Fully-Insured Medical Plans Service
- Client
- Washington
- RFP Number
- INSU-6612
- Posted
- 10/14/2026
- Category
- Insurance Services
- Budget
- Looking for Proposals
- NAICS
- —
- Set-aside
- —
- Contact
- —
Description
AI GeneratedThe Health Care Authority (HCA) in Washington requires a contractor to provide fully-insured commercial medical plans for non-Medicare PEBB and SEBB program subscribers and their dependents. The selected contractor must design up to six plans—three each for PEBB and SEBB—while supplying all necessary staffing, systems, and procedures to operate offsite and customize services for HCA's ERB Division. Eligible bidders are onshore USA organizations capable of executing a structured implementation plan from July 1, 2027, through March 31, 2029, and maintaining operational readiness prior to January 1, 2029. Bidders must submit answers to Exhibit C1.2 following the required template and page limits, including an implementation plan, a dedicated implementation manager, a staffing plan, and specific technical testing milestones. A pre-bid meeting is scheduled for October 20, 2026. Proposals will be evaluated using point-based criteria, including 10 points for community reinvestment experience, 10 points for fee-for-service projections, and 30 points for past complex implementation examples. The resulting contract term is five years, with implementation starting as early as November 2027, though final funding remains subject to authorization by the Washington legislature.
Key solicitation details
AI-extracted from RFP 2025HCA5 Exhibit C1.2 - Written P1.docx, RFP 2025HCA5 Exhibit B Draft Contract.pdf, RFP 2025HCA5 Final 10.12.26.pdf. Confirm against the original documents before bidding.
The Washington State Health Care Authority is seeking proposals from eligible commercial health plan contractors to provide fully-insured medical plan services for non-Medicare PEBB and SEBB program subscribers and their dependents. Up to six health plans per contractor may be procured, with offsite performance based in the United States. The solicitation is open to vendors available to perform work in Washington State that meet minimum qualifications.
- Issued by
- Washington State Health Care Authority
- Pre-bid meeting
- October 20, 2026
- Proposals due
- January 14, 2027, by 4:00pm Pacific Time
- Contract implementation plan start
- July 1, 2027
- Contract start
- January 1, 2029
- Contract end
- December 31, 2033
- How to submit
- Electronic via email
- Submission details
- Only e-mailed bids will be accepted. Exhibits must be completed following formatting and page limit requirements outlined in Section 3.2.D of the RFP.
- Contract term
- Five-year base period (January 1, 2029, to December 31, 2033) with options to extend up to seven additional one-year periods.
- Estimated value
- Per Member Per Month (PMPM) rates; exact total budget looking for proposals.
- Place of performance
- Performance of the work will be Offsite (Washington State / USA).
- Insurance and bonding
- Professional Liability Errors and Omissions policy; Industrial Insurance Coverage as required by Title 51 RCW.
- Funding
- State of Washington Legislature final funding; subject to 2 CFR 200, HIPAA, HITECH Act, and state statutes including RCW 41.05 and RCW 48.43.
How proposals are evaluated
| Step 7 Performance Standards and Payments Attestation | 500 points |
| Plan Design parameters and completed Exhibit G | 40 points |
| Provider contract negotiation and strategies to reduce total cost of care | 35 points |
| Provider contract negotiation and strategies to incentivize care quality | 35 points |
| System format changes and claims process updates | 35 points |
| Customization of existing systems and culture of flexibility | 30 points |
| Policies to protect members in case of financial losses | 30 points |
| Implementation plan examples and methodology | 30 points |
Scope of work
- Commercial fully-insured Health Plans (APM, EPO, HMO, or PPO) for PEBB and SEBB programs
- Staffing, systems, and procedures for plan administration and customized ERB Division needs
- Standardized plan designs with 80% to 92% Federal Actuarial Value
- Claims processing, adjudication, and payment services, including out-of-network and emergency care
- Monthly electronic submission of non-Medicare paid claims encounter and eligibility data
- Comprehensive implementation plan and dedicated implementation manager
- Participation in annual Request for Renewal and rate adjustment processes
- Customer service center operations meeting required customer service standards
Minimum qualifications
- Open to Bidders that satisfy minimum qualifications and are available for work in Washington State
- Onshore (USA Organization Only)
- Perform all administrative services within the United States
- Ability to provide all required staffing, systems, and procedures
- Proper banking registration with State of Washington to accept premium payments
- Maintain NCQA accreditation over the term of the Contract
- Network contracting and credentialing program meeting NCQA standards
Documents to include with the bid
- Exhibit A - Bidder Forms and Certifications
- Exhibit C1.1 - Mandatory Attestations
- Exhibit C1.2 - Written Proposal Phase 1
- Exhibit C2 - Written Proposal Phase 2
- Exhibit D1 - PEBB Cost Proposal Template
- Exhibit D2 - SEBB Cost Proposal Template
- Exhibit E - Service Area
- Exhibit G - Plan Design Outline
- Exhibit H - Bree Collaborative for Complex Discharges and SDOH
- Exhibit I - Bidder Subcontractor List
Verify important details
Document checkConfirm submission instructions and amendments with the issuing agency before responding.
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