The Vendor is required to provide for the administration of Short-term and Long-term disability benefits administration of Family Medical Leave Act (FMLA) benefits for employees.
- Disability benefits to employees through a self-funded short-term disability (STD) plan and a fully insured long term disability (LTD) group benefits plan; the county also contracts for FMLA administration services; administration fees are paid on a per-employee-per-month basis.
- Provide that County will be an additional indemnified party of the subcontract;
- Provide that the County will be an additional insured on all insurance policies required to be provided by the Subcontractor except workers compensation and professional liability;
- Provide a waiver of subrogation in favor of the County and other insurance terms and/or conditions
- Claim intake, approval,
- Denying or closing claims for benefits,
- Management of claims to facilitate the earliest possible return to work
- Determining the amount of benefits payable.
- Offer advice to pay
- Claims Administrative Services, including the following:
• Prompt 5-business day notification after receipt of complete, initial STD claim; courteous and accurate processing of claims within the provisions of the certificates for both the STD and LTD plans.
• Full claim intake by the carrier using telephonic, online, and/or paper submission of claims.
• Printed materials, including group master policy, individual plan description booklets for each employee, pamphlets, and other materials to educate employees on the STD and LTD plans and to encourage enrollment in the LTD plan.
• Electronic materials for placement on the Pinellas County benefits website.
• Participate in monthly Absence Management Meetings with county representatives.
• Providing an action plan and timeline for corrective actions identified during monthly meetings. - Disability Management Services, necessary for approval of claims and appropriate management afterward, including the following:
• Medical intervention by nurse case managers, physicians, and other professionals,
• Independent medical and psychological exams, peer review, second opinions, functional capacity exams, and workplace therapy or rehabilitation,
• Vocational counseling, testing, transferable skills analysis, retraining services and placement services,
• Professional investigation services and disability evaluation interviews for potential fraud.
• Reports as stipulated for STD and LTD,
• Quality control standards for both the claims approval and claims management process.
• Rendering decisions on STD claims and performing all duties required under federal FMLA regulations and the County FMLA policy.
- Full administration of FMLA; use of the reporting hierarchy in the county human resources information system (HRIS) to identify employee’s supervisory chain and properly route administration correspondence by email, mail and/or phone to immediate supervisor, director, and human resources benefits division contacts.
- Provide a single point of contact for employees requesting FMLA leave, filing and administration of short-term disability claims, and long-term disability claims.
- Rendering of timely and accurate decisions on FMLA leave requests and performing all duties required under federal FMLA regulations and the county FMLA policy.
- Timeliness will be monitored frequently and must be consistent across all employees.
- Providing first-level appeal processes for FMLA decisions.
- Provide required reporting for the FMLA program.
- Advising employer contact of suspected misuse of or fraudulent claims for FMLA leave in a timely manner.
- Conduct the investigation of the misuse of or fraudulent claims for FMLA leave on behalf of the employer.
- Cooperate in any investigation conducted by the county or any of its agencies of a claim of violation of its family and medical leave policy.
- Make all records relating to the administration of the contract available for investigation or audit by the county upon request at no additional cost.
- Request authentication or clarification of certifications, if appropriate.
- Participate in monthly absence management meetings with county representatives.
- Providing an action plan and timeline for corrective actions identified during monthly meetings.
- Please provide samples of your reports. Please confirm your ability to make reports available by billing division.
• STD and LTD claim status reports including pending, approval status, and approved through dates
• STD and LTD Payment reports
• FMLA open leave reports
• FMLA activity reports
• STD, LTD and FMLA management reports
• Integrated reports for FMLA and disability
• Describe the frequency and means of accessing absence management and other reports by the plan sponsor and options for custom reporting.
- Ability to integrate the employer’s management hierarchy into your administration processes.
- Contract Period/Term: 2 years