Self Insured Paid Family Leave Program Third Party Administrator Services

The Vendor is required to provide Third-Party Administrators (TPAs) to manage and administer its voluntary opt-in paid family leave (PFL) program in accordance with state workers’ compensation.
- Union-Specific Provisions and Coordination:
• Ensure that administration of PFL benefits aligns with collective bargaining agreements.
• Support integration with additional negotiated leave entitlements (FMLA overlays and accrual banks).
• Provide claim notices and determinations in formats agreed upon in union contracts.
• Work with the employer to address and respond to union concerns regarding leave denial or benefit determinations.
- Benefit calculation and payment:
• Proven accuracy in benefit calculations and payments aligned with state PFL wage replacement rates using state average weekly wage (SAWW).
• Disbursement of benefits in accordance statutory timelines.
• Distribute benefit payments to approved applicants via direct deposit, debit card, or manual check as selected by the applicant. 
• The awarded vendor will use funds from a designated account for this purpose. 
• All transactions will be recorded and made in accordance with statute and generally accepted accounting principles. 
• The awarded vendor will make available current and accurate data on transactions from the designated account.
1. Please confirm whether direct deposits can be divided among multiple bank accounts if desired.
• Provide an explanation of the overpayment recovery process.
- Customer service and employee support:
• Provide a dedicated state PFL knowledgeable customer service team with multi-channel support (phone, email, chat) call center for claimants and human resources representatives and provide information on the hours of operations.
• Multilingual support to accommodate diverse employee populations as required by state.
• Clear communication processes including status updates, notifications, reminders, and appeal assistance to employees and employer.
• An online portal for claim submission and employer oversight.
• An Interface that will integrate with UKG pro WFM and UKG pro HCM.
• A phone app for claim submission, account information, and question submission.
- Technology and systems:
• Advanced claims management system capable of electronic claim submissions, tracking, and automated workflows.
• Secure online portal for employers and employees to submit claims, upload documents, and check claim status.
• Ability to integrate with payroll systems for verification of wages and benefit calculations.
• Employer access to the claims system to review submitted and processed information for employee events.
• Employer can pull reports on claim volumes, determinations, and other variables.
• Claim submission by employees.
• Employees can confirm or update leave start dates and return to work dates.
• Employees can ask questions about, and see the status of, submitted claims.
• Report the expected frequency of duration of intermittent leave, and the actual occurrences of this leave when work is missed.
• The ability of employee and employer to see how much leave entitlement is left to use.
• Upload certification paperwork or other documentation supporting the need for leave.
• Employee and employer can review communications related to a claim.
• The ability to set communication preferences and update contact information.
• Indicate and make updates to bank information for direct deposit of benefit payments.
• Option to have taxes withheld from benefits that may be paid to employees.
• Allows healthcare providers to complete certification forms or other paperwork to show the existence of a serious health condition on the part of the applicant or the applicant’s family member.
- Technology integration and data security:
• TPA must provide a secure, encrypted data exchange with agency UKG pro WFM and UKG pro HCM systems.
• The awarded bidder shall be responsible for all costs of interfacing its system with agency.
• TPA should be able to provide technical support for questions, problems, or development of customized reporting.
• TPA system should have a quality control program to ensure data integrity and claimant confidentiality.
• TPA must have robust cybersecurity measures for data security and privacy controls including HIPAA and state cybersecurity regs to protect employee and employer data.
• Interface must include an enrollment file containing active employees and key indicators (full-time/part-time, waiver status, eligibility date).
• Interface must include an employment status file tracking hires, termination, appointment status, and eligibility status.
• Interface must include a waiver flag field to exclude from billing and claims eligibility.
• Integration with leave and attendance tracking systems.
• Implement strategies to prevent paying fraudulent claims resulting from identity theft.
1. Provide strategies for balancing fraud mitigation and identification with efficient and prompt claim resolution for applicants of valid claims.
- Contract Period/Term: 5 years
- Pre-Proposal Conference Date: July 2, 2025
- Questions/Inquires Deadline: July 2, 2025