Managed Care Health Insurance

Background
The West Virginia Public Employees Insurance Agency (PEIA) is seeking experienced Managed Care Providers to design and administer Managed Care Plans for its members. PEIA provides group health and life insurance for approximately 600 employers across the state, covering over 200,000 active and retired members, including Medicare-eligible individuals.

The agency aims to increase enrollment in fully capitated managed care plans, having first offered this option in 1995. PEIA contracts with at least one Health Maintenance Organization (HMO) in every county of West Virginia.

Work Details
The selected Managed Care Provider will be responsible for:
1. Designing and administering Managed Care Plans that PEIA members can choose for their health benefits.
2. Providing services that include medical claims management, eligibility rules consistent with PEIA, and stratified enrollment based on qualifying events.
3. Demonstrating industry expertise in the development and management of a Managed Care Health Plan.
4. Reporting operations related to the provision of Managed Care programs to enrolled members.
5. Ensuring compliance with applicable State and Federal laws related to medical and pharmacy claims management.
6. Full indemnification of PEIA for any claims resulting from non-compliance with laws governing managed care operations.

Period of Performance
The contract is expected to be finalized within 30 days following the award date, anticipated on November 8, 2024.

Place of Performance
The services will be performed within the state of West Virginia.