Employee Benefits Consultant Services

The Vendor is required to provide employee benefits consultant services for actuarial, consulting and broker services.
- Requirement:
•    Employee benefits to permanent employees in positions budgeted for a minimum of 1,950 hours/year, including the following benefit programs:
o    Medical (with $100,000 specific stop loss and aggregate stop loss)
o    Prescription including mail-order, and
o    Dental, vision and basic life
•    The medical, dental and vision benefit plans include organizations.
•    Employee dental, vison, and basic life insurance is provided at no cost to the employee.
•    Employee and dependent medical and voluntary life, and dependent dental, vision, dependent basic life insurance is available through payroll deduction.
•    Former employees who leave employment with ten (10) or more continuous years of service may elect to make monthly premium payments for retiree health coverage until month end of their 65th birth month.
•    Prepare a strategic benefits review and report with benchmarking to other comparable governmental entities.
•    Perform an initial review and report of employee health benefits program for cost effectiveness, program design, competitiveness and plan or claims administration.
•    Provide written reports of findings and recommendations with definitive reasons for recommended changes in terms, conditions or limits.
•    Prepare a comprehensive, objective review of the received and processed claims medical/dental/vision/life to determine whether the claims are adjudicated according to contractual performance standards, appropriate benefits, and industry standards which includes, but is not limited to on-site review of transactions processed by the third-party claims administrator, including the preprocessing of claims to evaluate the third-party claims administrator's process and systems relating to such areas as eligibility, coding, pricing, including proper application of allowable charge and discount arrangements, deductible accumulators, identification of duplicate bills, application of plan benefits, cob, medical necessity, ineligible/eligible charges, compliance with other vendors, and file documentation.