Medicare Advantage Benefit Administration Services

The Vendor is required to provide for the administration of fully insured Medicare Advantage and Prescription Drug (MAPD) benefits
- Provide high quality, cost-effective benefits to its Medicare-eligible retirees and their families.
- The State collects applicable contributions from participants and pays the carrier 100% of the Medicare Advantage premium.
- Provide a fully insured Medicare Advantage (MA) medical plan alongside a fully insured Prescription Drug Plan (PDP).
- Provide financial modeling to assist the State with consideration of plan changes.
- Full range of customer (client and member) services including, but not limited to:
o    Member Services
o    Claims Adjudication
o    Data Reporting and Data Sharing
o    Member Enrollment and Eligibility Maintenance
o    CMS Star Ratings Maximization
o    Medical Management
o    Member Case Management Services
o    Network Access and Network Management
o    Rx Formulary and Clinical Program Management
o    Provider Advocacy and Assistance with Claims Issues
o    Medicare Advantage and Part D Administrative Assistance
o    Effective Member Communications
o    Patient and Family/Caretaker Education and Assistance
o    Integration of a separate fully insured MA alongside a fully insured PDP, if the State elects this option.