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SFHSS to issue competitive RFP for active ASO PPO dental plan covering 71,000+ members
Summary
SFHSS announced it will issue an RFP for an active, self‑funded ASO PPO dental plan intended to preserve network access and provide predictable out‑of‑network reimbursement (MAC/MPA); results are targeted for April/May 2026 with benefits starting Jan. 1, 2027.
San Francisco Health Service System staff told the Health Service Board on Nov. 13 that SFHSS will issue a competitive request for proposals for an active self‑funded administrative services‑only (ASO) PPO dental plan that will affect the system’s largest dental enrollment segment.
Contracts Administration Manager Michael Visconti said the RFP will be released before mid‑December and aims to preserve the current active PPO plan design while ensuring network breadth and administrative transparency for the roughly 71,000‑plus active members the solicitation will cover. Visconti said the nonfinancial evaluation criteria will be weighted heavily (about 75%) and emphasize network strength, claims accuracy, performance guarantees and transparent out‑of‑network processes that use the carrier’s fee schedule.
To control out‑of‑network volatility and provide predictable member cost expectations, the procurement will use a Maximum Allowable Charge/Maximum Plan Allowance (MAC/MPA) method for out‑of‑network reimbursement. Visconti said that method sets an explicit ceiling for plan reimbursement so members "would know what they can expect to pay" when they choose an out‑of‑network dentist; he added SFHSS will continue to allow out‑of‑network choice. Visconti also said SFHSS and its procurement partner Aon expect to receive multiple responses (he estimated as many as 10) and will shortlist approximately three respondents between Phase I (financial/disruption analysis) and Phase II (nonfinancial panel review).
Visconti highlighted a member survey of more than 2,500 responses showing high in‑network satisfaction and that about 30% of the dental population uses out‑of‑network dentists; he said survey results will inform the disruption analysis included in the RFP. SFHSS is targeting an April or May 2026 presentation of recommended awards and is seeking multi‑year rate guarantees (up to five years) where possible. The board approved a blackout notice (see votes summary) that will apply to this procurement and the SFHSS annual rates and benefits process.
Next steps: SFHSS will post the RFP and permitted communication guidelines on its RFP webpage; proposals will be due early next year, and staff will return to the board with results for award consideration in spring 2026.
