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 cost stability, value, and broad provider access for its retirees. The agency requires a national PPO network equal to or better than the incumbent vendor, with no degradation to Kentucky access for hospitals, primary care, specialists, or behavioral health. The scope of work covers medical and pharmacy services that feature strong CMS Star Ratings performance reflecting clinical, member experience, and operational outcomes. The requested services must include modern supplemental benefits such as dental, vision, hearing, fitness, over-the-counter and flex allowances, transportation, meals, in-home support, and social determinants of health benefits. Additionally, the agency requires digital member engagement tools, clinical and chronic condition management programs, dedicated retiree customer service, and comprehensive reporting dashboards. Eligible bidders must perform all work offsite and within the United States. Bidders must also demonstrate a willingness to commit to performance guarantees with at-risk fees across implementation, service, clinical, and financial categories. The agency is looking for proposals to define the budget, which must include competitive pricing, multi-year rate guarantees, and a transparent rate build. The contract period will be for one year. Bidders must submit all questions no later than June 17, 2026.