Group Health Insurance Agent and Employee Benefits Consulting Services

The vendor required to provide group health insurance agent and employee benefits consulting services for include:
1. Strategic planning: 
•    Support board in developing and refining long-range strategies for its employee benefits program—including health insurance, opt-out options, vision, dental, flexible spending accounts, and life insurance. 
•    This includes conducting cost-benefit analyses and providing annual actuarial services for self-funded health and dental plans, encompassing premium setting and compliance with state and governmental accounting standards board (GASB) reporting requirements.
2. Benchmarking and reporting: 
•    Conduct comprehensive evaluations to ensure board benefits package remains competitive. 
•    This includes analyzing employee benefit trends, wellness program developments, health insurance market changes, and legislation that may affect plan design or costs.
3. Operational efficiency: 
•    Evaluate in-house administration procedures and provide recommendations for improving services and efficiency through the strategic use of technology and HRIS integration. 
•    The agent will specifically focus on identifying opportunities to modernize workflows, reducing reliance on manual spreadsheet tracking, and automating data exchange between carriers and board systems.
4. Renewal process: 
•    Lead the annual contract renewal process, including conducting annual market analysis, developing comprehensive bid specifications that define standards for underwriting, pricing, plan design, customer service, claims administration, and network composition. 
•    The agent will focus on securing competitive renewal rates, stronger contract terms, and optimized benefits and services.
5. Financial projections: 
•    Provide final renewal rate estimates no later than September 1 of each plan year and assist board staff in developing accurate budget projections based on anticipated plan costs and market trends.
6. Contract oversight: 
•    Audit all insurance contracts and summary plan descriptions (SPDS) prior to execution to confirm accurate coverage provisions, terms, conditions, and service commitments. 
•    The agent will monitor active contracts through ongoing oversight of plan administration, vendor compliance, and incurred claims activity.
7. Claims support: 
•    Provide claims assistance and advocacy for employees and human resources staff when the insurance carrier is unresponsive or when complex issues arise related to claims processing, appeals, or dispute resolution.
8. Analytics: 
•    Deliver regular reporting on benefits utilization, plan costs, incurred but not reported (IBNR) liabilities, lag reports, and emerging trends. 
•    This includes conducting detailed claims analysis and recommending targeted cost-containment strategies.
9. Regulatory compliance: 
•    Manage all regulatory compliance requirements, including coordinating with carriers to deliver required notices, such as summaries of benefits and coverage (SBC). 
•    The agent will prepare and submit permissible filings on behalf of the plan, including institute reports, non-discrimination testing, gag clause prohibition compliance attestations (GCPCA), non-quantitative treatment limitations (NQTL) comparative analysis, and other mandated submissions.
10. Meeting frequency: 
•    Maintain a structured communication calendar to review performance, address emerging issues, and discuss strategic opportunities. 
•    The agent will support the annual renewal process through regular updates on negotiation strategies, timelines, and project progress.
11. Communication materials: 
•    Offer comprehensive digital, online, and printed decision-support tools to support new-hire onboarding and open enrollment. 
•    Materials must be clear, accessible, and available in multiple languages as required to meet the needs of the diverse board workforce. 
•    The agent must demonstrate the capability to provide, or assist in the implementation of, a mobile benefits platform or smartphone application that provides employees with on-demand access to plan details, id cards, and wellness resources.