Georgia Access for Business Services

The vendor is required to provide that provide, implement, and operate ga access for business, an employer health coverage solution separate from current shop functions.
- The solution must allow data entry of employer company information and employee census information.
- Requirements:
• Provide decision support tools widely available to employers and agents through the internet, without requiring security certificates or white-listing.
• Provide an employer portal that includes the following at a minimum
1. Account set-up and management.
2. Ability to upload an employee roster.
3. Ability to manually enter, view, and update an employee roster.
4. Available medical plan options.
5. Agent search and selection.
6. Plan shopping and selection.
7. Full time equivalent employee calculator.
8. Qualification for tax credits.
• System must allow capture of employer key contact and organizational information.
• Provide APIs or other tools to allow employers/agents to load large amounts of company and employee data without a great deal of manual entry.
• System must allow entry of current and/or renewal health coverage rates employer has currently been offered.
• System must allow entry of employee specifics, including age, gender, employee class, compensation, and other data points supporting selection of best coverage option.
• System must efficiently capture high-level information regarding employer priorities for health coverage set-up including planned contributions for employee classes for individual coverage health reimbursement arrangement (ICHRA)/ qualified small employer health reimbursement arrangement (QSEHRAs).
• System must allow agent working with employer to set consulting / agent fee along with acceptable state access for business guidelines.  for employers working through self-service without an agent, system must be able to set consulting/agent fee to a default determined by state access for business.
• System must perform and display comparisons of coverage options and anticipated costs relevant to this specific employer and locations for employees, to include commercial group coverage, shop coverage, ICHRA/QSEHRAs.
• Cost displays must include all costs that employers will be responsible for a fully transparent cost comparison.
• System must calculate estimated affordability by employee and provide feedback to employer/agent as to affordability in total, by class, and at individual employee level.
• System must allow decision support tools to be utilized without creating an account, but also allow account creation during later steps so that employers/agents interested in saving their work will not need to start over.
• System must allow agents to manage their own accounts and create and manage numerous employer quotes.
• System must allow modification of entered information and goals and re-running of comparative calculations.
• System must allow saving information and quotes to be able to be re-accessed without having to re-enter all information.
• System must allow printing/exporting of comparative materials in written and pdf form in well-formatted documentation.
• System must provide relevant next steps and contact information if the employer opts either for group coverage or shop coverage.
• System must provide easy mechanism for employers to search for agents who will work with them on group coverage.
• System must provide easy way for employer to contact state access for business if working in self-service mode and requiring assistance.
• System must store and make information available to reporting tools that can track and report activity in a number of different data cuts (e.g., by employer size, by specific agent, by self-service, etc.).
• For all user-facing interfaces (decision support, employer plan set-up, employee shopping, etc.), system must provide information to consumers in language that is approved by state access.
• For all user-facing interfaces, system must inform consumers about the availability and use of accessibility services for each engagement channel.
• For all user-facing interfaces, system must maintain compliance with all applicable requirements defined in title ii of the with disabilities act (ADA).
• For all user-facing interfaces, system must provide features and functionality that enable disabled consumers (employers, employees) to have access to the same information and services as non-disabled consumers.
• For all user-facing interfaces, system must manage communications and correspondence in multiple languages to include at least english and Spanish.
• For all types of user account, system must allow account management tasks via self-service, including at a minimum:
1. Reset account passwords.
2. Retrieve user ids.
3. Update account settings.
4. Update personal information.
5. Perform account activation and deactivation.
- Employer consolidated billing
• Supplier must provide the ability to aggregate premiums across multiple issuers for all the employees of a specific employer.
• Supplier must ensure that the billing system with the enrollment system and will allow retroactive adjustments to both coverage and bills under state access-approved scenarios.
• Supplier must provide employers summary and detailed bills describing their employee premium information, their commitment as employer for ICHRA/QSEHRA contributions, and employee compensation withholds to address additional premium costs.
• Supplier must provide detailed invoices to employers on a regular, predictable basis.
• Supplier must include retroactive adjustments on new invoices as appropriate.
•Supplier must provide support to assist with timely payments, such as reminder messaging about overdue invoices.
• Supplier must establish and manage a delinquency process for employers who do not make payments within established timeframes.
• Supplier must be able to create and send all invoices, as well as store and make them securely available to appropriate parties electronically.
• Supplier must be able to brand invoices and other billing-related communications with state access for business branding.  
• Supplier must establish and maintain an accounting system with procedures and practices in accordance with generally accepted accounting principles (GAAP):
1. Supplier must provide GAAP compliant summary level accounting transactions for all general ledger-related entries, including but not limited to:
a. Revenue,
b. Cash and cash receipts,
c. Billing,
d. Accounts receivable,
e. Expenses,
f. Disbursements, and
g. Accounts payable.
• Supplier system must provide the ability to track delinquency status by account.
• Supplier system must provide the ability to configure delinquency business rules defined by state access.
• Supplier system must offer essential user roles, including agent and employer administrators to search for consumers, subscribers, and dependents and view necessary billing/payment details.
• Supplier system must provide readily available financial reports accessible via the premium aggregation and billing system's user interface.
• Supplier must establish and manage an account, pledging collateralization that is dedicated to receiving and disbursing premium payments from employers and employees on behalf of state access for business including a payment lockbox.
• Supplier must have the ability to accept the following forms of payment from employers: ach/eft, credit card, paper check, cashier’s check, and money order.
• Supplier must post all payments at a member level to support member level reconciliation and issuer payments; this includes accounting for:
1. Full payments.
2. Partial payments.
3. Overpayments.
4. Suspense account management.
5. non-sufficient funds.
6. Cash postings corrections and adjustments.
• Supplier system must automatically apply payments at the coverage month level, oldest open invoice to newest.  
• Supplier system must automatically update the group’s paid-through date when payment has been made.
• Supplier system must suspend employer overpayments until they can be applied to a current bill/billing run.
• Supplier system must be able to track agent / consulting fees and regularly remit the appropriate amount to respective agents.
• Supplier system must track payments which cannot be automatically applied in a separate suspense account for research.
• Supplier system must provide the ability to configure fees for insufficient funds.
• Supplier system must provide the ability to set up automated refunds using configurable parameters.  
• Supplier system must support the life cycle of a refund request from the point of request through the issuance of a check.
• Supplier system must provide refunds to employers with credit balances as requested.
• Supplier system must provide daily cash reconciliation processes between the contractor and the bank.  
• Supplier system must remit premiums to issuers on a configurable schedule.   
• Supplier system must pay issuers directly via various payment methods
• Supplier system must support management of consumer returned or undeliverable payments.
• Supplier system must allow employees who wish to remain in ICHRA after termination to pay through cobra but shall track cobra status and apply additional administrative fees (normally 2%).
• Supplier must provide a system user guide/manual for employer premium payments that will be available in the employer’s account.
• Supplier must provide a system user guide/manual for employees responsible for making payments for cobra plans.
- Employee plan shopping and enrollment platform
• Provide user portal features that support employee account management (only available to the creator of the account, any linked agent, and privileged state access for business staff) which must include at a minimum the ability to:
1. Establish a password protected account.
2. Enter and maintain contact information, including at a minimum:
- Multiple addresses.
- Multiple telephone numbers.
- Multiple email addresses.
- Alternate and emergency contact names.
- Names of individuals and organizations designated to act on the consumer's behalf.
- Designate a primary for each contact information item listed above
- Provide a built-in feature for secure electronic messaging in the various user portals that will serve as the default messaging service between the agency solution and all user groups.
4. Designate communication channel preferences for notices and correspondence.
5. Perform account management tasks via self-service, including at a minimum:
- Reset account passwords.
- Retrieve user ids.
- Update account settings.
- Update personal information.
- Perform account activation and deactivation.
- Submit applications, forms, documents, information, requests, and complaints.
- Save unfinished applications and forms with the ability to return to them later to complete them.
- View the status of submitted applications and requests.
- View and print electronic notices, forms, and documents associated with the account.
• Present all applicable employer and contribution information to employee and allow for editing of demographic and contact information.
• Allow entry of employee supplemental income information for the purposes of determining affordability of ICHRA / QSEHRA options.
• Provide calculation of affordability for specific employee for ICHRA / QSEHRA options available to them. • Provide guidance to employees in picking on-exchange or off-exchange plans based on affordability results, and support links to agency access on-exchange application for employees who choose this path.
• Electronically link consumers opting for on-exchange shopping to the agency access state-based exchange upon selection by the employee.
• Enable two-way electronic communication with on-exchange system in the case that employees opt to take advantage of ICHRA but still opt to enroll in plans on-exchange through the exchange platform (e.g., in scenarios where the family may receive subsidies on-exchange, and the employee wishes to enroll as a non-subsidized participant).
• Have the capability to load approved off-exchange medical plans into agency for purchase by employees.
• Have the capability to load approved off-exchange dental plans into agency for purchase by employees.
• Provide anonymous plan comparison for off-exchange plans without requiring employees to establish an account within agency.
• Provide consumer shopping and decision support features for individual off-exchange medical plans, which either must include directly or have easy link access to at a minimum:
1. Provider directory.
2. Formulary lookup.
3. Indicators of plan characteristics.
4.Consistent presentation of standard features of plans.
5. Emphasis placed on points of comparison selected by the consumer.
6. Comparison across plan metal tiers (bronze, silver, gold, platinum, catastrophic).
7. Monthly premium estimator.
8. Out-of-pocket cost estimator.
9.  Medical loss ratio.
10. Results of enrollee satisfaction surveys.
11. Enrollee commentaries about plans and issuers.
• Enable consumers to delegate authority to designated individuals, such as agents or authorized representatives, for purposes of facilitating plan selections and enrollments.
• Accurately calculate premiums for presentation to consumers using a defined methodology.
• Provide easily accessible links to the websites of issuers that offer approved off-exchange ICHRA / QSEHRA medical plans.
• Provide easily accessible links to the websites of issuers that offer approved off-exchange ICHRA / QSEHRA dental plans
• Allow consumers to select and enroll in approved off-exchange medical plans.
• Allow consumers to select and enroll in approved off-exchange dental plans.
• Provide all information to consumers in language that is approved by state access.
• Inform consumers about the availability and use of accessibility services for each engagement channel.
• Maintain compliance with all applicable requirements defined in title ii of the american with disabilities act (ADA).
• Provide features and functionality that enable disabled consumers to have access to the same information and services as non-disabled consumers.
• Manage communications and correspondence in multiple languages as required by applicable state and federal laws.
• Indicate enrollment deadlines and effective dates established by the employer.
• Provide on-screen notices and confirmations throughout the shopping and plan selection process.
• Provide appropriate electronic and written notices throughout the shopping and plan selection process.
• Track and reconcile individual plan commissions from issuers.
- Contract Period/Term: 1 Year
- Questions/Inquires Deadline: February 27, 2025