Medical, Pharmacy, and Population Health Management Program Financials: ♦ Quote a self-funded program (Administrative Services Only for medical and pharmacy claims administration and medical management) ♦ Include $400,000, $425,000, and $450,000 individual specific stop loss limit for medical and pharmacy on a paid basis and noted in Proposed Risk Contract. ♦ Include 100% pass through of pharmacy rebates. ♦ Rates must be guaranteed for a minimum of 12 months ♦ Proposal should include illustrative FOUR and FIVE tier rate structures on Medical and Pharmacy to include: FOUR: Employee, Employee and child, Employee and spouse, and Family based on the current tier factors as provided in this RFP (Appendix II Rates and Contributions) on 12 month rates FIVE: Employee, Employee and Child, Employee and Children, Employee and Spouse, and Family ♦ All quoted fees and rates are final regardless of changes in enrollment and fluctuations in claims experience ♦ Please provide 12 month mature claims projection for current plan design, proposed plan options (chart in Appendix) and current Rx plan design for Medical and Pharmacy ♦ Please include an offer for a wellness fund in the amount of $100,000 annually for the life of the contract.
