TPA and Record Keeping Services

The vendor required to provide TPA coordinates the monthly billing for participating employers and can arrange for add-on health savings accounts (HSA), health reimbursement arrangements (HRA) or flexible spending accounts (FSA) through the state’s selected insurance carrier, currently anthem for medical coverage and Caremark CVS for prescription coverage.
- Requirement:
•    Provide third party administration and record keeping services for the program; 
•    Develop and maintain a website for the program that contains information on the program, plans available and allows potential customers to obtain on-line rate quotes; 
•    Collect and account for all premiums collected and disburse funds to the appropriate health care carrier(s) authorized to provide coverage through the program; 
•    Develop professional marketing materials and maintain sufficient supplies to vigorously market the program; 
•    Develop a strategic marketing plan that includes attending marketing meetings, giving presentations to potential participants, outreach to business organizations, non-profit organizations, broker and trade groups; 
•    Respond to all quote inquiries from broker and client regarding quote, differences in plan designs, and program in general. 
•    Obtain clarifications from carrier and transmit to broker when census of data changes; 
•    When sold, verify rates with all parties, provide broker all relevant setup materials including program customized forms, plan summaries, summary of benefit coverage’s, business associate agreements between TPA and group. 
•    Obtain printed material from carriers and distribute employee kits when requested. 
•    Answer all questions from group, broker or participants regarding plans and benefits;
•    When requested, conduct on-site employee meetings for potential or existing participating employers; 
•    Obtain signed installation documents, transmit to carrier, including checking enrollments for completeness, following up with group if not complete, securing binder check, completing communication sheet for the carriers and completing internal processes to enroll group; 
•    Update the billing system with new groups, plans and rates; 
•    Update the billing system with enrollment data.
•    Enter enrollment from paper forms when required by carriers or employer groups. 
•    Act as liaison with the carriers during the entire installation process, including printing temporary id cards if carrier does not enroll group in a timely manner, contacting providers to confirm coverage, and obtaining written benefit confirmations from carrier for scheduled procedures; 
•    Provide cobra administration services; 
•    Provide account maintenance services; 
•    Provide ongoing program reports to the comptroller; 
•    Participate in status of operation meetings as requested by the comptroller; and 
•    Provide any additional third party administrative and record keeping services deemed necessary for the program.