Employee Group Benefits Program

The Vendor is required to provide for the provision of a comprehensive employee group benefits program.
- Also manages the distribution and sale of liquor and cannabis and oversees gaming activities such as casinos, lotteries, and charitable gaming.
- Strives to balance consumer access with public safety, integrity, and social responsibility. Revenue generated supports community programs and public services.
- Key Program Data:
•    Approximate number of employees: 1,148
•    Approximate number of unionized employees: 791
•    Current carrier since: January 1, 2020
- Program Objectives
•    Governance: Ensure competitiveness of carriers and transparency in program management.
•    Financial: Deliver competitive rates and expense charges with long-term sustainability.
•    Service: Provide superior customer service and responsive support.
•    Claims Management: Implement proactive claims management and outcome reporting.
•    Plan Administration: Simplify administration through efficient tools and processes.
•    Implementation: Support change management and communications during transition.
•    Member Experience: Enhance employee value proposition through user-friendly services.
•    Disability & Drug Cost Management: Offer proven strategies for managing claims and costs.
•    Harmonization: Insure all employees under one carrier where feasible.
•    Flexibility & Innovation: Provide customizable and innovative solutions tailored to agency needs.
- Insurance and Disability
•    Basic Life
•    Dependent Life
•    Optional Life
•    Accidental Death & Dismemberment (AD&D)
•    Critical Illness
•    Long-Term Disability (LTD) benefits
•    Absence Management Services
- Health, Dental and Wellness
•    Extended Health Care
•    Large Amount Pooling (LAP) with $15,000 in-country threshold
•    Dental Care
•    Health Spending Account (HSA)
•    Personal Spending Account (PSA)
•    Employee Benefit Administrative Services
•    Plan administration
•    Claims processing
•    Customer service support
•    Technology platform access
- Employee & Family Assistance Program (EFAP)
•    Confidential counselling
•    Mental health support
•    Crisis intervention
•    24/7 access to wellness resources
- Program Requirements
•    Provide secure, bilingual (English and French) online portals for plan sponsors and members, accessible via desktop and mobile devices.
•    Ensure portals support claims submission, coverage information, and member self-service.
•    Deliver customer service excellence, including SLAS for claims processing, portal uptime, and inquiry response times.
•    Provide robust reporting on claims activity, cost trends, and performance metrics.
•    Comply with state privacy legislation, maintain data residency within state, and adhere to cybersecurity and fraud prevention standards.
•    Support cost control and sustainability through competitive rates, extended guarantees, and innovative solutions for managing high-cost claims.
- Claims Management
•    Provide a comprehensive list of account categories available under the wellness spending account (HSA/PSA) offered to agency.
•    Deliver plan member-level reporting on taxable benefit amounts paid to members on a monthly basis for income tax reporting purposes.
•    For EFAP services, define what constitutes a “case” in utilization reporting and provide detailed reporting on utilization, including calls or requests that did not result in a referral or provider connection.
•    For long term disability (LTD) benefits, offer enhanced online administration and reporting capabilities beyond standard requirements.
- Claims Submission and Adjudication
•    Provide a clear and efficient process for life claim submissions, including required documentation and steps for adjudication.
•    Enable digital submission of life claims where possible, or specify when paper-based processes are required.
- System Requirements
•    Provide secure employee access to review coverage details, update personal information, and access claims information through online and mobile platforms.
•    Deliver responsive call centre and support services for plan administrators and members, ensuring all service standards for inquiry handling are clearly stated in state time and accommodate multiple access channels (e.g., phone, online, and electronic communication)
•    Enable plan administrators to access a secure portal to:
o    Update member data in real time (e.g., new hires, life events)
o    Restrict certain functions for employees
o    Access real-time reporting on member and dependent data
o    Print id cards, contracts, forms, member listings, and statements of account
•    Provide online enrollment functionality via mobile app (iOS and android), mobile-enabled website, and desktop platform.
•    Offer real-time reporting capabilities for:
o    Dependent data
o    Monthly invoices and financial summaries
o    Claims reporting by member, section, benefit type, drug identification number (din), and top drug report
o    Advisor-level reporting
•    Enable plan administrators to generate standard and ad hoc analytical reports (monthly, quarterly, and annual) and export data in downloadable formats.

- Contract Period/Term: 5 years
- Questions/Inquires Deadline: February 20, 2026