The Vendor is required to provide self-funded medical plan administration for county self-insured medical plans.
- The cost of care, clinical management programs, network strategies, reporting on plan payments as a percentage of medicare, custom plan design administration, direct contracting and more.
- Our intent is to explore:
• Data reporting capability
• Administrative costs and ease of administration
• Network access
• Medical management and care management programs.
- Current Program
- The current third-party administrator (TPA) for the three medical plans is meritain.
• The “standard PPO plan” and the “choice PPO plan” both have deductibles, coinsurance and co-pays.
• The “HDHP with HSA” plan is deductible only for in-network and deductible/coinsurance for out-of-network.
• SBCS and plan documents are provided in the attachments.
- Eligible employees are:
• An employee is regularly scheduled to work at least 20 hours per week for the employer.
• An elected official.
• Temporary employees who, on average, work 30 hours per week during the established look-back period.
- The waiting period varies based upon hire date.
• If the hire date is between the 1st and the 15th, benefits begin the 1st day of the next full month. E.g. hired March 12th, benefits begin aril 1st.
• If the hire date is between the 16th and the 31st, benefits begin the 1st day of the second full month. E.g. hired March 19th, benefits begin May 1st.
- An employee must be covered under this plan in order for Dependents to qualify for and obtain coverage.
- County has an on-site wellness clinic available to those enrolled in the medical plans.
- Currently there is no cost for the standard or choice plan participants to utilize the clinic, the HDHP participants incur claims costs towards their deductible.
- The clinic is currently run by marathon health.
- Other benefits vendor partners: delta dental, VSP vision, surency (HSA, FSA, cobra), the standard (life/AD&D, disability), sun life (accident, critical illness), compsych EAP, my secure advantage (financial coaching).
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: May 13, 2025
