The Vendor is required to provide third party administrators for claims administration, claims management services and provider network services for its medical health plans for employees and retirees.
- Disease Management
• Provide detail on the wellness and disease management programs offered by your organization.
• Distinguish between standard services (no additional fee) and specialty services (additional fee required); services of interest include, but are not limited to:
• Chronic/catastrophic case management
• Online health screenings (health risk appraisal)
• Online health education (diet, exercises, stress reduction)
• Telephonic health coaching
• Fitness center discounts
• Onsite biometric screenings
• Gym membership discounts/senior programs.
- The medicare primary population in the self-insurance proposal administration response, responders are encouraged to provide a medicare advantage proposal for the medicare retiree population.
- The Provider must provide detailed monthly/ reporting on all individual claims exceeding 50% of the specific deductible to the medical stop loss reinsurer and provide appropriate detail to the reinsurance company allowing prompt reimbursement.
- Provider insurers/providers, as they pertain to the employee benefit program whenever it is deemed appropriate using “whatever methodology’ the city may select assuming claim selection is statistically valid and random.
- Contract Period/Term: 1 year