Medical Administrative Services, Third-Party Administration, and Pharmacy Benefit Management

The City of Omaha is requesting proposals from qualified vendors for comprehensive medical administrative services, third-party administration (TPA), and pharmacy benefit management (PBM). The selected vendor will be responsible for administering the city's self-insured healthcare plan, including managing medical and prescription drug benefits in compliance with collective bargaining agreements and relevant laws. Key responsibilities include plan document drafting, network access, management reporting, customer service, claims processing, and subrogation/coordination of benefits. The scope also encompasses managing different group structures and plan designs, including HDHP and PPO plans for active employees and retirees, as well as specific plans for fire and police retirees. The city is seeking a TPA that can provide competitive proposals with excellent network access, provider discounts, effective clinical/claims management programs, and superior customer service. The vendor must also be able to integrate with the city's current eligibility system, INFOR, via an electronic data interface (EDI). A bid bond or acceptable substitute is required, with the original document to be received by the City Clerk within seven calendar days of the closing date.