By Jason Coon
July 1 renewal season is here.
Across the country, Catholic colleges, dioceses, ministries, and apostolates are preparing to issue RFPs for health plans. Spreadsheets are being updated. Claims data is being scrubbed. Consultants are modeling renewals. And in most cases, the process will follow a familiar pattern.
Cost comparisons.
Network access reviews.
Administrative fee negotiations.
A few paragraphs about Catholic values.
A short list of exclusions.
Then, a decision. From a purely financial perspective, that may feel sufficient. From a Catholic governance perspective, it is not.
We are operating in a healthcare ecosystem that has changed structurally — technologically, culturally, and legally. Clinical decision-making is now automated. Formularies are shifting to comply with federal regulations. Patient advocacy programs are turned on without human oversight. Embedded vendors that are automatically part of the proposals bring their own assumptions about what constitutes “appropriate care.”
The risk to Catholic institutions is no longer obvious or confrontational. It is quiet. Structural. Algorithmic. And most RFP processes have not evolved to address that reality.
This season presents something larger than a procurement exercise. It presents a governance moment.
The Illusion of Alignment
Acheiving faith and mission alignment with vendors is not just getting a “Yes” to whether they respect your organization’s Catholic Identity. It’s also about system design and building it so that secular defaults don’t kick in.
A Catholic institution may have exclusions written into its plan document. Yet its Pharmacy Benefit Manager (PBM) might have standard formulary lists that go out to employees and include contraceptives.
A telehealth vendor may automatically triage cases and send patients toward services that are inconsistent with Church teaching.
A behavioral health carve-out may subcontract with entities whose clinical philosophy directly conflicts with Catholic beliefs about the nature of the human person.
None of this happens maliciously. It happens because most healthcare systems are built on secular defaults. Many providers bundle multi-vendor services into their offering. Have you ever looked at them all?
If we are honest, many Catholic RFPs still assume that excluding what I call the “Big 5” services (contraception, abortion, sterilization, infertility, and gender transition) is enough to protect their mission.
It is not.
Real mission alignment is acheived by weaving the mission and Catholic values into workflows, contracts, coding structures, and vendor oversight mechanisms. Without structural reinforcement, even well-intentioned plans drift.
Delegating Ministry Without Realizing It
When a Catholic employer selects a health plan administrator, it is delegating a portion of its ministry, and that has concrete impacts. Health plans influence decisions about fertility, end-of-life care, gender confusion, mental health treatment, pharmaceutical usage, and family formation. They shape employee experiences at vulnerable moments.
We’ve seen this through employee questions to our member leadership – “Well, I just don’t know why we don’t cover contraception?”
What a teaching moment on mission-alignment and our faith.
If the Church has long recognized that hospitals, universities, and charities must reflect Catholic teaching, then it follows that benefit programs must as well.
The problem is that many RFP processes treat vendors as vendors — not as partners participating in institutional mission.
A more mature RFP process asks harder questions:
- Does this firm understand Catholic moral theology beyond surface-level exclusions?
- Does it have internal governance structures to protect our identity
- Are its incentives aligned with our mission?
- Will it defend our religious liberty if pressured?
These are not culture-war questions. They are fiduciary ones.
The Regulatory Undercurrent
At the same time, the legal environment affecting religious employers continues to evolve.
Just in the last several years we have seen interpretations of nondiscrimination law shift, state mandates expand into fertility and reproductive services, federal agencies reinterpreting gender identity provisions, and mental health parity enforcement intensifying.
For Catholic employers, compliance and conviction must coexist.
That requires advisors who understand not only ERISA and ACA reporting — but also religious exemptions, CBA-informed protections, and the jurisprudence surrounding faith-based institutions.
An RFP that does not explicitly evaluate a respondent’s strategy for preserving religious liberty is incomplete.
Protection must be proactive. Waiting for conflict is not governance.
Moving From “Values-Based” to “Structure-Based”
Many Catholic institutions will discuss their values and mission as part of who they are. But values do not protect institutions. Structures do.
A sophisticated RFP process does three things simultaneously:
- It defines non-negotiable moral parameters with clarity.
- It requires operational proof that vendors can enforce those parameters.
- It embeds oversight and audit mechanisms that prevent erosion over time.
That shift — from aspirational alignment to structural protection — is where the real work lies.
It requires leadership willing to say: “Our Catholic identity is not a marketing point. It is a governing principle.”
Raising Expectations
While ensuring we are doing a great job of excluding the “Big 5”, there is a real opportunity and hunger for a Catholic health experience that adds faith-aligned benefits structure.
A stronger support structure asks: Why shouldn’t Catholic employers expect more? More transparency from PBMs. More fiduciary clarity from brokers. More disclosure from TPAs about subcontractors.
And it can go further by adding pro-family and marriage coverage.
- Natural Family Planning coverage supported by local and telehealth services
- Restorative Reproductive Medicine (RRM) services treating underlying conditions
- Catholic marriage and family concierge and coaching support
Mission alignment is not a constraint on excellence; it is a driver of it. When Catholic institutions raise their expectations, the market responds.
The Decision Before the Decision
Long before pricing comparisons are finalized, there is a more fundamental decision to be made: Will this RFP simply test the market? Or will it strengthen the institution?
One path produces marginal savings and familiar vendors. The other produces a benefits structure intentionally aligned with Catholic anthropology, legal prudence, and long-term governance stability. The difference is not in the formatting of the RFP document. It is in the seriousness with which leadership approaches it.
A Final Thought for Leaders
A final question for leadership to consider this year: “Have we built our RFP process to protect who we are?” Not just what we exclude. Not just what we save. But who we are. Because in this environment, identity left unguarded is eroded.
RFP season offers a real opportunity to strengthen Catholic institutional fidelity.
If you need some help in walking through your RFP process this year, reach out to the Catholic Benefits Association and our Health Care Benefits Consultative Services Division for guidance. We are here to serve our members.