RFP 2013-09 Actuarial Services

This contract awards Milliman, Inc. to provide comprehensive actuarial consulting services for Covered California’s 2015 Qualified Health Plan (QHP) pricing and ongoing operational needs. The work includes rate review and validation, actuarial analyses of medical loss ratios, demographic and enrollment modeling, risk‑assessment using commercial tools, financial performance forecasts, pricing calculations, plan‑design support (including pediatric dental), market‑shelf analyses, tiered network evaluations, and the preparation of actuarial certifications and reports. The effort is estimated at roughly 2,250 service hours, capped at $832,500, and must be performed primarily on‑site in Sacramento with the ability to respond 24/7 for urgent matters. Key deliverables are to be accepted before payment, and the contract may be extended for up to two additional one‑year terms. • Scope covers full actuarial review of QHP submissions, risk‑adjustment, reinsurance, and tiered‑network analysis. • Contractor must use CMS URRT/SRRT templates, Federal Actuarial Value Calculator, and may employ commercial risk‑assessment software (preferred). • The engagement requires close coordination with other vendors and adherence to conflict‑of‑interest rules.