Group Health Benefits Consulting Services

The Vendor is required to provide employee benefits program supporting a large and diverse workforce, including medical, pharmacy, dental, vision, and other ancillary benefits.
- Requirement:
1. Strategic consulting and planning
•    Provide strategic guidance and long-term planning for the district’s health benefits program. 
•    Evaluate current plan design, identify cost-saving opportunities, and develop recommendations aligned with district goals. 
•    Provide insight on industry trends, best practices, and regulatory changes impacting employee benefits.
2. Financial and actuarial analysis
•    Analyze claims data, utilization trends, and financial performance of the district’s health plans. 
•    Provide forecasting, budgeting support, and actuarial analysis to assist in decision-making and cost containment strategies. 
•    Develop multi-year financial projections and assist in setting employer and employee contribution strategies.
3. Vendor management and procurement support
•    Assist the district with evaluation, selection, and ongoing management of third-party administrators (TPAS), pharmacy benefit managers (PBMS), and other benefits-related vendors. 
•    Support procurement activities, including development of specifications, evaluation of responses, and negotiation support. 
•    Assist with vendor renewals and performance monitoring.
4. Plan design and compliance
•    Provide recommendations on plan design, including medical, pharmacy, dental, and ancillary benefits. 
•    Ensure compliance with applicable federal and state regulations, including aca, HIPAA, COBRA, and other requirements. 
•    Monitor regulatory changes and advise the district on required updates.
5. Reporting and data analytics
•    Develop and deliver regular reports and dashboards related to plan performance, utilization, and cost trends. 
•    Provide actionable insights and recommendations based on data analysis. 
•    Conduct periodic audits, including claims audits and other program-specific reviews as requested.
6. Employee communication and support
•    Support the district in developing communication materials and strategies to inform employees about benefits offerings, plan changes, and enrollment processes. 
•    Assist with open enrollment activities and development of benefit guides and related materials.