Employee Benefits Services

The Vendor is required to provide for provision of critical illness and life insurance and administration of the city's employee benefits program.
- Insurance carriers are to match the current coverages offered by the City.
- To assist with your evaluation of whether this is possible, insurance carriers will be provided with the following documents for your review:
• Policy documents for the City’s basic and optional life insurance coverages.
• Policy documents for the City’s basic and voluntary critical illness coverages.
• Employee benefit booklets for three of the City’s classes.
- Employees review their coverage options and select new plan options annually, moving up or down by at most one plan option. The lone exception is a life event, in which case a member may move by more than one plan option.
- Healthcare spending account credits are allocated to employees on a monthly basis over the course of the plan year.
- The City contributes the full cost of life insurance up to $75,000 in coverage. Upon hire, members may elect for up to 2 times annual salary for basic life insurance (with the member covering any differences in premium) without submitting medical evidence.
- Their extended health, dental, and healthcare spending account benefits are listed below:
• Assign a full service team to provide the city with timely responses to remedy issues that have arisen under the plan and troubleshoot solutions (applies to all contracts).
• Adjudicate in- and out-of-state claims in accordance with the established plan provisions for the city’s employee groups.
• Enforce eligibility criteria for members based on established criteria for each of the city’s employee groups (applies to all contracts).
• Ensure the city’s members utilize government-sponsored programs prior to accessing city coverage (where deemed appropriate).
• Applying best practices with respect to coordination of coverage.
• Processing and distributing benefit cards to new employees joining the city.
• Creation and maintenance of employee benefit booklets.
• Processing amendments based on updated coverage terms as directed by the city, and adjudicating retroactive claims as required (applies to all contracts).
• Establishing reasonable and customary (“R&C”) limits based on market research and enforcing them when adjudicating member claims.
• Act as the city’s pharmacy benefit manager with respect to prescription drug coverage. Services include the evaluation of medications to include/exclude for coverage under the city’s drug formulary, establishing and enforcing the prior approval process required for members to access coverage, and facilitating any specialty care networks that may be coordinated by the insurance carrier.
• Provide access to an online member profile for members to maintain information (including their direct deposit) and view their coverage balances.