PBM and Stop Loss Insurance

Summary (Newest Update)

Background The Mesquite Independent School District (MISD) is seeking proposals for Pharmacy Benefits Manager (PBM) and Stop Loss Insurance as part of their partially self-funded health insurance program. The district serves over 38,000 students across 52 campuses in the communities of Mesquite, Garland, Balch Springs, and parts of Dallas. The goal is to find qualified health insurance providers that can offer plans that match or improve upon the current benefits provided by BCBSIL (Luminare). The contract aims to ensure compliance with applicable federal, state, and local standards while providing quality healthcare coverage for all eligible employees. Work Details The selected vendor will provide Pharmacy Benefits Manager (PBM) services and Stop Loss Insurance. Proposals should include plans that significantly match or improve upon the existing plan benefits. Specific requirements include: - National PPO and alternative HMO style networks must be included in the proposals. - A clear outline of any deviations or alternative plans must be provided for evaluation. - The effective date for the new coverage is set for September 1, 2026. - Current coverages include various medical benefit plans with specific deductibles, out-of-pocket maximums, coinsurance rates, and copays as detailed in the solicitation. Period of Performance The term of the prospective contract is up to 5 years, with options for renewal including a three-year contract with two one-year renewal options or a one-year contract with options for four one-year renewal options. Place of Performance The services will be performed in Mesquite, Texas, covering all eligible employees within the district. Bidder Requirements Proposers must comply with all instructions detailed in the RFP and submit required forms including but not limited to: Execution of Offer, Vendor Information, References, General Certifications, Exceptions Form, Conflict of Interest Questionnaire (Form CIQ), Confidentiality Declaration Form, IRS Form W-9, Federal and State Certifications. Vendors must also provide proof of financial stability and may be required to submit audited financial statements.