Specifications include, but are not limited to: The County is seeking proposals for a “bundled” medical plan to include the following lines of coverage: • Administrative Services Only (ASO) services medical, prescription drugs, disease management, utilization and case management, wellness services; and • Stop Loss. A single medical vendor is preferred. Fully integrated Administrative Services and Stop Loss is required. Proposals will be accepted from ASO providers capable of offering the following on a bundled bases: 1. Claims administration a. Incumbent response to RFP, as applicable, must represent continued payment of claims and continued assumption of stop loss risk for claims paid without regard to service date. b. Non-incumbent Offeror’s response to RFP will assume payment of claims under the administrative services contract for services received on or after the proposed effective date. Evaluation of nonincumbent carrier's administrative services responses will include cost of current carrier's payment of run out claims for services received prior to proposed effective date. 2. Provider network: Limit response to one (1) network solution with Offeror’s most comprehensive provider panel. Note: if necessary, Offeror may provide an additional network for out-of-area coverage. Offeror must identify if this is a network owned by Offeror or if it’s a rented/leased network. Offeror will also be asked to identify the cost of this network and how the fee is collected (included in core fee, separate fee, etc.) a. NOTE: Offeror must currently have an established medical provider network in the Los Alamos, Espanola, Santa Fe, Taos, Rio Rancho, and Albuquerque metropolitan areas. Offers from vendors who do not have an existing medical provider network will not be considered. 3. Pharmacy benefit manager (prescription drug coverage): Offerors must provide fully integrated prescription drug coverage.
