Department of Human Resource Management

Buyer seeks a contractor to provide actuarial and related services for the Commonwealth's health benefits programs. Services include actuarial analysis, regulatory compliance, benefits design, data integration, general consulting, and data warehouse management. The contractor will support programs serving approximately 146,000 active employees, retirees, and extended coverage contract holders. The contract period is three years with two optional one-year renewal periods.

• 3/27/2025 - Pre-Proposal Conference
• 4/7/2025 - Inquiry Deadline
• 4/17/2025 - Proposal Due Date
• 7/1/2025 - Contract Start Date

• Experience with Virginia public sector health insurance within past 5 years
• Experience providing proactive compliance assistance with ACA and regulations
• Experience with actuarial valuation of multiple health benefit programs
• Experience with strategic planning for benefits programs

• Provide actuarial analysis for health programs and OPEB valuation
• Develop premium models and recommendations for annual rates
• Conduct claims utilization review and analyze high-cost trends
• Develop demographic factors to equalize risk among health plans
• Maintain claims database for analytics and financial forecasting
• Model program costs based on variable enrollment and benefit designs
• Review and analyze current benefit plans with recommendations
• Conduct claims audits and performance reviews of third-party administrators
• Ensure compliance with federal and state laws including ACA
• Support RFP development and vendor negotiations for health programs