Board sends three medical carriers to best‑and‑final round after RFP presentations

Don Calderon, the district's director of risk management and employee benefits, and Dustin Keen of the Garren Group presented initial offers from three carriers responding to the district's RFP for fully insured medical and pharmacy coverage.

The proposals reported by Dustin Keen showed lower increases than the initial renewal from the incumbent: Florida Blue proposed a 15.9% increase across plans, Cigna a weighted 13.1% increase (with plan‑level variation) and UnitedHealthcare a 9.8% net increase. Each carrier offered different rate caps for year two, wellness and technology credits and varying levels of a discretionary or implementation fund. UnitedHealthcare proposed a $100,000 discretionary fund and a $100,000 one‑time implementation credit plus a $50,000 per year technology credit; Cigna proposed $50,000 per year and Florida Blue offered a $50,000 one‑time implementation credit. Wellness funding proposals ranged from $150,000 to $200,000 per year depending on the carrier.

Keen summarized network disruption analysis against the district's 4,079 providers used in the prior 12 months: Cigna showed a 97% in‑network match, Florida Blue about 91% for the PPO and 81% for the HMO, and UnitedHealthcare's NHP network about 70% match for the district provider list used in the analysis. Pharmacy disruption analysis (based on ~32,000 prescriptions) showed a small percent of positive and negative impacts by carrier; UnitedHealthcare showed a higher negative‑impact share due to formulary differences.

Board members asked detailed questions about plan‑level loss ratios, the district's goal to preserve a zero‑cost high‑deductible employee‑only option, the effect of migrating members from the PPO and the possibility of pursuing self‑insurance and an on‑site health center in the future. Staff reported current year‑to‑date loss ratios of HMO ~101%, HDHP ~47% and PPO ~165% (high cost claimants concentrated in PPO enrollment). Staff and the Garren Group said their scoring model ranked Cigna highest on the RFP scoring matrix, Florida Blue second and UnitedHealthcare third, but the insurance committee recommended shortlisting all three carriers for the best‑and‑final negotiation round.

After discussion the board agreed to include all three carriers (Florida Blue, Cigna and UnitedHealthcare) in a best‑and‑final (BAFO) negotiation round. Staff will release the district's February claims data to carriers for final negotiations and asked carriers to improve their pricing and terms in the BAFO. The insurance committee will meet to review BAFO responses; staff expects a recommendation to the full board in late March.

Quotes used with permission: "Great news is that it's coming down from that 30% not to exceed," Dustin Keen said, referring to the initial renewal and the lower RFP responses. Don Calderon summarized next steps: "We will be looking for recommendations, in 3 weeks."