Supplemental Benefits for Non-Emergent Surgeries

The vendor is required to provide supplemental benefits for non-emergent surgeries to all district members covered under any of their self-funded medical plans.
- Offers a network of participating medical service providers, including physicians, hospitals, and other healthcare professionals and facilities, which is made available to covered members for medical, surgical, diagnostic treatment, and other medical care and care-related services (“network services”).
- Coordination of the delivery of network services to covered members by providing administrative, settlement, case management, travel, and other non-medical logistical services for the interaction among the participating care providers, employees electing to use such services, and the health plans responsible for payment for such services on behalf of the employees.
- Provide a high-performance surgical network to help reduce medical costs for the most commonly performed surgeries, such as:
• Hysterectomy
• Carpal tunnel
• Hernia repair
• Knee, spine, heart, shoulder & hip surgeries
• Bladder repair
• Rotator cuff repair
• ACL, mcl or PCL repair
• Pacemaker implant or replacement
• Bunionectomy
• Over 100 additional elective procedures
- Access to premier network of high-quality surgeons who have met / exceed rigorous screening standards for:
• Board certified
• Specialty training requirements
• Procedure volume requirements
• Sanctions and malpractice review
• Ongoing Recredentialing
- Full-service health concierge: members should receive assistance from a care advocate, including but not limited to:
• Providing member with a hand-picked selection of surgeon’s best suited for their specific needs.
• Scheduling consultations, operative and post-operative appointments.
• Arranging for the transfer of medical records to the appropriate physicians.
• Coordinating any travel (if required) for the procedure.
• Following up with the member after surgery.
- Financial incentives:
• Waived deductible and coinsurance for procedures through this program (except for members enrolled in the choice HSA health plan – 100% of costs covered after deductible is met).
- Communication materials:
- Provide custom materials for county for open enrollment communications, live well app, and other on-going initiatives throughout the year.  
- Contract Period/Term: 2 years
- A Pre-Proposal Conference Date: February 18, 2025
- Questions/Inquires Deadline: February 20, 2025