HMO Specifications for the
New York State Health Insurance Program
Overview
ENTITLED: "Health Maintenance Organizations Specifications for the New York State Health Insurance Program"
Release Date: January 10, 2025
Proposal Due Date: March 4, 2025 3:00 p.m. ET
The HMO Specifications has been Amended as of February 28, 2025All inquiries, questions, filings and submissions must be directed in writing to:
NYS Department of Civil ServiceAttn: Office of Financial Administration
Swan Street Building, Core 1, Empire State Plaza
Albany, New York 12239
E-mail: DCSprocurement@cs.ny.gov
Table of Contents
Specifications
Health Maintenance Organizations Specifications for the New York State Health Insurance Program Amended
Appendix
APPENDIX A - Standard Clauses for New York State Contracts, June 2023
APPENDIX B -Standard Clauses for All Department Contracts, March 2024
APPENDIX C - Information Security Requirements, August 2024
APPENDIX D - Insurance Requirements
Attachments
ATTACHMENT 1 - Offeror Affirmation of Understanding and Agreement
ATTACHMENT 2 - Procurement Lobbying Policy
ATTACHMENT 3 - Formal Offer Letter
ATTACHMENT 4 - Questions Template
ATTACHMENT 5 - NYS Department of Civil Service Debriefing Guidelines
ATTACHMENT 6 - Offeror Certifications Form Amended
ATTACHMENT 8 - Non-Material Deviations Template
ATTACHMENT 9 - Key Subcontractors or Affiliates
ATTACHMENT 10 - PLACEHOLDER
ATTACHMENT 11 - Freedom of Information Law Request for Redaction Chart
ATTACHMENT 12 - PLACEHOLDER
ATTACHMENT 13 - Glossary of Defined Terms
ATTACHMENT 14 - Notice of Intent
Exhibits
EXHIBIT 1 - JLMC Contact Members
EXHIBIT 2 - Prescription Drug Benefit Form
EXHIBIT 3 - Wellness Programs - Activities Chart
EXHIBIT 4 - Current Five Largest Employer Groups Chart
EXHIBIT 5 - NYSHIP Enrollment by NYS County and by State
EXHIBIT 6 - Employer Premium Contribution Rates
EXHIBIT 7 - 2024 NYSHIP Dependent Eligibility Rider
EXHIBIT 8 - 2024 Health Fair and Events
EXHIBIT 9 - Medicare Enrollment Report Format and Frequency
EXHIBIT 10 - PS - 451 Statement of Disability
EXHIBIT 11 - NYSHIP Enrollment by Group
EXHIBIT 12 - SAMPLE Schedule of Benefits
EXHIBIT 13 - SAMPLE Side-by-Side Comparison
EXHIBIT 14 - Timeline of Key Events for Plan Year 2026
EXHIBIT 15 - NYSHIP Authorization for Release of Protected Health Information
EXHIBIT 16 - Medicare Disenrollment File Layout
EXHIBIT 17 - PS-457 Statement of Dependence
EXHIBIT 19 - HMO Rate Submission Template
EXHIBIT 21 - Commercial Benefits Chart
EXHIBIT 22 - Medicare Benefits Chart
EXHIBIT 23 - Quarterly Reconciliation File Layout