The Vendor is required to provide benefits administrator having experience in the implementation of integrated benefits administration solutions – highly functional website customized specific to benefits offered, defined contribution capabilities, carrier connectivity that allows data feeds to carriers for updated employee information, consolidated billing and carrier payment, reconciliation, dependent verification/documentation services, COBRA administration, and ACA reporting.
- Core Administration Services
1. Eligibility Determination:
• Support waiting periods/effective date logic
• Receive and process data file from central source
2. Enrollment Support
• Capture enrollment elections
• Manage eligibility and enrollment across all benefit programs
• Support medical, dental, vision, life, disability, FSA, HSA, COBRA and voluntary benefits
• Administer open enrollment including employee-facing tools.
• Monitor elections requiring EOI and communicate to participants
• Accept/retain beneficiary designations
• Produce/distribute electronic confirmation statements
• Send (up to 5) summaries of enrollment elections to carriers
• Support documentation online
• Benefit Fair Support
3. Deduction Processing
• Calculate payroll deductions
• Notify client of EE elections/deductions in file format
• Processing for new hires and life events
• Maintain current, accurate records and data feeds with carriers and payroll.
4. Premium Reporting
• Calculate premiums
• Configure premium reports to summarize premiums
• Provide access to summary and participant level supporting detail (through online reporting tool)
• Provide Consolidated billing & Bill Reconciliation Services
5. Event Processing
• Process life events
• Notify employer and carriers of changes in electronic file
• Notify participants of change in coverage or cost
6. QMCSO Admin
• Receive orders from client (or their counsel)
• Manage enrollment/eligibility determination
• Qualify orders
7. Data Conversion
• Receive data for elections
• Manage enrollment/eligibility determination
8. Customer Service
• Dedicated Account Manager
• Customer Service Call Center available 8-6 EST, M-F
• Training for HR Staff and employees
9. Implementation
• Project Management and implementation plan
• Data conversion and Testing
• Parallel Testing Prior to Go-Live
• Enrollment site buildout and ongoing maintenance
10. Performance Standards
• Defined SLAs for accuracy, response time and file delivery.
• Regular performance reporting
- COBRA/HIPPA and Direct Bill Admin
1. COBRA Rights Notification
• Identify COBRA eligible participants
• Provide Initial COBRA rights notification to participant
• Provide HIPAA COCs as required
2. COBRA Enrollment
• Support COBRA decision making process through call center
• Process COBRA elections
3. COBRA Admin
• Perform COBRA direct billing and collections
• Track and remit premiums to employer monthly
• Process annual enrollment and coverage changes
• Track COBRA coverage periods and process terms
4. Direct Bill Admin
• Perform COBRA direct billing and collections
• Track and remit premiums to employer monthly
• Process annual enrollment and coverage changes
- Customer Service Center (Optional)
1. Security Maintenance
• Generate passwords
• Manage password changes
• Follow client-specific alternate security procedures
2. Call handling
• Provide toll-free number
• Provide call routing system
• ID caller’s employer via authentication process
• Provide CSRs
3. Service Center Hours
• Representatives: 8-6 EST, M-F
4. Call Monitoring
• Quality monitoring and evaluation of CSRs
• Provide client w/ call monitoring results
5. Call Tracking
• Record all employee calls
6. Performance Reporting
• Will be provided.
- Questions/Inquires Deadline: January 16, 2026
