The vendor is required to provide health benefits consultant services for include:
• Market all insurances and stop loss to include, but not be limited to, preparation of bid specifications, evaluation of proposals received, and recommendations on contracts to be signed for with effective date to be determined by the town.
• Coordinate and review necessary demographic data for marketing
• Should the town and board of education elect to change carriers following the marketing process, manage and review the SPD development ensuring that the successful respondent provides benefits that are comparable to or better than those currently in effect.
• Provide a disruption analysis relative to the provider, pharmacy, hospital and appropriate other vendor networks. attend various employee, committee, BOE and town meetings as necessary.
• Review all contracts and booklets. prepare, advise and file any IRS required forms.
• Review current plan experience, claims, and market trends, and negotiate cost savings and renewal premiums with all insurance providers on an as needed basis.
• Periodically review the health insurance plans, claims and fees and provide a reasonability analysis in comparison with industry norms.
• Ensure accurate follow-through and completion on all negotiated contractual arrangements made between the town and board of education and their health insurance carrier(s).
• Ensure that any self-funding arrangements with third party administrators are appropriately managed
• Monitor the third-party administrator’s actuarial assumptions under self-insured programs, if applicable.
• Intervene and resolve with providers, problems that may arise regarding claims, proper coverage, routine administration and day-to-day account service.
• Cause the town and board of education to be provided with accurate management reports/utilization, review on comment information from all carriers on a continuing basis.
• Meet with town representatives and BOE as required.
• Provide the town and board of education with information and recommendations on new health insurance programs, more cost-effective products, funding options, future trends in employee benefit plans and plan designs.
• Analyze annual renewals for all self-insured and insured plans and periodically solicit coverage proposals from alternative providers for insurance coverage as well as stop loss coverage.
• Develop strategies for presentation and implementation of any new benefit program to employees, unions, other employee groups and town boards.
• Serve in an advisory capacity during negotiations with collective bargaining units.
• This includes costing and analyzing benefit proposals, providing counsel to negotiators, and testifying at negotiation, mediation, and arbitration sessions as needed.
• Coordinate employee communications and conduct employee informational meetings for current benefit plans and as new programs are implemented
• Provide expert advice and/or testimony in disputes that may arise between the town and board of education and their labor unions, as they pertain to the health insurance benefit plans.
• Inform the town and board of education and administration of changing legislation and legal decisions affecting employee benefits. recommend and discuss methods to comply with these changes.
• Perform a feasibility study, to include interested regional municipalities, of pooling benefit plans for potential cost savings and to spread out individual municipality’s exposure to risk.
• Make any necessary presentations of the study’s findings to appropriate representatives of these municipalities.
• Provide information as necessary for actuaries evaluating the other post-employment benefits (OPEB) plan.
• Periodically conduct a claims audit which randomly reviews the accuracy of claims administration.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: May 23, 2025