Fully Insured Medicare Advantage Service

RFP posted: April 9th, 2026

Deadline to submit questions: April 21st, 2026

Proposal opening date: May 19th, 2026

The government authority located in Baton Rouge, Louisiana is seeking a qualified vendor to provide a fully insured Medicare Advantage Health Maintenance Organization (HMO) plan for Medicare-eligible Office of Group Benefits (OGB) retirees and their eligible dependents. The plan must include prescription drug benefits and encompass quality, cost-effective health care services, covering inpatient and outpatient hospital services, ambulatory surgical services, and associated ancillary services.

The selected provider will be responsible for comprehensive medical claims administration, including processing claims, remitting timely payments to providers, issuing notices of payments, explanations of benefits, and handling claim denials, appeals, and grievances. Maintenance of integrated medical and carved-out pharmacy claims for out-of-pocket maximum accumulation, as well as adjudication and processing of all claims prior to termination dates, are also required.

Vendors must furnish at least 45 days advance written notice to OGB and plan participants of any significant changes in the provider network, specifically any changes affecting more than 1% of network providers or disrupting 3% or more of plan participants. A robust network of primary, specialty, and ancillary care providers within 60 miles of plan participants' addresses must be maintained. Additionally, the vendor must process premium refunds to Low Income Subsidy (LIS) members enrolled in Medicare Advantage Part D plans on behalf of OGB.