIP, and CIP). • The Agency will provide all funds deposited into the bank accounts, and the vendor will be responsible for monitoring the daily activity in the bank accounts and summarizing the account activity.