Reply to APS and new healthcare provider

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Reply to "APS and new healthcare provider"

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[quote=Anonymous]This was sent to APS staff this afternoon with additional details.

Background on the Procurement Process

APS’s contract with our current providers, Cigna and Kaiser Permanente, expires on Dec. 31, 2023.  APS advertised requests for proposals in Dec. 2022 with an original deadline of Jan. 20, 2023. To increase competition, APS extended the deadline through Feb. 3, 2023.

APS advertised the solicitation on eVA and on the APS Procurement Office website. eVA is the Commonwealth of Virginia’s electronic procurement system, an electronic marketplace that maximizes competition by allowing vendors from within the U.S. to register to receive information about solicitations posted by Virginia public bodies. APS does not actively solicit bids or give preferential treatment to any current or prospective provider during this process.

In response to the solicitation, APS received four proposals submitted by Aetna Life Insurance Company, CareFirst BlueCross BlueShield, Cigna Health and Life Insurance Company, and Sentara Health Plans, Inc./Optima Health Plan.

The proposals were evaluated separately with the assistance of a healthcare consultant. The evaluation criteria addressed each offeror’s qualifications and experience, its service qualifications, its approach to the scope and the quality of the response, and the cost to both APS and staff enrollees. The evaluation process involved conducting interviews and negotiating more favorable terms, conditions and prices with selected offerors. Based on the evaluation criteria advertised in the solicitation, the proposal submitted by CareFirst was selected because it offered improved healthcare plans and services, an expanded network of providers at lower rates for employees and provided the best value to APS.

Although the contract was awarded to CareFirst on July 17, 2023, additional negotiations and exchange of information to set rates and other details were recently finalized. We wanted to have as much information as possible, including assurance on the lower rates, prior to communicating.

Continuity of Treatment

To ensure continuity of treatment, CareFirst offers a special program called Transition of Care. The Transition of Care program allows you or your covered dependent(s) to continue to receive care from your current Kaiser, Cigna or other out-of-network physician for up to 90 days following the date of enrollment in CareFirst. Benefits will be paid at the in-network level (i.e., minimal copayments and no calendar year deductible.)

Examples of medical conditions that may qualify for the Transition of Care program include:

pregnancy (beyond 24 weeks gestation)
bone fractures
recent heart attack
other acute trauma or surgery
joint replacement
newly diagnosed cancer
Examples of chronic medical conditions that typically are not eligible for the Transition of Care program include but are not limited to: arthritis, allergies, hypertension, asthma, diabetes and COPD/emphysema.

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