Group PPO Medicare Advantage Medical and Pharmacy Service

The Lexington, Kentucky government authority is seeking a vendor to provide group PPO Medicare Advantage medical and pharmacy services. The agency is trying to solve the problem of premium volatility while ensuring broad provider access and modern supplemental benefits for its retirees. The agency requires a financial model that protects both the organization and its retirees through competitive pricing, multi-year rate guarantees, and a transparent rate build. The scope of work covers a national PPO network with Kentucky hospital, primary care, specialist, and behavioral health access equal to or better than the incumbent vendor. The requested services include clinical and chronic condition management programs, dedicated retiree customer service, and digital member engagement tools tailored for an older adult population. Additionally, the selected vendor must provide comprehensive reporting dashboards, modern supplemental benefits like dental, vision, hearing, and transportation, and maintain strong CMS Star Ratings. Eligible bidders must perform all work offsite and within the United States. The agency is requesting proposals to establish the budget and requires bidders to commit to performance guarantees with at-risk fees across implementation, service, clinical, and financial categories. The contract period will span one year, and bidders must submit all questions no later than June 17, 2026.