Third-Party Administrator Services

The Vendor is required to provide Third-Party Administrators (TPAs) to submit proposals to provide administration services for ancillary employee benefits, which may include dental, vision, basic and voluntary life/AD&D, short-term disability (STD), long-term disability (LTD), critical illness, accident, hospital indemnity, annuities, benefits enrollment system and related programs.
- The District serves approximately 5200 benefit-eligible employees across 51 locations/schools and operates on a 12-month calendar.
- Services include:
•    Plan administration for selected ancillary lines.
•    Eligibility management, EDI file exchanges, and evidence of insurability workflows.
•    Billing, reconciliation, retroactivity rules, and carrier remittance.
•    Claims intake/adjudication (where applicable), appeals, and quality assurance.
•    Customer service (member and employer) with multilingual support and accessibility compliance.
•    Implementation project management, testing, and parallel runs.
•    Ongoing account management, quarterly/annual stewardship, and plan optimization recommendations.
•    Data management, reporting/analytics, and ad hoc reports.
•    COBRA, Section 125, and other compliance services.
•    Integration with benefits enrollment platform/HRIS: Tyler Munis.
•    Performance guarantees and service-level adherence
- Onsite District Benefits Representative
•    Funding must cover salary, benefits, and employer payroll costs for the position.
•    Funding must be guaranteed annually and may not be tied to enrollment levels, premium volume, or participation rates.
•    The District retains full authority over recruitment, hiring, supervision, evaluation, and termination of the FTE.
•    The FTE will support eligibility management, onboarding, employee education, campus visits, benefits administration support, and Open Enrollment activities.
•    Bilingual English/Spanish capability is strongly preferred.
- Enrollment Administration & Life Event Processing
•    New hire enrollments
•    Qualifying life event changes
•    Open Enrollment elections
•    Coverage terminations
•    Dependent additions or removals
- Open Enrollment & Employee Support Services
•    On-site Open Enrollment assistance across multiple District campuses and administrative locations
•    Bilingual English/Spanish benefits representatives available to support employees during enrollment.
•    Assistance with benefit elections, plan education, and employee questions.
•    Coordination with the District for scheduling campus visits and enrollment support sessions.
•    A dedicated customer service phone line for District employees to provide enrollment and benefits assistance.
•    Post-enrollment support for employees needing assistance with benefit elections or corrections.
- Employee Communications & Education
•    Description of communication materials provided (digital and print).
•    Ability to create or customize materials such as benefits guides, open enrollment materials, presentations, FAQs, and educational resources.
•    Availability of communication credits, allowances, or vendor-funded communication support for the District.
•    Sample communication materials.
- Billing, Accounting, and Reconciliation Services
•    A detailed description of the vendor’s billing and reconciliation methodology, including the end-to-end process from eligibility data receipt through carrier remittance and reconciliation.
•    Description of controls used to ensure billing accuracy, reconciliation integrity, and financial accountability.
•    Frequency and format of billing statements and reconciliation reports.
•    Procedures for identifying and correcting discrepancies between enrollment files, carrier invoices, payroll deductions, and remittances.
•    Description of how retroactive adjustments, terminations, and qualifying life events are reflected in billing.
•    Sample reporting illustrating billing statements, reconciliation summaries, discrepancy reports, and financial audit trails.
•    Expected timelines for reconciliation completion and carrier remittance.