The purpose of this Request for Proposals (RFP) is to solicit proposals from interested and qualified vendors who can:

- provide a nationwide Medicare Advantage preferred provider option (PPO) and/or regional Medicare Advantage HMO services; and/or

- provide a Medicare Plus (Supplemental or Medigap) option

to State of Wisconsin Group Health Insurance Program retirees and Medicare-eligible dependents of retirees. 

This solicitation includes two RFPs:  

a. RFP ETD0050: IYC Medicare Advantage  

b. RFP ETD0051: Medicare Plus

Vendors may submit a Proposal for one or both of the RFPs.

The Wisconsin Department of Employee Trust Funds (Department) administers the Wisconsin Retirement System (WRS), the Group Health Insurance Program (GHIP) for State employers and many Local government entities, and a variety of other public employee benefit programs. The WRS has consistently ranked among the top 10 largest public pension funds in the United States, providing retirement benefits for more than 663,000 current and former State and Local government employees and their families on behalf of more than 1,500 employers. Participants in the WRS include public school teachers, current and former employees of State agencies and the Universities of Wisconsin, and employees of most State and Local governments. All State WRS members and those from participating Local employers are eligible to enroll in the GHIP. The Department is overseen by independent governing boards and funds are held on behalf of the benefit program beneficiaries in the Public Employee Trust Fund created and regulated under Chapter 40 of the Wisconsin State Statutes.

The Department intends to use the results of this solicitation process to award one or more contracts for the services described in the RFP and its attachments. The contract(s) will be administered and managed by the Department, with oversight by the Group Insurance Board (Board). The RFP document, its attachments, and the awarded Proposal(s) will be incorporated into the contract(s).

One or more separate contracts may be awarded pursuant to the RFP. The term for each contract for providing services will commence on the date a contract is executed and extend through December 31, 2028 (the initial term), unless terminated earlier per the terms of the contract.

Premiums will be reviewed and negotiated annually.

Note: The contractor(s) will assist the Department with implementation, transition, and participant communication prior to services being made available for the 2026 plan year. This implementation and transition period will begin after a contract is executed and continue until implementation and transition are completed. The contractor(s) will begin providing and administering the services on the launch date of September 9, 2025 for the 2026 plan year. The 2026 plan year begins on January 1, 2026.

The Board retains the option, by mutual agreement of the Board and the contractor, to renew the contract for two (2) additional two (2) year periods extending the contract through December 31, 2032, subject to the satisfactory negotiation of terms, including pricing. Extensions beyond this may occur as needed for a period of one (1) year (or less) to transition services to another service provider during a transition period.

The RFP documents can be viewed at the links provided below. The RFP details the procedures proposers must follow to submit a proposal, and the minimum requirements that proposers must meet to be eligible for consideration.

The deadline for receipt of vendor questions is Thursday, April 4, 2024. See RFP for submission details.

The deadline for receipt of proposals is Thursday, July 11, 2024 by 12:00 p.m. central time. Note: Proposals must be submitted electronically to BOX. See the RFP for submission details. Late submissions will not be considered.

This solicitation is authorized under Chapter 40 of the Wisconsin State Statutes. All decisions and actions regarding this solicitation are solely under the authority of the Board. Procurement statutes and rules that govern other State of Wisconsin agencies may not be applicable.

Any news releases or release of broadcast e-mails pertaining to this solicitation, any resulting contract(s), or the acceptance, rejection, or evaluation, or review of vendor proposals shall not be made without the prior written approval of the Department.

NOTE: All modifications and other information associated with the RFP will be posted on the Department’s web site at https://etf.wi.gov/node/35426. Interested vendors are encouraged to check this site for updates frequently. No other notification regarding modifications will be provided.

Questions must be submitted as indicated in the RFP via email to ETFsmbProcurement@etf.wi.gov. 

Revision History

DateItem
March 7, 2024RFP Released
April 5, 2024Updated Form F - Vendor References
April 26, 2024Addendum No. 1 Posted

Uploaded Documents

RFP ETD0050-51 Addendum No. 1 - 4.26.2024
RFP ETD0050-51 Medicare Advantage and Medicare Plus
Exhibit 1 - Certificate of Coverage (ET-2180)
Exhibit 1 - Program Agreement (Medicare Advantage & Medicare Plus)
Exhibit 1 - Schedule of Benefits (ET-2108sb)
Exhibit 1 - Medicare Plus Certificate of Coverage (ET-4113)
Exhibit 1 - Schedule of Benefits (ET-2158sb)
Appendix 1 - 834 Overview & Companion Guide
Appendix 2 - Drug Claims Functional Specification
Appendix 3a - Wellness Data Specifications-WebMD ONE Health Assessment Results
Appendix 3b - Wellness Data Specifications-WebMD Biometric Data
Appendix 3c - Wellness Data Specifications-Coaching Outcomes
Appendix 4 - Medical Claims Data Specifications
Appendix 5 - Provider Data Specifications
Appendix 6 - State Employer Group Roster (ET-1404)
Appendix 7 - Local Employer Group Roster (ET-1407)
Appendix 8 - Premium Rate Bid Tool (sample)
Appendix 9 - Non-Disclosure Agreement among Vendor, the Department, and Board Actuary
Appendix 10 - Pro Forma Contract
Appendix 11 - Department Terms and Conditions
Appendix 12 - Data Supplier Agreement (sample)
Appendix 13 - Non-Disclosure Agreement (Data Out) (sample)
Appendix 14 - Grievance Report Template (sample)
FORM A - Proposer Checklist
FORM B - Proposer Attestations
FORM C - Subcontractor Information
FORM D - Request for Proposal Signature Page
FORM E - Vendor Information
FORM F - Vendor References (rev. 4.5.2024)
FORM G - Designation of Confidential and Proprietary Information