The vendor is required to provide administrative services for the workers compensation insurance plan.
- Provide all of the services listed below for the plan:
1. Administrative services for the plan
• Reinsurance mechanism
• Management services to the board, such as regular management reports on losses, policy count, market share of the plan and similar reports
• Interaction with ratemaking bureaus, statistical agents, governmental agencies, etc.
• Supervision of subcontractors providing services to plan insureds
• Interaction with licensed producers and brokers
• Communication with the board
• Preparation for and conduct of board meetings
2. Application processing services
• The establishment of needed rules and processes to accept applications for coverage in the plan.
• The review of applications for accuracy, completeness and potential fraud, and binding of coverage in accordance with plan rules.
3. Selection and oversight of servicing carriers, if any
• The establishment of a means of selecting servicing carriers to provide policy services, underwriting, loss prevention, claims, premium collection and audit services if the bidder is unable or chooses not to provide these services itself, and the process the bidder shall use to monitor the performance of such selected servicing carriers.
o Underwriting services include insurance policy binding, policy issuance and policy servicing, e.g., premium billing and collection, premium audits, responding to insured queries.
o Claims administration includes establishing and implementing a claim reporting system, claims investigation procedures, fraud detection, medical or managed care services, disability management or return to work programs and defined procedures for prompt, complete payment of bona fide claims.
o Loss control services include systems and procedures established by the bidder to help employers prevent or mitigate losses.
• Favorable consideration will be given to loss control programs targeting small employers, i.e., employers with policies generating less than $10,000 in annual premium.
• Such means shall include methods to discern from interested servicing carriers those that are qualified financially and technically to provide such services to the plan.
• This would include scoring methodology concerning both quantitative and qualitative measures. 4. Establishment of service performance standards
• The description of performance standards regarding timeliness, and quality of policy issuance, underwriting, claims administration, loss prevention, auditing and other appropriate policyholder services for accounts covered in the plan.
5. Depopulation mechanisms for the plan
• Systems and procedures designed and intended by the contractor to reduce the total number of employers in the plan.
6. Establishment of rates, rules and forms for the plan
• Bidder develops, files for approval, and publishes approved rates, rules and forms in accordance with applicable statutes, rules and regulations.
7. Filing services for the plan
• Bidder submits filings of plan rates, rules, rating programs, and forms through the system for electronic rate and form filing (SERFF).
• To the extent that bidder needs to use loss costs (to establish residual market rates), rules, rating programs, classifications, and forms filed for the voluntary market by a workers compensation rating organization in state, bidder has entered into an agreement with such rating organization to license its materials, products, and services for use in the residual market.
8. Dispute resolution mechanism for the plan
• Bidder develops and implements a dispute resolution process for resolution or assigned risk policyholder disputes so that grievances can be reviewed, resolved, or heard by the mechanism that has been established and approved in the state for such grievances.
9. Reinsurance mechanism
• The method the bidder will use to provide reinsurance for state policies including any exposure of a multi-state risk insured under the plan.
• Assigned carriers providing workers compensation insurance must collect and report all premiums and losses based on the exposures for each state’s physical operations to each individual state and be a signatory to an agreement providing reinsurance for workers compensation insurance policies issued to residual market employers in each state where the coverage must be provided.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: May 23, 2025