Private Medical Benefits Administrator

Transport for London (TfL) is seeking to procure an Administrator for its Private Medical Benefit under new contract commencing on the 1 April 2027. The contract will run for an initial three-year period with an option to extend for a further two years (1+1), at TfL's sole discretion.
The Administrator will be expected to manage the Private Medical Benefit on behalf of TfL, including assessing claims and paying treatment costs. The scheme is currently financed via a trust with c. 7,100 employees and their eligible dependants. TfL does not guarantee any minimum number of Scheme Members or volume of activity under the contract.
The administration service is of critical importance to TfL. The successful Administrator will be expected to deliver high quality service to both TfL and the Scheme Members, including an efficient claims process, responsive member helpline and proactive account management support.
TfL is seeking an Administrator that can effectivley procure and manage medical treatment spend while supporting positive member outcomes. The selected provider should be able to demonstrate robust cost control capabilities and experience of managing claims spend through appropriate treatment pathways. This includes the use of mechanisms such as direct access to musculoskeletal services and open referral networks, which form part of the benefit design and help deliver an effective claims journey whilst controlling costs.
Bidders must also demonstrate their ability to manage the implementation and transition of the scheme effectively, ensuring continuity of service and minimal disruption to TfL and Scheme Members.
The estimated contract value stated within this notice is based on the anticipated administration fees and stop-loss insurance premiums over the maximum potential contract term of five years. The estimated value stated in this notice reflects projected administration fees and stop loss insurance premiums across the maximum potential five year contract term. The stated value is indicative only and should not be interpreted as a guarantee of contract spend, supplier revenue or membership levels during the term of the contract.