The vendor is required to provide from qualified health insurance carriers to deliver medical plan administration services for its self-insured preferred provider organization (PPO) and fully insured health maintenance organization (HMO) medical plan products.
- Administration process requirements
• Carrier will manage tier i and tier ii fiduciary responsibilities as well as all claim appeals.
• Carrier is compliant with HIPAA and HITECH regulations.
• Carrier’s processes are compliant with all health care reform provisions, 2021 consolidated appropriations act.
• Carrier will manage the city’s benefit in compliance with all federal and state laws and provisions.
• Carrier agrees to allow city to terminate its contract without any charge, cost, termination fees, or withholding of payments due to city-related transpired events falling under carrier’s scope of services.
• Carrier will, in the event of a future termination of relation with the city, send data and all relevant transition files to the city’s new carrier post termination at no additional cost.
• Carrier will provide all members with explanation of benefits statements. this is to be done at no cost on an annual basis.
• Carrier agrees to produce a full summary plan description on an annual basis.
• Carrier agrees to produce a written summary of benefits on an annual basis.
• Carrier agrees to produce a full summary of benefits and coverage on an annual basis.
- Reporting and data requirements
• Carrier will send (via secure ftp) detailed ‘raw’ data claims extracts to the city’s third-party vendors (i.e., data warehouse, PBM, consultants, etc.) on a monthly basis. up to four different recipients, each with potentially unique formats/layouts, can be included at no cost.
• Carrier will provide access to standard management reports via the internet. provide a username and password, and sample reporting or link to a demo site.
• Carrier confirms capabilities to support custom/ad-hoc reporting.
• Carrier confirms that reporting will be provided for all metrics that are subject to guarantees committed elsewhere in this offer.
• The city currently partners with deer walk for data reporting and analytics. carrier is to provide a count of your current clients that also utilize deer walk for data warehousing and reporting.
- Credits and allowances
• Carrier agrees to annual communication and wellness budget of $100,000.
• Carrier agrees to a one-time implementation credit of $25,000 to be used for any expenses incurred by the city of long beach for completion of 2026 plan set up.
• Carrier agrees to provide accounting for the communication and wellness budget and training on the usage of funds to the city of long beach human resources employee benefits staff upon request.
• Carrier will have the ability to reimburse vendors directly, where applicable and requested.
• Carrier will have the ability to reimburse the city of long beach, where applicable and requested.
• Carrier will allow for the use of outside wellness vendors, without restriction, even if similar programs are available within the carrier’s capabilities.
- Audit requirements
• Carrier agrees to allow the client, or its third-party representative, access, and the right to audit all claims, utilization, performance guarantee provisions, provider contracts, and other information relevant to account services.
• Carrier confirms the city will be able to select an auditor of their choosing, without being subject to pre-selected or limited number of approved auditors by the carrier.
• Carrier will identify any aspects of the proposed plan administration services that are not able to be audited.
• Carrier confirms any payments or credits due to the city of long beach are released within thirty days of analysis.
- Eligibility management
• Carrier has capability of spending and receiving eligibility electronically. define any limitations you have in terms of how eligibility can be received from the city.
• Carrier can support a secure environment for eligibility transmission (from the city and to city vendor partners).
• Carrier can receive weekly eligibility change files from the city.
• Carrier must be able to support and work with the city’s cobra vendor, health equity.
• Carrier will accept both future and retroactive effective and termination dates for eligibility (up to 60 days) for both PPO and HMO plans.
• Carrier will assign a unique identifier for eligibility and has the capability to cross reference against the SSN or can use a unique identifier assigned by the client or the carrier.
• Carrier will process and load eligibility information and will inform the city regarding discrepancies within 48 hours of receipt.
• Carrier will perform reasonability and quality assurance checks regarding eligibility updates.
• Carrier commits to test and review eligibility files for accuracy and reasonability or review protocols prior to an auto-update of eligibility files.
• City agrees to provide discrepancy reports for eligibility files where issues may exist.
• Carrier offers the city a tool to view eligibility online.
• Carrier must be able to ingest non-binary gender information/codes and incorporate into enrollment and claim system.
- Legislative and legal compliance support
• Carrier will support the city in evaluating and determining the impact of any relevant legislative changes at the state and federal level that may impact the city’s employee medical health plans.
• Carrier will promptly notify the city by email of any impact of legislative activity that directly affects the city.
• Carrier confirms that access to an in-house (or contracted) benefits attorney for compliance support is available.
- Account service support
• Carrier confirms the team responsible for servicing the city will be dedicated and designated to the plan and that a live account service team member will be available 8am to 5pm PST from Monday through Friday.
• Carrier agrees to monthly telephonic/virtual and two in-person meetings: one meeting with the city of long beach human resources employee benefits staff and one meeting with the health insurance advisory committee to discuss carrier and city plan utilization, carrier updates, and strategic initiatives to meet the city’s objectives.
• Carrier agrees to attend two in-person open enrollment events annually: one for active employees and One for retirees.
• carrier agrees to track open items and projects via monthly call log and share pre- and post-scheduled monthly meetings.
• Carrier agrees to highly experienced and dedicated account management team, with bio and summary of team to be shared with city of long beach prior to assignment of duty. there is no expectation that the account management team works solely on the city’s account.
• Carrier agrees to monitor and inform the city of long beach when high value claims over $2 million are identified.
- The main documents for this RFP are not accessible on our website. Kindly reach out to the contact person listed in this description for more details.
https://longbeachbuys.buyspeed.com/bso/external/bidDetail.sdo?docId=HR-25-592&external=true&parentUrl=close
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: April 17, 2025