MEDICAL PLAN ADMINISTRATION

The City of Charlottesville is seeking a qualified third‑party administrator (TPA) to manage its self‑funded medical benefits program for approximately 1,100 active employees and 90 pre‑65 retirees. The contract will begin on January 4 2027 and run through June 30 2028, with an option to extend for up to six additional one‑year terms. The TPA must provide full‑service administration—including enrollment, eligibility, claims processing, provider network management, customer service, care‑management programs, pharmacy coordination (carve‑in or carve‑out), and stop‑loss support—while integrating with the City’s existing BenefitFocus enrollment platform and complying with ACA and other regulations. Proposals are due September 16 2026; a pre‑proposal conference is not required. • Scope: End‑to‑end medical plan administration (ASO) for active employees and pre‑65 retirees. • Options: Medical ASO with pharmacy carved‑in (requires separate pharmacy RFP) or carved‑out (stand‑alone PBM). • Term: 18 months initial (Jan 4 2027 – Jun 30 2028) with up to six one‑year renewal options. • Required services: eligibility/enrollment, claims adjudication, network negotiations, customer service (multilingual, 24/7), care‑management, HSA/HSA strategy, decision‑support tools, reporting, stop‑loss coordination. • Evaluation criteria: qualifications/experience (35 %), methodology (30 %), proposal quality (20 %), price (15 %). • Submission: electronic via OpenGov portal; questions due Sep 11 2026; proposal deadline Sep 16 2026, 2:00 PM.