The vendor is required to provide that employee benefits consultancy and brokerage services for medical/prescription/dental/vision coverage on behalf of the township.
- Perform an annual consultative review and detailed analysis over all benefit and insurance programs; includes performing the following detailed tasks and services:
• Performing a base line analysis of all programs and coverage in place and determining what updates, amendments and changes shall need to be implemented on an immediate and thereafter routine basis
• Offering recommendations and immediate action plans for compliance and other coverage issues
• Providing annual updates for benchmarking reviews over all areas of coverage
• Provide options, alternatives and alternate strategies and approaches for benefits delivery and administration
- Lead the design of a client specific benefit planning process that includes:
• Plan design
• Carrier selection and reviews
• Health and wellness plan strategies
• Funding types
• Industry comparisons and benchmarking
• Other strategic areas of consideration - prepare and marketing services for all lines of coverage; including;
• The development of customized RFP materials, bid specifications and analytical tools used in managing and evaluating the data analysis process
• Evaluating carrier provider networks, provider discounts, service levels, data capabilities and other client specific metrics
• Conducting vendor negotiations and conducting and overseeing finalists’ presentations
• Providing global implementation support for carrier or plan design changes
- Project manage and oversee all benefit related initiatives including:
• The routine review of plan design materials, internal benefit related policies and procedures
• Assisting with day-to-day carrier interaction and general tasks affiliated with the management of the benefit plans
- Provide standard client reporting, specific carrier results and other client specific performance results and metrics that will include but not be limited to:
• Loss ratio reports for applicable lines of coverage
• Claim utilization reports
• Carrier service results
• Large claimant services
- Provide recommendations for plan design alterations, health and wellness programs, and new coverage and benefit opportunities; shall include but not be limited to:
• Providing routine plan design alternatives and options
• Developing underwriting and actuarial implications and modeling to outline cost impact and changes
• Assist in designing health and wellness plan services and features to integrate with the benefit plans
• Providing side-by-side program comparisons for current and alternate coverages
- Provide regular benchmarking and industry information relative to employee benefits. this shall include but not be limited to:
• Providing annual plan information that profiles and compares the current plans against regional normative data in the area of design, cost, contributions and other variables
• Offer commentary and benchmarking about emerging trends and techniques being adopted that deal with issue of health and welfare benefit strategy design and financing
- Participate and facilitate executive level strategy sessions affiliated with employee benefits, including:
• Coordinating planning session with key decision makers
• Assisting in developing strategic plans from senior leaders with the client’s organization
• Manage benefit planning sessions to determine strategic changes and direction as it relates to health and welfare
• Present annual benefit plan plans, budgets, renewals, plan changes and other key updates to key executive and leadership groups
- Provide an annual benefit stewardship report to outline and summarize the annual activities, goals, objectives and results for employee benefits; report shall include but not be limited to:
• Overview of all activities for the year related to employee benefit plans
• Renewal and financial summaries
• Review of key legislative or regulatory changes
• Outline of program changes
• Review of carrier issues or modifications
• Status of key deliverables and projects
- Track and monitor the financial performance of each contracted benefit plan against budget estimates and financial forecasts; includes but is not limited to providing the following key consultative services:
• Underwriting analysis over current and proposed plans
• Routine data reporting to illustrate year to date or policy period results
• Developing and providing standard summary performance reports - Direct all renewals, settlement and financial related activities for all lines of contracted coverages including but not limited to the following activities:
• Examining preliminary claim data used to calculate renewals and financial projections
• Reviewing month over month claim and enrollment results
• Evaluating the impact of benefit or plan changes
• Examining the legitimacy and appropriateness of underwriting protocols including areas like trend, completion factors, reserve adjustments, large claim charges, administrative expenses and other technical areas;
• Oversee the carrier and vendor negotiations in areas related to funding, finance and underwriting
• Validate carrier and vendor cost projections
• Assist in the establishment of cobra and budgetary rates
• Test and validate funding approaches including the review of insured, minimum premium and self
funded approaches
• Calculate and review employee and employer contributions methodologies
- Review and evaluate benefits budgetary information, including assisting in the annual development of the employee benefits budget for all lines of coverage; key services include but are not limited to:
• Validate carrier and vendor cost projections
• Assist in the establishment of cobra and budgetary rates
• Test and validate funding approaches including the review of insured, minimum premium and self
funded approaches
• Calculate and review employee and employer contributions methodologies
- Evaluate financial implications of plan changes, program alterations and provide benefit cost modeling, including using underwriting and actuarial software to determine:
• Benefit values
• Decremental and incremental changes in cost
• Behavioral impacts and changes
• Model and examine the appropriateness of stop loss and re-insurance levels
- Provide claim reserve (IBNR) analysis and forecasting (as applicable); this shall include but not be limited to:
• If applicable, evaluate the appropriate level of terminal liability reserves by plan;
• Determine the relative changes necessary to the liabilities, including securing actuarial attestations
• Review the appropriateness of impress balances for claim handling and payment processes - Oversee all carrier and administrator issues for all lines of coverage, including insurers, administrators, PBMS, TPAS, etc. (“carriers”); key services shall include but are not limited to:
• Monitoring carrier performance results against agreed upon service standards
• Handle and resolve day to day carrier related issues and items
• Review contractual materials and other carrier issued documentations
• Interface with carriers on account management and other day to day issues and matters
• Monitor carrier financial ratings and performance - Conduct regular vendor meetings to discuss and review strategic issues, client issues and overall results and expectations. this includes but is not limited to:
• Conducting pre-renewal discussions and meetings to review client objectives
• Conduct regular performance meetings with carriers and administrators or other vendors
• Coordinate routine service and results oriented meeting with carriers to review performance and
outcomes
• Meet regularly to discuss client objectives and discuss key goals and business metrics
- The at-large capabilities, service features and overall performance for each carrier and administrator or other vendors; this includes but is not limited to:
• Collecting and monitoring overall carrier results, capabilities and services in key service disciplines
• Monitor or catalogue key carrier characteristics and results in areas including network discounts,
network size and geography, disease management and chronic illness capabilities, web features,
service features and other distinguishing features
• Report at-large carrier capabilities with clients to assist in simple and complex market solicitations - Provide routine regulatory and industry updates and bulletins that deal with benefit related issue. this includes and is not limited to:
• Providing state level regulatory and legal updates that impact benefits business on an insured
funding basis. this includes offering impact statements, commentary and suggestions for next steps
• Issue federal updated and bulletins dealing with legislation, proposed legislation, ERISA implications and general benefit implications.
• Includes offering impact statements, commentary and suggestions for next steps
- Review and validate carrier and administrator contracts and agreements for compliance purposes. this includes but is not limited to a review for ensuring compliance with:
• Agreed upon coverage and plan design issues
• Applicable state and federal laws
• Language addressing coordination of benefits, medicare, pip and other related coverage areas
• Industry standards for billing terms and conditions
• Industry standards for rate change provisions
• Industry standards for claim dispute resolution
• Appeal rights and obligations
- As applicable, assist in the preparation of signature ready form 5500 (as applicable) for the benefit plans under management. this includes but is not limited to:
• Collecting information and data from the various carriers and insurers for completion
• Developing and formatting the necessary regulatory materials and explanatory documentation for
annual filing
• Preparing the necessary forms and materials needed for submission - Evaluate employee benefit booklets and benefit certificates for plan and program accuracy. this shall include but not be limited to examining the materials for the following:
• Adherence to the schedule of agreed upon benefits
• Compliance with applicable state and federal laws
• Appeal provisions
- Assist in the review of the summary plan descriptions and plan documents for accuracy and compliance purposes; areas to be considered include but are not limited to:
• Adherence to the schedule of agreed upon benefits
• Compliance with applicable federal laws and department of labor specific language and criteria
• Appeal provisions
• Fiduciary language
- Produce legally compliant plan document and accompanying summary plan descriptions (documents) for select lines of coverage specific to the employee benefit health and welfare programs; this shall include but not be limited to:
• Collecting the necessary data and materials for all applicable lines of coverage to develop the
documents
• Prepare properly formatted and compliant template documents for all applicable lines of coverage
• Collect comments and updates for the plan sponsor overall draft documents
• Provide print ready documents for publication and distribution
• Provide regular updates and maintenance as warranted, with legal oversight and compliance check
- Manage and oversee all contract negotiations with benefit related vendors, carriers, administrators and insurers. this includes but is not limited to:
• Validating the proposed terms and conditions
• Reviewing materials for compliance and concurrence with proposed arrangements agreed upon
between the plan sponsor and the vendor
- Assist and support all collective bargaining processes related to issues dealing with employee benefits plans; include but not be limited to the following:
• Assist in designing desired benefits strategy and offer recommendations and strategies for benefits
• Model and develop pricing for possible bargaining implications
• Work with the various carriers and vendors to ensure potential plan changes may be administered
• Interface with labor counsel participate in all bargaining sessions and present and outline proposed
benefit modifications
• Attend all negotiating and planning sessions affiliated with the bargaining process
• Provide grievance and arbitration testimony as may be necessary in ongoing labor related matters
dealing with employee benefits
- Assist with dependent eligibility audits to validate enrollment and eligibility under the various group benefit plans; this shall include but not be limited to:
• Examine all current enrollment and eligibility contract requirements and offer recommendations
for eligibility management
• Performing a review of the current enrollment and documentation management practices and
policies in place for new employees and dependents
• Providing recommendations for changes and modifications to the benefit enrollment and documentation process
• Review policies and procedures to validate student eligibility practices
• Provide suggested template materials to be used annually for dependent eligibility attestation
• Determine the appropriate methodology and process for audit individual employee reviews
- Oversee and assist with the coordination of the annual enrollment process. this shall include but not be limited to supporting the following activities:
• Arrange for pre-enrollment strategy sessions to discuss employee meetings, schedules, communication campaigns and other related functions
• Inventory the necessary materials and resources needed to coincide with the forthcoming plan changes, vendor changes and other program modifications
• Assist with developing schedule for on-site benefit meetings, as necessary, including coordinating vendor participation
• Support the coordination, if applicable, for on-site health fairs to complement the open enrollment
process
- Assist in the design of open enrollment employee communication materials including but not limited to the following assisting with the development of the following type materials:]
• An annual benefits guide to overview all current benefits, changes and modifications
• Explanatory materials to be used in illustrating employee contributions and scheduled
• Enrollment instructions
• Internal HR requirements related to dependent verification
• Benefit waiver forms
- Produce suggested communication materials related to the employee benefit programs, including but not limited to preparing
• New hire benefit communication materials that outline the provisions of the employee benefit programs
• Develop simplified benefit outlines that can be used to illustrate levels of coverage for all benefit plans • Assist in the development of overall benefit communication materials that are used in the global explanation of employee benefits
• Produce print-ready employee benefit newsletter content that can be regularly distributed to employees
• Distribute regular content and material that can be shared with employees in the area of health and wellness
• Coordinate and consolidate vendor communication materials used in the administration of the benefit plans
- Conduct employee focus groups of the enrolled population to assist in goal and objective setting. this shall include but not be limited to:
• Designing the focus group format to be used to solicit objective information and feedback from the eligible work force
• Coordinating employee focus group sessions at multiple work locations
• Facilitate employee focus group sessions
• Collect and coordinate focus group response data
• Prepare survey result data for group benefit decision makers and provide corresponding recommendation based on the focus group results
- Create and manage employee satisfaction surveys related to group employee benefit plans. this shall include but not be limited to:
• Creating the desired employee benefits survey tool; both print and web based
• Work with benefits and human resources staff to design a survey too that incorporates group specific areas for review
• Create the corresponding communication materials used in announcing the survey process
• Assist in the data collection process and populate survey results
- Provide standard employee benefit statements that may be distributed to eligible employees. such statements may include the following data elements, pending the availability of the data from the group sponsor’s internal systems:
• Employee salary and bonus income
• Vacation, sick or pool time
• Employer contributions to 401k or retirement plans
• Value of employer contributions towards benefit plans value of employer contribution to taxes and
other statutory expenses
• Social security contributions
• Other
- Perform claims, utilization and related analysis of a claims data by plan. this shall include but not be limited to:
• Applying internal underwriting review
• Engaging actuarial review and analysis
• Utilize underwriting software and algorithms to test and validate benefit cost assumptions
• Examine standard carrier and vendor reports and offer financial analysis and assessments
- Review medical and pharmacy claims for disease management program analysis and recommendations; include but not be limited to the following:
• Evaluating standard and ad-hoc vendor reports to identify prominent illness and chronic condition cost areas
• Review medical and pharmacy data reports to identify immediate and long-term areas for program intervention
- Evaluate high claimant activity and carrier care management reports; include but not be limited to:
• Reviewing the appropriateness of the large claim protection limits
• Examining the legitimacy of large claims application against future cost projections based on emerging claim costs
• Recommend changes in large claim protection limits
• Evaluate effectiveness of large claims management of the contracted vendors - Develop and produce standard client reporting package leveraging carrier / vendor data management tools and other available applications; include but not be limited to:
• Providing standard claims, utilization and enrollment data reporting
• Offering analysis and observations based on carrier / vendor reporting templates
• Issuing additional reports using available claims and enrollment data
• Developing recommendations for network, plan design and other program alterations based on data
and cost results
• Providing regular data analysis and reports that may be used in conjunction with financial consulting services
- Provide access to customer services support to employees and dependents in the resolution of complex benefit related service issues; this shall include:
• Access to a toll-free service line with access to the member advocacy services team staffed with
properly trained customer service specialists (CSS)
• Providing access to CSS services to assist with:
o Claim payment issues errors
o Eligibility and enrollment issues
o Plan design questions or inquiries
o Billing disputes
o Other benefit related inquiries
• Providing activity reports at the group level that shall illustrate call activity, service issues, call types, response and close rates and other tracking information.
- Contract Period/Term: 12 Month