Solicitations

RFP 2015-48 Consulting Services for the 1332 Innovation Waiver Application

The purpose of this solicitation is to obtain technical assistance services to develop the Affordable Care Act Section 1332 State Innovation Waiver application (waiver application) and manage the waiver application development process.

Section 1332 of the Affordable Care Act (ACA), also known as State Innovation Waivers, authorizes states to request five-year renewable waivers from the U.S. Departments of Health and Human Services (HHS) and the U.S. Treasury. These waivers allow for flexibility regarding the ACA’s key coverage provisions, including those related to benefits and subsidies, exchanges, and the individual and employer mandates. States may propose waivers to pursue broad alternative approaches to expand coverage or targeted fixes to improve consumers’ experiences. Some ACA provisions, such as guaranteed issue, may not be waived and all applications must demonstrate that coverage remains as accessible, comprehensive, and affordable as before the waiver and that the proposed changes will not contribute to the federal deficit.

Details & Downloads


RFP 2015-34 Covered California for Small Business Provider Plan Policy

The purpose of this RFP is to secure a Contractor to support the Covered California for Small Business Division in the following areas: Developing QHP and QDP certification/recertification into an Exchange; premium rate review and health plan provider application assessment; creating and managing regulations specific to the small group market; creating and managing policies as regulations are implemented or changed; developing a knowledgebase of the group market specific to data modeling, competitive analytics, and strategy development. Contractor will provide consulting services to ensure the self-sustainability goals of the Sales Division are attainable and can be reached in a timely manner. These services will provide the critical support needed to develop QHP and QDP policy and strategic planning as an integral foundation for the ongoing operations of the Sales Division as the Small Business division as it seeks to place itself strategically in the small group health market.

Details & Downloads


RFP 2015-33 QHP Selection, Oversight and Management Support

The purpose of this RFP is to acquire a Contractor for technical consulting services in support of the Exchange’s Qualified Health Plan (QHP) selection, oversight and management activities. The Contractor will provide consulting services to support the reviewing, scoring and analysis of QHP applicant responses to “eValue8” questions contained within the QHP application and consulting services for the management of electronic reports based on responses to the Exchange’s QHP certification application.​

Details & Downloads


RFP 2015-32 Financial Statement and Single Audit

As set forth in 45 CFR Part 155 Exchange Establishment Standards and Other Related Standards under the Affordable Care Act, Subpart M-Oversight and Program Integrity Standards for State Exchanges, § 155.1200(c) External Audits, the Exchange must engage an independent qualified auditing entity which follows generally accepted governmental auditing standard (GAGAS) to perform an annual independent external financial and programmatic audit and must make such information available to the Department of Health and Human Services (HHS) for review.

In addition, 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F – Audit Requirements, § 200.501(a) and (b) requires a non-federal entity that expends $750,000 or more during the non-federal entity’s fiscal year must have single or program specific audit conducted for that year in accordance with § 200.514 Scope of audit except when elected to have a program-specific audit.

As summarized, 2 CFR § 200.514 Scope of Audit, encompasses an audit of Covered California’s financial statements in accordance with GAGAS and generally accepted accounting principles (GAAP); an assessment of internal control over Federal programs; compliance with Federal statues, regulations, and the terms and conditions of Federal awards that may have a direct and material effect; follow-up procedures on prior audit findings for reasonableness; and completion of the data collection form as part of the report submission.

According to 2 CFR § 200.512 Report Submission, the Single Audit must be submitted by the earlier of 30 calendar days after receipt of the auditor’s report(s), or nine months after the end of the audit period to the Federal Audit Clearinghouse (FAC).  Covered California must electronically submit to the FAC the data collection form and the reporting package must include the following:

  • Financial statements and schedule of expenditures of Federal awards
  • Summary schedule of prior audit findings
  • Auditor’s report(s)
  • Corrective action plan
  • A copy of any management letters issued by the auditor

Details & Downloads


RFP 2015-31 Print Fulfillment Services

​The purpose of this RFP is to obtain print and fulfillment services to support the Outreach, Education and Enrollment functions of Covered California. 

Covered California is a rapidly evolving organization with need for a Print and Fulfillment vendor that can manage complex collateral production, mailings and distribution needs across California.  Collateral pieces will be used by the statewide outreach, education and enrollment network to raise awareness of and educate consumers.  Messages and or piece components may be changed based on refinement requirements, and it is important for Covered California to partner with a vendor that can assist in balancing appropriate production approaches to meet demand for materials, while minimizing waste of stored materials that may be updated or replaced with new versions. Critical to success is the ability to maintain awareness of utilization and versions of materials that are in circulation.

In addition to managing production, the selected Contractor will be required to manage order accounts for multiple grantees, entities and partners.

Covered California reserves the right to retain the services of the organization selected as a result of this RFP to assist with other related activities and projects embarked upon by Covered California during the established contract period, or through a contract amendment.

Details & Downloads


Qualified Health Plan Certification Application For Plan Year 2017 Covered California for Small Business

Covered California will accept Letters of Intent to Apply until 4:59pm PST April 15, 2016. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.


RFI 2016-03 EAP

​The purpose of this RFI is to gather information on technical solutions in the marketplace that could satisfy the requirements for a new EAP automated solution and obtain high-level cost estimates for comparative analysis. ​

Details & Downloads


IFB 2015-30 Invitation For Bid Fitness For Duty - Psychological Evaluations

Contractor shall provide Employee Fitness For Duty Psychological Evaluations to determine an employee’s capacity to perform their job functions, for one or both of the following Covered California regions, with a contract term through June 30, 2017.

Region 1:
Fresno Service Center, 7202 N. Palm Avenue, Fresno, CA 93711

Region 2:
Headquarters Office, 1601 Exposition Boulevard, Sacramento, CA 95815 Rancho Cordova Service Center, 10877 White Rock Road, Rancho Cordova, CA 95670 CalHEERS Field Office, 2329 Gateway Oaks, Suite 100, Sacramento, CA 95833

Details & Downloads


IFB 2015-29 Employee Fitness For Duty - Physical Evaluations

Contractor shall provide Employee Fitness For Duty Physical Evaluations to determine an employee’s capacity to perform their job functions, for all of the following Covered California locations, with a contract term through June 30, 2017.

Headquarters Office, 1601 Exposition Boulevard, Sacramento, CA 95815
Rancho Cordova Service Center, 10877 White Rock Road, Rancho Cordova, CA 95670
CalHEERS Field Office, 2329 Gateway Oaks, Suite 100, Sacramento, CA 95833

Details & Downloads


RFP 2015-26 Actuarial Services

The purpose of this RFP is to acquire health and dental insurance actuarial services to support a range of Plan Management activities, particularly for the certification, recertification, and decertification of Qualified Health Plans (QHP), including the certification of new QHPs for plan years 2017, 2018, and 2019. In addition, Covered California will need actuarial services to support the operation of its ongoing business in an efficient and effective manner.

Details & Downloads


Qualified Health Plan Certification Application For Plan Year 2017 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 19, 2016. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.


Qualified Health Plan Certification Application For Plan Year 2017 Covered California for Small Business

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 19, 2016. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.


Qualified Dental Plan Certification Application For Plan Year 2017 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 19, 2016. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.


Qualified Dental Plan Certification Application For Plan Year 2017 Covered California for Small Business

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 19, 2016. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.


RFP 2015-25 Tribal Consultation Services

The purpose of this Request for Proposal is to provide Covered California with subject matter experts in Indian affairs who will be able to deliver updates on all anticipated new and changing provisions in state and federal law that protect American Indians/ Alaskan Natives (AI/AN) and affect the Indian health care delivery system. Covered California will use this information to evaluate and incorporate changes into policies, procedures, software systems and promotional materials as needed. The selected Contractor will also provide an updated comprehensive contact list of Tribes, Tribal health programs and urban Indian health programs, will be responsible for the planning, organizing, and facilitating of an annual Tribal consultation, and coordinating and leading Tribal Advisory Group meetings, as requested.

Details & Downloads


RFP 2015-21 Chief Actuary

The Exchange is seeking the services of a Chief Actuary/Director of Research to advise the Exchange on the impact and long-term success of the Exchange in the areas of financial sustainability, health care cost containment, and evaluations of outcomes and analytics. In order to support and sustain the operation of the Exchange when federal funds are no longer available, the Chief Actuary will develop a comprehensive financial sustainability plan which guides the development, implementation and operation of the Exchange. 

Details & Downloads


RFP 2015-22: Health Insurance Market Analysis and Planning

​The purpose of this RFP is to assist the Covered California with its near and long-term financial and business planning to support establishment of the marketplace. The implementation of the ACA ushered in a very dynamic health insurance marketplace which contains many potential risks and opportunities. Covered California must consider how potential future developments could impact its enrollment and present opportunities for further growth.

Details & Downloads


IFB 2015-20 Invitation For Bid 2015-20 Fitness For Duty - Physical Evaluations

​Contractor shall provide Employee Fitness For Duty Physical Evaluations to determine an employee’s capacity to perform their job functions, for one or both of the following Covered California regions, with a contract term through June 30, 2017.

Details & Downloads


RFP 2015-19 Quality Rating System – Analysis and Implementation for Plan Year 2017 and 2018; Provider Cost and Quality Performance for Provider Directory

​The purpose of this RFP is to secure the services of a qualified Contractor that will support and provide guidance to the Chief Medical Officer and other key personnel with the analysis and implementation of a QRS for Plan Year 2017 and 2018.

Details & Downloads


RFP 2015-18 2017 Qualified Health Plan (QHP) Issuer Model Contract and Standardization of Evidence of Coverage (EOC)

​The purpose of this solicitation to secure the services of a Contractor to update and finalize the 2017 QHP Issuer Model Contract and standardize the 2017 EOC document for Covered California Health Plans.

Details & Downloads


RFP 2015-17 QHP Certification Project Management Support

​The purpose of the solicitation is to provide services to the Exchange that will support and refine the process of evaluating bids that will lead to selection of the most qualified and cost-effective Qualified Health Plans for the State beginning in February 2016. Services will include, but not be limited to, procurement support, support in transitioning this function to a State staff-driven process, resource allocations and workforce planning, and the ability to provide subject matter experts where identified. Services will not include responsibility for making QHP selection decisions.

Details & Downloads


RFP 2015-16 Health and Dental Plans Certification Application Technical Support

Provide a technical solution for the collection and review of the 2017 certification applications.

For Plan Year 2017, the Exchange will certify all QHP and QDP applicants during the annual solicitation period which only occurs over three (3) months of each year. The process will include new and existing QHP and QDP bidders. Bidders must demonstrate that their proposed plans meet or exceed the Exchange’s certification standards which include offering adequate provider networks; meeting or exceeding accreditation and quality requirements; proposing best practices and innovations in delivery system reforms; and other detailed and unique standards for the geographic areas they propose to serve. The Exchange will select and certify QHPs and QDPs based on their ability to meet or exceed the Exchange’s certification standards and that offer value and distinct choice and quality healthcare at an affordable cost.

The Exchange will require the technical support services of a Contractor with the system capability to collect the data submissions of individual product offerings for both the individual and small group markets from QHP and QDP Issuers for Plan Year 2017. This Request for Proposal (RFP) will be for a two (2) year contract spanning two annual solicitation cycles which includes the Certification and Recertification of QHPs and QDPs for Plan year 2018 as well as the 2017 Certification solicitation.

Details & Downloads


RFP 2015-15 Vision Plan

The purpose of this solicitation is to help consumers connect with and obtain coverage from quality vision plans. Covered California is conducting this Request for Proposal (RFP) to solicit applications from vision plans interested in offering coverage to Covered California consumers.  Covered California will select vision plans through this RFP process.  Covered California will provide a link for consumers from the Covered California website to selected vision plans’ websites. 

Details & Downloads


IFB 2015-14 Invitation For Bid 2015-14 Fitness For Duty - Psychological Evaluations

Contractor shall provide Employee Fitness For Duty Psychological Evaluations to determine an employee’s capacity to perform their job functions, for one or both of the following Covered California regions, with a contract term through June 30, 2017.

Details & Downloads


RFP 2015-07 Small Business Outreach, Education, & Marketing

The purpose of this RFP is to increase the number of small businesses enrolled in Covered California for Small Business by providing strategies and implementing tactics to efficiently and effectively reach small business owners by leveraging existing relationships with small business organizations, chambers of commerce, and local community organizations.

Details & Downloads


RFP 2015-08 Call Center Services

The purpose of this solicitation is to procure call center services (voice, chat, and data entry) during the projected peak call volume periods of November, 2015 through February, 2016. 

Details & Downloads


Request for Information - Web Based Entities

The purpose of this Request for Information (RFI) is to gather information on potential solutions available to Covered California for:

  • One or more online consumer-facing retail agent(s), known as Web Based Entities (WBEs) (inclusive of application entry and plan selection), and/or
  • One or more platform(s) and/or software product(s) that enable independent agents to obtain web-based quotes for their clients or prospective client(s), while meeting program compliance requirements of the California Health Benefits Exchange (Covered California).

The information sought includes:

  • An accounting of both quantitative and qualitative potential benefits to enrollment, including Medi-Cal enrollment.
  • The complexity, maintainability, and potential total costs of potential solutions,
  • The contribution of potential solutions to the mission, goals, and values of Covered California. 

Download


RFP 2014-40 Audit A-133

The Exchange seeks a Contractor who will provide the Exchange professional assistance to: prepare financial statements, including related notes, in compliance with U.S. Generally Accepted Accounting Principles (GAAP); conduct an audit of the Exchange's financial statements in accordance with auditing standards generally accepted in the U.S. and the standards for financial audits contained in GAGAS; prepare an opinion as to whether the presentation of the financial statements prepared by the Exchange conform to U.S. GAAP; perform tests of accounting records and other procedures, including an assessment of the risks of material misstatement of financial statements; evaluate the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by the Exchange, and evaluate the overall financial statement presentation. Certain limited procedures will be performed as required by auditing standards generally accepted in the U.S and GAGAS; perform audit procedures with respect to the Exchange's federal program in accordance with the provisions of OMB Circular A-133 Audits of States, Local Governments and Non-Profit Organizations. OMB Circular A-133 includes specific audit requirements, mainly in the areas of internal control and compliance with laws, regulations, contracts, and grant agreements that exceed those required by Government Auditing Standards; perform tests to evaluate the effectiveness of the design and operation of internal controls relevant to preventing or detecting material noncompliance with laws, regulations, contracts and grant agreements; provide one training session to the Financial Management Division and Program Integrity Division staff, with training to include an assessment and recap on the preparation of financial statements, detailed worksheets, and explanation of the preparation of adjusting entries; provide a document with recommended future fiscal years GAAP adjustments, with emphasis on adjustments related to sustainability funding; provide up to eight hours of consultation services on an as-needed basis.

Details & Downloads


RFP 2015-04 Tribal Consultation Services

The purpose of this Request for Proposal is to provide Covered California with subject matter experts in Indian affairs that will be able to deliver updates on all of the anticipated new/ changing provisions in the law that protect AI/AN and affect the Indian health care delivery system so that Covered California can evaluate and incorporate changes into policies, procedures, software systems, and promotional materials as needed. The Contractor will also provide an updated comprehensive contact list of Tribes, Tribal health programs and urban Indian health programs, be responsible for planning, organizing, and facilitating the annual Tribal consultation, and coordinating and leading Tribal Advisory Group meetings, as requested.

Details & Downloads


RFP 2014-38: Translation, Readability and Focus Group Testing

The purpose of this RFP is to provide readability, translation and consumer focus testing services to Covered California in English, Spanish (including California Latino cultural nuances), Traditional Chinese, Korean, Vietnamese, Tagalog, Hmong, Russian, Armenian, Farsi, Khmer, and Arabic; and, conduct a community review of translated materials prior to delivering a final translated document to Covered California. This includes soliciting and accepting recommendations from advocates and key stakeholders in coordination with Covered California.

Details & Downloads


Solicitations RFP 2015-05 African American Enrollment Initiative

The purpose of this solicitation is to procure a qualified vendor to conduct outreach and support for enrollment of the 130,000+ subsidy eligible African Americans in the state of California. The vendor will assist in identifying target rich communities for outreach, education and enrollment carried out by navigators and certified enrollment agents.

Details & Downloads


RFP 2015-01 African American Enrollment Initiative

The purpose of this RFP is to procure a qualified vendor to conduct outreach and support for enrollment of the 130,000+ subsidy eligible African Americans in the state of California.

Details & Downloads


RFP 2014-41: Business Process Management Support

The purpose of this solicitation is for Covered California to obtain consultant services to provide business process management support to facilitate the transition from startup operations to maintenance operations. The consultants services will promote Covered California’s business effectiveness and efficiency while striving for innovation, flexibility, and integration with technology. Covered California requires technical assistance to enable the organization to be more efficient, more effective and more capable of change.

Details & Downloads


RFP 2014-24: Plan Year 2016 Qualified Health and Dental Plan Certification/Recertification Project: Rate Review and Application Assessment and Reorganization and Training of the Plan Management and SHOP Sales Divisions

The purpose of this solicitation is for Covered California to solicit a contractor to create and manage summary output assessments to support the Plan Management Division with the Qualified Health and Dental Plan Certification/Recertification Project, with a focus on Rate Review and Application Assessment and to assist with the Reorganization and Training of the Plan Management and SHOP Sales Divisions.

Details & Downloads


RFP 2014-22 Salary Survey

The purpose of this solicitation is for Covered California to solicit a contractor to conduct a salary survey using two methodologies that will allow the Covered California to identify appropriate peer organizations for industry-specific roles, as well as understand the broader industry for jobs that have a wide market for talent. Additionally, the Contractor will collect compensation data and benefits data related to these positions. Finally, the Contractor will perform data analysis on the data collected and prepare a final report.

Details & Downloads


RFP 2014-18 Public Relations Campaign

The purpose of this solicitation is for Covered California to solicit proposals from qualified public relations agencies to provide multi-segment and multi-language, integrated communications services through a statewide public relations campaign with the goal of educating subsidy and non-subsidy consumers about Covered California’s services, while maintaining current members and attracting new members during open enrollment and special enrollment.

Details & Downloads


RFP 2014-20 Advertising & Marketing Campaign

The purpose of this solicitation is for Covered California to solicit proposals from qualified advertising agencies to provide multi-segment and multi-language, integrated communications services through a statewide media campaign with the goal of educating subsidy and non-subsidy consumers about Covered California’s services and maximizing the number of Californians enrolled in health insurance coverage.

Details & Downloads


QHP Certification and Recertification Applications for Plan Year 2016


QDP Recertification Application for Plan Year 2016


RFP 2014-19 – Premium Accounting

Part of the CalHEERS Project is the development of premium accounting and reconciliation functions, which includes compensating assisters. This work entails working with the health plans to perform accounting and reconciling of premium payments, calculating and collecting the California Health Benefit Exchange’s (Exchange) fee, developing and implementing the accounting and cash processes to compensate Assisters, and establishing proper controls and fraud prevention that will be associated with the continued implementation of the Exchange.

The purpose of this Request for Proposal (RFP) is to obtain the services of consultants to provide the Exchange with premium accounting and reconciliation support.

Details & Downloads


RFP 2014-21 – Audit Services

The purpose of this solicitation is to procure a contractor to perform a programmatic audit for the calendar year ending December 31, 2014. The audit will be conducted in accordance with the Generally Accepted Government Auditing Standards (Yellow Book). This programmatic audit will assess Covered California compliance with Title 45, Code of Federal Regulations (45 CFR) Part 155, Subparts C, D, E, and K for both the Individual Market and the Small Business Health Options Program (SHOP), and with the privacy and security standards stipulated at 45 CFR 155,260(a(3).

Details & Downloads


RFP 2014-05 - Community Outreach

Covered California requires strategic leadership and consulting services to under-serviced communities for the purposes of education and enrollment. Individual proposals will be specific to an identified community (ie; African American, Latino, Asian-Pacific Islander).

Details & Downloads


2016 QHP and QDP Certification and Recertification

The California Health Benefit Exchange/Covered California is seeking renewal and new entrant applications from issuers proposing to sell Qualified Health Plans (QHP) and Qualified Dental Plans (QDP) through the Exchange for Plan Year 2016.

In the links below please find information related to submitting applications. Please submit completed Notice of Intent with a cover letter. Only applicants who have submitted a Notice of Intent will be given access to on-line applications (non-PDF) which will be made available on March 2, 2015.


RFP 2013-08: Enterprise Analytics Solution

Covered California is seeking an analytics solution. Covered California encourages all interested parties to fully review this Request for Proposal (RFP), and if qualified, to respond.

Details & Downloads


Solicitations Archive