2026-0033-HR Employee Medical and Prescription Drug Administrative Service and Stop Loss Insurance

Santa Fe County is seeking a single‑carrier, bundled solution that administers its self‑funded employee medical and prescription‑drug plan and provides single‑loss stop‑loss insurance. The contract must include full claims administration, an existing NM provider network, a pharmacy‑benefit manager, disease‑management, utilization‑management, wellness services, performance guarantees, and a transparent 100 % pass‑through of pharmacy rebates. Proposals must be submitted by the carrier/administrator directly (no brokers or MGAs) and must include detailed cost proposals (PEPM rates, stop‑loss limits of $275 k, $300 k, $325 k) and required exhibits. The award is expected in October 2025 with benefits effective January 1 2026 and renewing each January thereafter. • Mandatory “bundled” contract – medical/Rx claims administration, network, PBM, and stop‑loss must be provided by the same entity. • Strict submission rules – drop‑box only, 15‑page technical narrative, no NDAs, and no extensions for questions or proposals. • Performance & fiduciary requirements – ERISA fiduciary status, fee caps, and performance guarantees required. • Data and reporting – online standard reports at no extra cost, website/portal for HR staff and participants, and detailed line‑by‑line pharmacy repricing (Exhibit 1G).