Self-Funded Medical Plan Administration

The City of Charlottesville is seeking a third-party administrator to provide end-to-end administration of its self-funded medical plans for active employees and pre-65 retirees, including claims, eligibility, provider networks, care management, reporting, and pharmacy coordination.

City of Charlottesville > Human Resources Department

General

Status:Open

Solicitation Identifier:RFP 27-24

Due Date:Sep 16, 2026 02:00 PM

Posted Date:Aug 19, 2026 02:45 PM

Contract Period:1 year 6 months base + 6 × 1 year options

Set Asides:

Small BusinessWoman-Owned BusinessMinority-Owned BusinessVeteran-Owned Business

Type:Request for Proposal (RFP)

Level:Local

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Original Solicitation Links

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RFP 27-24

]

medical plan administration

Contact

Name:Sara Butler

Email:butlers@charlottesville.gov

Phone:+14349703462

Address:Charlottesville, VA, USA

Description

The City of Charlottesville is soliciting proposals for end-to-end third-party administration of its self-funded medical program covering active employees and pre-65 retirees. The administrator must support the City's existing POS and HMO/EPO plan designs, including deductibles, copayments, coinsurance, out-of-pocket limits, benefit limitations, and the existing HRA arrangement, while also addressing a potential HDHP with HSA effective July 1, 2027. Offerors may propose medical administration with pharmacy benefits integrated or carved out, but integrated pharmacy proposals must also be submitted under the City's separate pharmacy benefits manager solicitation. Required services include eligibility and enrollment administration, claims adjudication and payment, appeals, provider network access and disruption analysis, customer service, utilization and case management, behavioral health and wellness support, stop-loss coordination, reporting, data warehouse feeds, Benefitfocus integration, pharmacy accumulator coordination, and regulatory compliance. Responses must include the buyer-provided medical questionnaire and financial tables, geographic-access and provider-disruption results in Excel, experience and staffing information, at least four similar references, a detailed methodology and service approach, a proposal with pricing and payment terms, and any required proprietary-information documentation. The draft contract provides an initial term from January 4, 2027, through June 30, 2028, with up to six additional one-year renewals.

Title	Date Posted
O - Attachment O - First Responder Peer Support Program flyer	Aug 11, 2026 10:34 AM
L - Attachment L - City of Charlottesville Medical Geo Access Template	Aug 11, 2026 10:34 AM
C - Attachment C - CHO Aetna POS 2026	Aug 07, 2026 02:34 PM
I - Attachment I - City of Charlottesville Combined Disruption File	Aug 07, 2026 02:34 PM
F - Attachment F - CHO Aetna Select Plan SBC 2026	Aug 07, 2026 02:34 PM
N - Attachment N - City of Charlottesville Repricing File	Aug 11, 2026 10:34 AM
B - Attachment B - City of Charlottesville Medical RFP Financial Tables	Aug 18, 2026 04:06 PM
A - Attachment A - City of Charlottesville Medical RFP Questionnaire	Aug 18, 2026 04:09 PM
D - Attachment D - CHO Aetna Select 2026	Aug 07, 2026 02:34 PM
R - Sample C.O.I. and Guide to the Accord Form	Aug 13, 2026 02:12 PM
P - Attachment P - Resources for Living First Responders Flyer	Aug 11, 2026 10:34 AM
M - Attachment M - City of Charlottesville Paid Claims	Aug 11, 2026 10:34 AM
MEDICAL_PLAN_ADMINISTRATION.pdf	Aug 19, 2026 02:45 PM
J - Attachment J - City of Charlottesville Enrollment Report	Aug 07, 2026 02:34 PM
Q - Attachment Q - DRAFT Contract for Medical Plan Administration	Aug 18, 2026 04:02 PM
E - Attachment E - CHO POS Plan SBC 2026	Aug 07, 2026 02:34 PM
G - Attachment G - 26-27 City of Charlottesville New Hire Benefits Guide	Aug 07, 2026 02:34 PM
K - Attachment K - City of Charlottesville Medical Census	Aug 11, 2026 10:34 AM
H - Attachment H - Active Structure 012126	Aug 07, 2026 02:34 PM