Challenges to contract rejected by State Health Plan

State Treasurer Dale Folwell

RALEIGH — State Treasurer Dale Folwell announced on Jan. 20 the State Health Plan (SHP) had rejected protest appeals for the Third-Party Administrative Services (TPA) contract submitted by the losing bidders; Blue Cross NC and UMR, Inc.  

“It’s embarrassing to see entities trying to confuse our members by falsely advertising information regarding Plan benefits, which only leads to unnecessary member confusion,” Folwell said in the release.  

“I’m proud of what the staff accomplished in the RFP process and the decision of the board. It is disappointing and unfortunate that others have used this as an opportunity to attack our integrity and carry out malicious accusations against the Board of Trustees and the professional staff of the State Health Plan,” said Folwell. “The money and time would have been better spent improving their systems.” 

The SHP’s Board of Trustees TPA contract for services was awarded to Aetna upon the completion of a Request for Proposal (RFP) competitive bid process. That contract is set to begin in 2025. 

The rejection of the appeals by the SHP for the lucrative contract likely mean official legal challenges may be on the horizon.  

According to the press release and Folwell’s office, the RFP process was “thoroughly explained to all bidders prior to it being issued and any bids being received.” That process began in June 2022 with the contract being awarded on Dec. 14 of that same year. Aetna, Blue Cross NC, and UMR, Inc. all participated in a debriefing event the following day; Dec. 15.  

Each response was evaluated and scored by SHP staff according to the criteria established with the SHP Board of Trustees later unanimously voted to award the TPA to Aetna. 

The release states explanation letters were sent to Blue Cross NC and UMR, Inc. on why their appeals were rejected, with the release stating both were found to be “without merit.” 

“Responding to an RFP is completely voluntary,” Interim Executive Director Watts said in the release. “Arguing that if the questions were asked in a different way or graded differently the outcome would have been different is not how procurement works.” 

In a call with reporters earlier in January, Folwell underscored that the TPA does not determine what benefits are covered, co-pays, or the price of premiums. The TPA Is only an administrative function and the transition to Aetna does not impact plans currently in place. 

The release states “Aetna has already begun a vigorous effort to recruit even more providers and will only continue to do so over the next two years.” 

The SHP covers upwards of 740,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents. 

About A.P. Dillon 897 Articles
A.P. Dillon is a North State Journal reporter located near Raleigh, North Carolina. Find her on Twitter: @APDillon_