Group Vision Benefits Plan Services

The Vendor is required to provide vision benefits to judges, justices, management confidential and other unrepresented employees, retirees and their dependents, henceforth, “Plan Members” or “Members”.
- Customer service representatives must be able to respond to questions and inquiries regarding benefits, claims status and explanations of benefits and the Awarded Contractor must adequately resolve inquiries, complaints, problems, and questions from Plan Members and from agency within a reasonable time of receiving such communication
- Reasonable times are based on the type of inquiry:
• Answer customer service calls within 30 seconds for at least 80% of calls;
• Acknowledge written or electronic inquiries within one (1) business day;
• Resolve standard inquiries within three (3) to five (5) business days; and
• Resolve complaints and escalated issues within ten (10) business days.
- The system must create a record of the Enrollee contacting the call center, the call type and all customer service actions and resolutions.
- The Awarded Contractor must utilize an integrated system for customer service representatives to log and track all Enrollee calls.
- Claims reporting includes providing monthly utilization reports to agency, providing annual detailed experience and other data to justify premiums, maintaining accounting records necessary to support claim payments, and providing reasonable access to those records for State audit requests.