Third Party COBRA and Retiree Billing Administration Services

The Vendor is required to provide customer service-oriented third party administrator (TPA) to provide consolidated omnibus budget reconciliation act (COBRA) and retiree billing administration of medical, dental and vision plans to eligible employees, retirees and dependents in accordance with federal/state laws and city policies.
- Insurance benefits include but are not limited to medical, dental and vision; provided by two fully insured health plan carriers (kaiser and blue shield), one fully insured dental plan, two self-insured dental plans and one self-insured vision plan.
- Determine whether a qualifying event has occurred, who is eligible, and when required notices must be furnished for COBRA and/or retiree participants. 
- Weekly reports listing separated employees, dropped dependents (including reason for coverage termination) and retiree information will be provided by the city.
- Notify all eligible participants of their continuation rights or termination of coverage, provide the participants an enrollment opportunity, and specify the monthly premium required to continue their current coverage under the plan.
- Distribute notices and election forms within 10 business days of notification of event via first-class mail.
- Send a notice of unavailability of continuation coverage, explaining the reasons a participant is not eligible for continuation coverage if a current or former employee requests COBRA coverage and is ineligible.
- Allow eligible participants to make necessary changes to their coverage upon a qualifying event.
- Billing and Payments
•    Establish billing, collection and reconciliation of insurance premiums and administrative fees for enrolled participants. 
•    All administrative fees will be paid by the participant or qualified beneficiary.
•    Receive and process duly executed COBRA /retiree election forms received and determine whether COBRA or retiree coverage is valid, the duration of coverage, and whether an event has occurred terminating coverage.
•    Calculate premium amounts to be billed.
•    Collect payments, deposit checks and transfer funds. 
•    If at any time premiums are not received by the established due date, the TPA must allow a 30-day grace period to receive the premium.
•    Generate follow-up letters to participants if payment is insufficient or not received, do not cancel immediately.
•    Send termination notice and explanation if coverage is canceled.
- Open Enrollment, Reporting, Communication, And Compliance
•    Provide a process for participants to make annual open enrollment changes during the month of November. 
•    Notices to be delivered by the TPA to eligible enrollees each October and are due by November 30th with an effective date of January 1st.
•    Provide the city with a designated contact person for continuity of communication, account maintenance and integrity.
•    Ensure timely communication with insurance carriers upon receipt of premiums to ensure seamless coverage for participants.
•    Provide experienced personnel with expertise that can effectively address all legislative, enrollment and billing cobra/retiree questions from participants as needed for problem-solving and excellent customer service.
•    As applicable, send introductory letter to existing covered participants notifying them of the TPA vendor change.  

- Contract Period/Term: 2 years
- Questions/Inquires Deadline: September 02, 2025