Healthcare Benefits Broker and Consultant Services

The vendor required to provide healthcare benefits broker and consultant services for include:
1. Strategy development
•    Conduct annual health and welfare strategic review and planning meetings
•    Provide data on benefit trends utilizing national, regional and local survey data
•    Provide recommendations and consulting on alternate plan designs, emerging solutions, funding alternatives, an employee impact
•    Build upon current wellness strategy (discovery and strategic planning)
2. Vendor management
•    Evaluate service provider contracts for appropriate pricing and performance standards
•    Review and assist in interpreting health and welfare plan contracts, plan documents, insurance policies for accuracy, consistency, and recommendations
•    Assist with claim issues, billing questions, policy interpretation, and other carrier issues as requested
•    Attend quarterly and annual vendor review meetings and manage overall vendor performance
3. Plan renewal and negotiations
•    Evaluate and negotiate vendor renewals and recommend continuation or replacement
•    Agency a report that will detail a comparison of market analysis, and recommendations for retaining and changing existing plan carriers; alternatives for plan design changes; the of recommended alternatives, the risk factors involved with implementing said alternatives, and the associated cost of each alternative.
•    Advise on competitiveness of benefit offering against established benchmarks
•    Prepare and evaluate pricing from vendors as necessary, including stop loss, RX options, etc.
•    Provide summary report of negotiations, recommendations, and fees
•    Review plan components and pricing for compliance with PPACA requirements
4. Financial reporting package
•    Provide quarterly financial summary of expenses agreed upon format
•    Evaluate risk pool options, self-insured versus fully-insured
•    Provide actuarial cost projections for self-funded plans assuming up to three pricing scenarios each year
•    Model employee and employer contribution splits (up to three scenarios)
•    Develop annual certified IBNP projection
•    Review claims utilization quarterly and provide recommendations for cost management
5. Compliance consulting services
•    Provide timely compliance updates and support, as well as interpretive guidance and plan impact, consulting regarding federal or state legislation impacting health and welfare programs
•    Advise and assist with any new PPACA legislation and any potential impact to agency
•    Provide access to staff attorneys for assistance in contract or legislative interpretations
•    Provide access to benefit news, survey tools, sample forms, legislative updates
•    Prepare form 5500 and request schedule a from service providers as needed
•    Conduct discrimination testing, interpret results, prepare a report of findings, and recommend appropriate changes for compliance with IRS code section 105 (h) and project associated costs.
•    Provide annual act training to agency staff to ensure compliance
•    Continually monitor and evaluate the effect of federal healthcare reform legislation on the agency plan(s).
6. Communications
•    Assist with communications and executive presentations, including board presentations
•    Provide technical review of benefits communication material
•    Review and provide input on employee announcements, SPDs, and other media as requested
•    Detailed review of all SBC’s, SPD’s and benefit schedules
•    Preparation of annual enrollment materials and presentation
•    Provide support to agency for information on enrollment and vendor management, including day-to day services.

- Contract Period/Term: 3 years
- Pre-Proposal Meeting Date: November 11, 2025
- Questions/Inquires Deadline: November 14, 2025