The City of New York (City) acting through New York City Mayor’s Office of Labor Relations (OLR)
in cooperation with the Municipal Labor Committee (MLC) is issuing a Request for Information
(RFI) to understand qualified organizations’ capabilities to provide a comprehensive, cost effective employee health benefit program. This RFI seeks information from a wide range of organizations. Interested qualified firms may submit responses to this RFI to the City and the MLC. This program will have a target effective date of January 1, 2024.
View the RFI on the OLR website here.
View the open call on the OLR website here.
BACKGROUND
The City currently provides health benefits for about 1.25 million employees, retirees, and
dependents through multiple programs from which its members choose. The most predominant
medical program for actives and pre-Medicare retirees1 has about 750,000 members in a single
PPO plan. Another 250,000 members are enrolled in HMOs and other smaller, fully insured
arrangements. With respect to prescription drug benefits, the City directly provides coverage only
for injectable and chemotherapy drugs. Preventive drugs mandated by the ACA are covered by
the PPO plan. All other prescription drug coverage, as well as other welfare benefits such as
dental, vision and disability, if any, is provided by individual union welfare programs that are
funded by the City but operated independently. The PPO program facility (Hospital inpatient and
outpatient) and professional (physician, lab, radiology, urgent care, and any other non-hospital
based care) benefits are delivered through a bifurcated program (two different vendors). The
prescription drug benefits are provided by multiple vendors via a combination of union welfare
funds, carrier optional riders, and a consolidated Specialty drug carve out (PICA). Care
management is provided primarily by the carrier that provides facility coverage; however certain
chronic condition management programs are provided by the carrier that provides medical
coverage.
The benefit designs have remained relatively untouched for years, with some limited changes in
cost sharing in recent years. The program funding mechanisms are either fully insured or
minimum premium, resulting in less flexibility on design. Finally, there have been limited
innovative financial or design strategies implemented, nor have the care coordination and
management programs been as successful as desired. Details can be found at
healthbenefitshome (nyc.gov)
The City and unions seek a partner with which to redesign the PPO to provide a state of the art,
cost-effective, member-focused program that is worthy of the greatest city in the world. Our joint
goal of the redesign is to reduce the cost of delivering healthcare by at least 10% while continuing
to provide efficient, high-quality healthcare to all City employees and pre-Medicare retirees
without significant increases in member out-of-pocket cost. This RFI requests information from
interested, qualified entities to determine whether creative ideas and better delivery strategy can
be achieved.