Medical Dental Vision Services

The vendor is required to provide that medical dental vision services  for all full-time eligible employees, and retirees
- The group currently offers insurance options through the local choice: anthem for medical, delta dental for dental, anthem for vision, and anthem for agency.
- The following services for benefit eligible employees and their household dependents
o Provides eligible employees and dependents with quality and affordable plans.
o Ensure the medical, dental, vision, and services offers the most competitive arrangement as measured by benefits, provider discounts, administrative costs, customer service and processing accuracy.
o Maintain flexibility of plan design structure
o Maintain current model with reinsurance and pharmacy carved out of medical.
o Maintain flexible preferred providers.
o Evaluate fully insured proposals.
o Evaluate high deductible plan and options.
o Seek opportunities for carrier investment into a wellness fund to help establish and support ongoing health management and improve outcomes.
o Evaluate specialty capabilities (disease management, population health management and wellness programs to ensure “best in class” programs are offered).
o Provide ease of administration for the group.
o Process eligibility records accurately, efficiently, and timely and provides accurate billing on a timely basis
o Provide simplified communication resources.
o Provide timely, responsive customer service to the plan members and to the group.
o Integrate and coordinate efficiently, timely and accurately with other related plan and service providers
o Provide fees associated with transfer of medical and pharmacy claims data to another vendor.
o Have meaningful financial and service performance guarantees.
o Maintain a dedicated account management team with highly skilled, qualified, and experienced personnel.
o Motivate employees and dependents to make and maintain healthy lifestyle choices and efficacious, cost-effective healthcare decisions.
• Products to be offered:
o Medical insurance
o Dental insurance
o Vision insurance
o EAP services
• The group will offer all benefits through payroll deduction.
• Medical must coordinate with pharmacy and wellness benefits.
- Statement of needs
• Medical proposed plan design specifications:
o The offeror is requested to submit a proposal for only the following products:
 All carriers/vendors are to provide either fully insured or self-insured medical proposals. if self-insured proposals are submitted, please include options with and without pharmacy and reinsurance carved out.
o Plan design descriptions are available on current plan designs.
o Client is to have flexibility in desired plan design structure
o As to how to manage costs, encourage smart and effective utilization, improve healthy choices, and provide value to new county and their employees.
o Provide detail of wellness resources including educational support, employee and employer communications, engagement/activity-based programs, and outcome-based programs. pricing is to be based on estimated utilization, not all eligible employees on a per member per month basis
o Plans must meet all affordable care act and state mandate requirements.
o Three-year contract desired – carrier can receive additional points in the evaluation if willing to offer future cost guarantees
o If your company cannot provide a quote for all plans listed above, it is acceptable to present an offer for one or more of the plans listed.
• Dental and vision proposed plan design specifications:
o Lease submit proposals for fully insured and/or self-insured basis for dental and vision.
o Provide examples of benefit structure with submission
• Wellness objectives:
o Keep work-force healthy, engaged, and productive.
o Help mitigate risk by proactively managing “at risk” population.
o Motivate and clinically support our employees and dependents to make and maintain healthy lifestyle choices and efficacious, cost-effective healthcare decisions.
o Focus on outcome-based program.
o Integrate and coordinate efficiently, timely, and accurately with other related plan and service providers including medical, pharmacy and reinsurance providers.
o Improve morale and productivity, minimize absenteeism, and continue to build a culture of health and well-being.
o Carriers that provide wellness dollars to help launch the program will be favored during the evaluation process.
o Client to be able to use outside wellness vendor, if desired
o Carrier to provide claims data to one digital, wellness vendor, pharmacy vendor, reinsurance vendor and data warehouse vendors. carriers must provide cost to provide claims data to these vendors.
• Health management services to include:
o Targeted health programs
o Group health education sessions.
o Health promotion tool resources
o Biometric screening options, clinical health risk assessment and patient consultation
o Individual score card report after completion of biometrics and health risk assessment
o Aggregate employer report
o Advanced health coaching
o Integrated telemedicine
o Reporting of outcomes
o Reward resources.
• Performance management:
o Provide good key plan performance stats compared to solid benchmarks.
o Provide average renewal rate increases for similar plan designs for comparable size groups.
o Seamless, smooth implementation expected.
o Provide ongoing support of the program along with reporting and outcome results of program.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: February 07, 2025