Administrative Services for Group Medical and Prescription Drug Coverage, And Reinsurance

The vendor is required to provide administrative services for group medical and prescription drug coverage, and reinsurance.
- Provide eligible employees, pre-65 retirees, cobra continuants, city council members, and their eligible dependents with qualitative and affordable medical and prescription drug programs.
- Ensure costs are managed effectively by accessing superior data management capabilities, understanding the cost drivers within the program, and taking advantage of enhanced cost and utilization management opportunities available in the marketplace while maintaining or enhancing quality
- Protect the city’s risk with a financially strong and well administered reinsurance program.
- Provide members with a program that offers broad network access and minimizes disruption for current members.
- Partner with a company that is able to provide accurate and efficient account administration, efficient billing and eligibility updates, as well as quality management reporting.
- Partner with a company that will provide superior customer service to plan members and to the city’s human resources and benefits staff.
- Current Medical and Prescription Drug Program:
A. Current Plan Design – Active Employees & COBRA Beneficiaries
• Point-of-Service (POS) plan.
• High deductible health plan (HDHP) with an HSA.
B. Plan Eligibility Requirements
1. Active full-time Employees
• Full-time employees are employees of the City whose positions are authorized as full-time.
• New employees have 31 days from date of employment to enroll.
• Coverage is effective the 1st day of the month following 30 days of employment
2. Active full-time Employees of the Airport Commission
• Full-time employees are employees of the Newport News Airport Commission whose positions are authorized as full-time.
3. Pre-65 Retirees
• Post-retirement benefits offered to retirees includes health insurance for retirees who meet the state Retirement System (VRS) or city Employees’ Retirement Fund (NNERF) criteria for age, years of service and are vested in either of the respective retirement plans.
• Airport retirees are also eligible for post-retirement coverage.
• Tier selection is made at the time of retirement and may be decreased but not increased in retirement.
• Vested employees who leave city employment before meeting the age and service requirements are not eligible for post-retirement health insurance.
• If a retiree elects to terminate the health coverage, the retiree is not allowed to re-enter the plan
4. Surviving Dependents of Covered Retirees
• An enrolled retiree’s enrolled dependents (spouse and eligible dependent children) who are eligible for a spousal or dependent annuity benefit may continue group medical coverage upon the death of the retiree, as long as the surviving dependents continue to pay the full required premium.
C. Premium Contributions
1. Active Full-time and Benefit Eligible Employees
• Employees' contributions as a percentage of budget rates are approximately 9% to 13% for the POS and 0% - 4.5% of the HDHP
2. Pre-65 Retirees
• NNERF retirees are eligible for an employer contribution towards retiree coverage, based on their length of service.
• The City also provides a contribution towards coverage of the retirees’ eligible dependents
• VRS retirees are not eligible to receive an employer contribution for retiree coverage and must pay the full cost for themselves and any eligible, covered dependents.
D. Plan Dependent Age Limits
• In compliance with the Affordable Care Act, children are covered until the end of the month in which they reach age 26.
E. Plan Changes
• No plan changes were made to the benefit plans for 1/1/25.
- Medical and Prescription Drug, and Reinsurance Assumptions and Options
A. Offerors should submit proposals assuming a shared risk funding arrangement. The shared risk funding arrangement should include:
• $325,000 SSL and Increase to SSL at $350,000 & $375,000.
• Specific Stop Loss on a Paid Basis and 24/12.
• Terminal Liability Option (TLO).
• No New Lasers for the length of the contract.
• 40% Rate Cap for the length of the contract.
• Guaranteed Renewable for the length of the contract. B. Current benefits as outlined in Attachments documents
• Assume a bundled award for medical, drug, and reinsurance. and
• Assume an unbundled award with separate administrators of medical, prescription drug, and reinsurance.
- Contract Period/Term: 12 months
- Questions/Inquires Deadline: March 14, 2025