Health Plan Administrative Services

The City of Orlando is seeking proposals from qualified organizations to provide administrative services for its self-funded group medical and pharmacy benefit plans. The City aims to identify a collaborative administrative partner with experience supporting alternative care delivery models and to maintain high-quality medical and pharmacy coverage. The selected Proposer must demonstrate the ability to contract with and support the administration of a high-performance network. The Proposer should have experience providing Medical ASO or PBM services to three or more employers with 2,000 or more subscribers within the past five years. Key responsibilities include claims administration, customer service, and provider network management. The City seeks a flexible, innovative partner capable of supporting evolving delivery models and plan designs. Some key points to consider: * The City currently offers two self-funded medical plan options to eligible full-time employees, retirees, and dependents. * The City intends to introduce a third plan option in 2027 built on a high-performance network. * The selected Proposer must provide a full-time onsite Nurse Liaison/Clinical Coordinator to support member health engagement and care coordination. * The Proposer should have the capability to administer an integrated medical and pharmacy self-funded program for active employees, retirees, and eligible dependents. * The City requires the Proposer to provide ADA-compliant, web-based informational and educational tools for Plan participants. * The Proposer should demonstrate successful coordination with medical ASO/PBM vendors and provide a list of carriers with whom they have worked in carve-out arrangements.