MEDICARE ADVANTAGE BENEFIT ADMINISTRATION

The State of New Hampshire is seeking a single vendor to administer a fully‑insured Medicare Advantage (MAPD) or separate MA + PDP plan for roughly 11,000 retirees nationwide. The vendor will duplicate the current plan design, manage member enrollment, claims processing, provider and pharmacy networks, and deliver extensive reporting and performance guarantees. The contract runs from 1 Jan 2027 through 31 Dec 2029 with possible one‑year extensions, and the award is contingent on Governor & Executive Council approval. • Administer a passive PPO MAPD plan (or separate MA and PDP) with identical benefits to the existing State plan. • Provide 24 × 7 member‑service call centre, ID‑card issuance, network‑adequacy, claims adjudication, and CMS‑compliant data reporting. • Meet extensive performance‑guarantee metrics (implementation readiness, call‑answer time, reporting timeliness) with penalties for non‑compliance. • Submit detailed financial proposals (PMPM rates) using State‑provided data, include rate‑cap guarantees for 2028‑2029, and offer a gain‑sharing/MLR arrangement.