Specifications include, but are not limited to: The State intends to secure one self-funded contract with a Third Party Administrator (TPA) for a broad Preferred Provider Organization (PPO) network for medical, behavioral health, and pharmacy benefits (pharmacy may be carved out at the State’s request) servicing all ninety-five (95) Tennessee counties statewide as well as nationally for Members residing or traveling outside of the state. The TPA shall provide access to an existing (current) high-quality cost effective broad commercial network that meets the state’s access requirements. The State intends to procure a contract with a TPA who has a current tiered copay only benefit design in place with other large self-funded employers. This contract and benefit design shall include all medical and behavioral healthcare services as well as pharmacy services (unless the State requests to carve out pharmacy). The tiered copay only benefit design sets member copay ranges for provider office visits, healthcare services, behavioral healthcare services, and pharmacy benefit services based upon the quality and cost of the providers, facilities, pharmaceuticals, healthcare services and outcomes. Cost and quality data must be displayed online in a transparent, customer friendly way that is easily accessible by members. Members pay a copay for all services covered by this contract up to a maximum out of pocket amount. Copays and the maximum out of pocket amounts will be finalized by the State after the award of the contract during implementation.
