The vendor is required to provide third party administrator (TPA) to administer the state flexible spending accounts (“FSA”) and commuter benefits.
a. Administrative services
• Have a dedicated account management team and maintain sufficient staff to perform the following functions which shall include, but not be limited to:
o Regulatory compliance;
o Eligibility determination and enrollment;
o Accounting and finance; and
o Customer service and support
• The state with the amendment, as necessary, of the plan document, administrative rules and summary plan description, including attending administrative rules public hearings.
• The benefit programs to ensure that the state is in compliance with all applicable federal and state laws, rules, and regulations.
• Advise department on the merits of maintaining the program and its provisions, and recommend amendments to the program as may be required by changing conditions, laws, or regulations.
• State, all customized written informational materials to fully apprise all eligible employees of the program’s purposes and provisions, and design, print, and distribute all necessary program forms, including but not limited to, enrollment, cancellation and reimbursement claim forms.
• Provide assistance to all employees in completing all required forms, including, but not limited to, annual enrollment forms, payroll forms, and any other forms required by the state.
• The island flex plan, ensure that all eligible employees sign a participation form annually, as required by the state.
• Work with and coordinate all FSA open enrollment activities/forms with the state’s employer-union health benefits trust fund, as appropriate.
• Perform all other day-to-day responsibilities necessary to ensure the effectiveness and integrity of the program in accordance with generally accepted industry practices and/or as requested by the state.
• Provide administrative services, at the same level as the medical expense reimbursement and dependent care expense reimbursement FSA, for any other flexible spending account the code may authorize and the state chooses to implement.
b. Customer service and support
• Maintain a local service office that is open Monday through Friday, 8:00 a.m. to 5:00 p.m. (HST)* to answer in-person and phone inquiries about enrollment status, program benefits, cobra applications, contribution amounts, claims procedures, etc.
• The contractor shall maintain a toll-free customer service telephone number to the local service office that will be available Monday through Friday, from 8:00 a.m. to 5:00 p.m. (HST)*
• Allow for employee self-service via a secured website on the internet. such self-service capabilities shall include, but not be limited to:
o Information on the benefit programs;
o Frequently asked questions;
o Forms;
o E-mail inquiry capabilities;
o On-line enrollment, during open enrollment and for mid-year changes;
o Address changes;
o Account status and history; and
o Any other information reasonably requested by the state.
• The form of telephone calls, correspondence or personal visits from participants or state agencies with respect to program requirements, eligibility, family status changes, procedures, rules, and other matters.
• Promptly respond by telephone, mail and e-mail to inquiries from participants and all interested parties regarding program requirements, eligibility, problems, procedures, rules, and other matters, provided that:
o Telephone inquiries shall be promptly responded to within one business day.
• Provide a system, computer or otherwise, so that customer service representatives have the ability to gain immediate access to a participant’s account to verify enrollment, deposits, claim authorizations, amounts and dates of reimbursements processed and account balances, status of authorizations of claims, dates of mailing and deposit, etc.
• Provide an adequate number of local customer service representatives to handle the volume of walk-ins for the office and employee telephone calls.
• Provide prompt, knowledgeable, and courteous service at all times.
• Ensure that customer service representatives have laptop and notebook computers and appropriate software to assist employees in making decisions, including the ability to inform each employee how contributions to the programs affect his/her net paycheck.
• Provide staff to explain the programs when requested by the state and at new employee orientation sessions sponsored by the state and elsewhere as requested.
c. Enrollment
• Process ongoing and annual open enrollment, terminations, and changes in a timely manner.
• This includes, but not limited to processing allowable family status changes for all island flex plan participants such as birth and adoption of a child, marriage, divorce, termination, and death, etc. for pretax transportation benefit program (PTBP), allow eligible employees to make benefit election and changes to their account year-round.
• Send written confirmation letters to all enrollees prior to the first employee payroll deduction.
• The program enrolled, the type of account, the annual amount of salary reduction, the pro-rated semi-monthly amount, and instructions on how to file for reimbursement for eligible expenses.
• Design a system that shall not use a participant’s full social security number as an identifier to process claim reimbursement forms.
• For the island flex plan, assist employees with family status changes and ensure that the changes qualify under the plan document and administrative rules and the code
d. Processing claims
• Establishing a claims processing and reimbursement system with a standard that at least ninety percent (90%) of claims shall be processed within five (5) business days after receipt of a claim and that one hundred percent (100%) shall be processed within ten (10) business days of receipt of a claim.
• Offer a debit card under the FSA and commuter benefit program (“debit card”) to interested plan participants.
o The debit card shall allow a participant to pay for qualifying medical expenses by debiting the participant’s medical expense reimbursement account, up to the total medical expense amount designated by the participant at the start of the applicable plan year.
o Thus, by using the debit card, the participant will not have to pay for the qualifying medical expense with out-of-pocket funds nor seek reimbursement.
o The debit card shall be offered and provided at no cost to the state or participants.
• Provides a summary of the participant’s account status, including but not limited to year-to-date (“YTD”) total deposits, YTD total reimbursements, YTD totals of authorized claims, and other information reasonably requested by the state.
• Maintain participants’ YTD contributions and process a state cancellation of payroll deduction at the point any employee exceeds his annual elected amount, or the legal account limit.
• Provide a late-billing procedure to accept claims filed after the close of the grace period, if the late filing was not the participant’s fault
• Provide a stop-pay, void, and stale-date check procedures, with the approval of the state.
e. Accounting and recordkeeping and financial support services
• Accurately input all participant data and validate data fields and ranges, including but not limited to: names; social security numbers; line-item numbers, agency codes, payroll distribution codes; and contribution amounts
• Provide on a semi-monthly basis, within the deadlines prescribed by department, data containing any or all required participant data information to the state payroll office(s) in a format specified by the state, or electronic transfer of such data.
• Develop and provide error resolution and prevention instructional materials, subject to the state’s approval.
• Provide a comprehensive system of audit and control to track and balance accounts and to ensure the overall fiscal integrity of the program, maintaining all records associated with an individual’s account (including contributions, enrollment forms, authorizations, address, reimbursements) that relate to the proper administration of an account, and ensure that all necessary forms and authorizations are complete, on file, and in compliance with the program’s rules and requirements of the code.
f. Consultation services
• provide consultation to the state regarding all cafeteria plan-related benefits, including FSA and premium conversion plan, and qualified transportation fringe benefit.
• Answer questions regarding all cafeteria plan-related benefits as well as commuter related benefits;
• Assist in review and analysis of the impact of legislative bills/ statutes relating to cafeteria plan and commuter related benefits.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: June 23, 2025