Supplemental Medicare Insurance Services

The Vendor is required to provide a plan that is similar in all respects to the current medicare supplement plan and group agency.
- Company must be a medicare approved agency sponsor with a history of good standing with the centers for medicare & medicaid services (CMS).
- Company should be able to demonstrate ability and experience processing medicare agency, vision and dental claims.
- Must have an established communication strategy that includes mail, phone and web channels.
- Maintain accurate enrollment information.
- Review and prepare compliant prototype plan documents.
- Respond to inquiries from plan participants regarding benefits.
- Provide information concerning plan benefits and participants to agency and any other party indicated by agency.
- Review and analyze all claims and determine whether the charges are within reasonable payment guidelines.
- Correspond with claimants, as necessary, to process claims and to ascertain whether other coverage exists which might pay the claim in whole or in part.
- Receive, review and administer all agency, vision and dental claims for benefits under the agency medicare agency plan, including evaluation of claims made.
- Aid agency in developing an efficient claims control program.
- Provide schedule an information for the employer 5500 filing.
- Provide agency with a regular reporting of claims paid and fees charged.
- Provide act portability and privacy services.
- Company should provide a toll-free telephone line for customer service.
- A representative(s) of the company will be available by phone during normal working hours for customer service.
- Provide flexible premium payment arrangements.
- Company will provide reporting necessary for administration of the plan.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: May 21, 2025