Self Insurance Medical Claims Administrative Services and Medical Insurance Services

The Vendor is required to provide for self-insurance medical claims administrative services, and medical insurance (fully-insured, level funded, or self-insured options).
- Aims to:
•    Identify the most affordable and responsible Insurance Carrier or Fund
•    Most sustainable funding alternative
•    Minimize disruption for members
•    Secure a long-term, sustainable solution
•    Ensure equal to or better benefits for all participants
- Fiscal Responsibility & Affordability/ Innovation & Wellness (Value-Added Considerations)
•    Competitive pricing and sustainable long-term performance. Proposed rates and funding structure summary (self-insured, level-funded, and fully insured).
•    Clear disclosure of funding options (self-insured, level-funded, fully insured) provisions.
•    5-year trend or renewal history for similar public sector clients.
•    Description of available cost-containment and risk-management programs and strategies (e.g., medical case management, nurse case managers care coordination for critically ill complex cases)
•    Out-of-network repricing describe how claims are negotiated for non-network claims. Specify any fees or percentage of savings retained by carrier.
•    Carriers are required to submit letters guaranteeing they will administer plan designs in place on an "equal to, or better" basis on effective date of coverage, and include benefits review comparison.
•    Describe wellness and population health management programs included in your proposal. List available programs that come at an additional cost to the county.
•    Integration of pharmacy and medical management total cost of care.
•    A $10 per member implementation allowance that reimburses county for direct costs incurred as a result from transition from the agency. At county’s directive, this may be in the form of a check or credit.
- Employee & Retiree Protection
•    Specify continuity of care plan for County members who have scheduled procedures or ongoing services by providers who may or may not be in network with proposed carrier.
•    State your amenability to recruit local providers who are not in your network to assist with minimizing network disruption.
•    Strategies to protect both actives and retirees, including coordination with Medicare Advantage for 65+ retirees, supplemental programs for 65(-) early retirees.
•    Sample member communications or transition letters used in similar public-sector transitions

- Contract Period/Term: 1 year