Health and Welfare Employee Benefits

Assumptions are as follows:

1. The proposal is to be based on the proposed plan of benefits.
2. The quote is to be based upon the census provided in the RFP.
3. All participants enrolled in the Employee Benefits Plan as of December 31, 2026 are to receive immediate coverage under the new plan.  All health services incurred on or after January 1, 2027, for currently enrolled participants are to be eligible expenses.  The City’s enrollment records are to be the basis for “take-over.”
4. All Respondent proposal offerings will comply with the Patient Protection and Affordability Care Act.
5. Coverage for employees (full time) becomes effective on the 1^st day of employment. Medical terminates at the end of the month in which the employees separates from employment. Retirees are eligible for continued coverage up to Medicare eligibility, provided they were enrolled in benefits the day preceding the date of retirement.
6. This RFP is for a five-year contract. A three-year contract with two one-year renewal options with caps, a two-year contract with three one-year renewal options with caps or a one-year contract with options for four one-year renewal options with caps will be considered.   If it is the respondent’s intent to increase rates at the renewal date, the City must be notified of the maximum increase for each renewal period and the basis for calculating the increase.  The City must be notified of renewal rates at least 120 days prior to the effective date of the rate change.

Background

The City of Sugar Land is home to 111,026 (Source: US Census Bureau, 2020) residents who celebrate our rich history while helping push us forward to be a City of the future. Sugar Land has always been a trailblazing city, fearlessly forging new paths and surpassing expectations while delivering top-tier services to our residents, employees, and businesses. According to our last Citizen Satisfaction Survey, 95% of residents love calling Sugar Land home and 10% say that nothing would make their lives better than it already is. Sugar Land’s fast-growing population is one of the most highly educated and globally diverse in the region, attracting top talent from the University of Houston’s Sugar Land campus and the greater Houston area. In fact, nearly 60% of residents aged 25 and over have at least a bachelor’s degree and more than 500,000 college graduates lived within 30 minutes of Sugar Land. Sugar Land also boasts one of the most affluent and diverse populations in the State of Texas, with a median household income of $123,261 in 2020 and with an Asian population – including, among others, Chinese, Indian and Pakistani residents– representing over 38% of its residents. Located just 20 minutes from downtown Houston, many of Sugar Land’s attractions are within a short distance from each other, including a world-class baseball park, several museums, and the Smart Financial Centre at Sugar Land, one of the nation’s top ranked entertainment venues. In addition to our world-class destination venues, our residents can enjoy 27 city parks and over 20 miles of hike and bike trails. Sugar Land is consistently voted one of the ‘best suburbs of Houston”, and we think it’s easy to see why.

Project Details

• Reference ID: 2026-RFP-019
• Department: People & Culture
• Department Head: Paula Kutchka (Director)

Important Dates

• Questions Due: 2026-04-24T22:00:36.222Z
• Answers Posted By: 2026-05-01T22:00:10.660Z

Evaluation Criteria

• Cost (30 pts) —

  a)     Fixed Costs: includes insurance costs and administrative costs

  b)     Variable Costs: costs stated as a percentage of paid claims, cost management (i.e., shifting of more/less workload to City staff)

  c)     Ability to reduce claims expense: network discounts and network access

  d)     Ability to substantially match current plan design structures

  e)     Financial Stability (AM Best Rating)

• Cost Containment / Innovative Solutions (20 pts) —

  The respondents demonstrated and proposed ability to implement innovative cost containment solutions is a significant factor to provider selection.  These can include but are not limited to:

  1. Ability to Administer Multi-tiered Network Solutions
  2. Provider cost and quality solutions
  3. ACO and Narrow Network Strategies
  4. Health risk management solutions
• Population Health Management Programs (20 pts) —

  The respondents demonstrated and proposed abilities to improve health of the population and prevent health plan costs are critical to provider selection.

  1. Utilization review programs
  2. Case management programs
  3. Disease management programs
  4. Wellness programs, tools and resources
  5. Dedicated wellness consultant and coordinator
  6. Return on investment analysis and reporting
• Communication (5 pts) —
  1. Educational material for employees
  2. Summary Plan Description capabilities
  3. On-line resources and tools
  4. Administrative kits for locations
  5. Bilingual capability
• Claims Processing (10 pts) —
  1. Turnaround time excluding medical review of claims
  2. Pended claims procedures
  3. Statistical accuracy
  4. General service procedures
  5. Dedicated service team
  6. Willingness to contractually establish performance criteria
• Integrated Systems / Technology Initiative (10 pts) —

  Capability to integrate systems. The following components make up the whole of an integrated system:

  1. Eligibility
  2. Claims function
  3. UR / CM / DM  integration
  4. Stop loss intrusion
  5. Electronic claims inquiry
  6. Internet based enrollment/eligibility capabilities
  7. Access, format and frequency of management reporting
• Past Performance (5 pts) —
  1. Active and terminated references
  2. Past relationship with the City
  3. Recognitions / reputation of proposer

   

• Cost (50 pts) —
  1. 1. Fixed Costs: includes insurance costs and administrative costs
     2. Variable Costs: costs stated as a percentage of paid claims, cost management (i.e., shifting of more/less workload to City staff)
     3. Ability to reduce claims expense
     4. Cost of Stop Loss integration with current third party administrator
• Financial Stability (15 pts) —
  1. 1. Financial Stability (AM Best or Equivalent Agency Rating)
• Claims Processing (25 pts) —
  1. 1. Turnaround time excluding medical review of claims
     2. Pended claims procedures
     3. Statistical accuracy
     4. General service procedures
     5. Dedicated service team
• Past Performance (10 pts) —
  1. 1. Active and terminated reference
     2. Past performance with client
     3. Recognitions / reputation of proposer

Submission Requirements

• Submission Form (required) —

  Please download the below Submission Form, complete, and upload. Please note there is a tab for each type of coverage/plan. Respondents may submit on one or more coverages/plans. 

• Third Party Administrators Questionnaire (required) —

  Please download the below documents, complete, and upload. If it does not apply, please mark as Not Applicable of N/A

• Deviations from Specifications (required) —

  Please download the Deviations from Specifications Form, complete, and upload. If there are no deviations, please note there are no deviations on the form. 

• Vendor References (required) —

  Please download the Vendor References Form, complete, and upload.

• Additional Information (required) —

  Please include any additional information to help support your proposal response to this Request for Proposal. 

• Disclosure —

  The disclosure section of this RFP must be addressed specifically in Respondent’s response, even if no conflicts exist. Failure to submit disclosure statement will eliminate Respondent from further consideration of the RFP.

• Any Respondent to this RFP shall disclose all potential conflicts of interest or representation of any firm that could be involved in the proposed project. (required) —

  By selecting "Please confirm" below, Respondent agrees to disclose all potential conflicts of interest/representation of any firm that could be involved in the proposed project.

• Required Forms —

  The following forms must be filled out and turned in with the Submittal in order for Respondent to be considered responsive. Failure to include the following forms, signed and dated, will result in the Submittal being rejected. 

  1. Conflict of Interest Questionnaire (CIQ Form);
  2. Certification Regarding Debarment;
  3. House Bill 89 Verification Form;
  4. Senate Bill 13 Verification Form; and
  5. Senate Bill 19 Verification Form.
• Sample - Contract for General Services (required) —

  Please download the below documents and review.

• Insurance Requirements/Instructions —

  Please download the document and review.

• Acknowledgement of City of Sugar Land - Insurance Requirements (required) —

  By selecting "Please confirm" below, Respondent acknowledges they understand the Insurance Requirements of these specifications and will comply in full if awarded this contract.

• Proof of Insurance Requirements (Optional at this Stage) —

  Please upload all documentation needed for the Insurance Requirements here.

• Conflict of Interest Questionnaire (CIQ Form) (required) —

  Please download the below documents, complete, and upload.

• Certification by Contractor Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters (required) —

  Please download the below documents, complete, and upload.

• House Bill 89 Verification Form (required) —

  Please download the below documents, complete, and upload.

• Senate Bill 13 Verification Form (required) —

  Please download the below documents, complete, and upload.

• Senate Bill 19 Verification Form (required) —

  Please download the below documents, complete, and upload.

• Pricing (required) —
  • Choose Option 1 when you have set line items, for example: 
    • This is a quote for goods or commodities.
    • This is a public works bid, with a pricing table that can be uploaded into OpenGov Procurement from an Excel spreadsheet.
    • Seeking services for hourly rate schedules.
  • Choose Option 2 when you need vendors to provide you with the line items.
• Are Key Performance Indicators (KPIs) being used for this solicitation? (required) —
  • What is a Key Performance Indicator (KPI)? A KPI (a subset of metrics) provide a quantifiable measure of performance over time for a specific objective. A KPI will help the vendor to understand what success looks like at the end of the contract. 
  • KPIs in solicitations ensure vendors are accountable, improve efficiency, and align performance with city and/or department goals, leading to better decision-making and cost savings. Implementing KPIs also promotes transparency and strengthens vendor relationships for long-term success. 
  • Including KPIs is strongly recommended. Not sure where to start? You are encouraged to reach out to the Department of Data & Innovation using the department’s service request form. Data & Innovation will work alongside you to integrate KPIs into your procurement processes.
• Which Insurance Requirements apply to your project? (required)
• Enter description of any other insurance requirements that are needed for this solicitation. (required)
• Select the Risk that is required for Commercial General Liability (required)
• Select the Risk that is required for Automobile Liability (required)
• Contract Duration and Renewal Options (required) —

  Please provide the intended contract duration and whether there are any renewal options. 

  Example text includes: 

  UPON COMPLETION OF PROJECT:

  The contract will commence on the latest date executed by both parties and continue until project is complete.

  OPTION TO RENEW:

  This will be a 12-month contract. The City of Sugar Land reserves the option to extend this contract upon the same terms and conditions, including prices, established hereunder, for four (4) additional one-year terms by notifying the bidder in writing of the extension at least thirty days prior to the date the contract would otherwise terminate.”

  AUTOMATIC RENEWAL: 

  The annual contract(s) commencing on the latest date executed by both parties and continuing for a twelve-month period. The term of the Contract shall automatically renew without further documentation or agreement annually for four (4) additional one-year terms under the terms and conditions provided herein, unless written notice of a party’s intent not to renew is received by the other party on or before thirty (30) days before the expiration of the then current term.