Third-Party Administrator: Benefit Services

The Vendor is required to provide for a third-party administrator.
- Provide services associated with the administration of agency medical, dental, vision, life, AD&D, long term disability, short-term disability, wellness program, employee assistance program (EAP), ancillary voluntary benefit plans as well as section 125 flexible spending accounts (FSAS), dependent care accounts (DCA), health savings accounts (HSAS), the consolidated omnibus budget reconciliation act of 1985 (COBRA), family medical leave act (FMLA) administration, health insurance portability and accountability act (HIPAA) and patient protection and affordable care act (PPACA), the consolidated appropriations act (no surprises act), and the providing urgent maternal protections for nursing mothers act (pump act).
- Services will include, but are not limited to, ensuring compliance with state and local regulations and legislation, providing detailed analysis of current coverage to identify solutions that will increase cost effectiveness and savings, and assisting with employee communications during open enrollment and throughout the year. 
- Current insurance providers and third-party administrators include BCBSM, Benistar (retiree health), Guardian, Spring Health, Legal Shield, ID Shield, and Nationwide Pet Insurance.
- Community mental health agency that provides emergency services, assessments, health and medication services, client services management, individual and group therapy, assertive community treatment, older adult services, respite, substance abuse services, community supported living, wraparound and psychosocial rehabilitation.
- Health/RX/Dental/Vision Plan Review and Summary
•    Annually review claims history and current health plan, including managed care utilization for change opportunities that maximize cost savings while minimizing agency and employee/retiree impact.
•    Prepare an annual report summarizing current benefit plan arrangements and potential action steps, as well as financial impact to both employees/retirees and the agency.
- Legislative Position Analysis
•    Provide agency with legislative analysis and position development relative to proposed legislation impacting public sector benefits and benefit administration as needed.
- Plan Change Communication Development
•    Work with agency and its insurance providers to prepare clear communication materials to support implementation of any benefit changes and participate, as requested, in employee meetings.
•    Work with agency to conduct employee information sessions to educate staff about the specifics of any changes to health care options and administration.
- Facilitation of Set-up Meetings and Bi-Annual Vendor Meetings.
•    Facilitate bi-annual (twice a year) meetings with each insurance provider to ensure that vendor relationships and service levels are maintained at promised levels.
- Contract/Plan Document/SPD Review and Recommendations
•    Review contracts, plan documents and summary plan descriptions from all vendors for accuracy and completeness as well as inclusion of appropriate language for compliance and reservation of rights as needed. Provide recommendations for updating contracts, documents and/or descriptions.
- Open Enrollment Process Review and Update
•    Annually (late summer/early fall) review agency open enrollment process and develop updated open enrollment materials that provide personalized enrollment materials for all employees and new hires through electronic means.
•    Coordinate and Conduct, at a minimum of two (2) employee meetings for all employees explaining the Benefit Plans and Flexible Benefits.
•    Perform and provide online enrollments – completely paperless.
- Ad-Hoc Research
•    Conduct research, provide reports and conduct presentations to the Board and Administration as requested.
- Access to Technical Bulletins and Seminars
•    Provide access to educational materials for the Human Resources Department and the administration, such as technical bulletins and seminars on benefit related topics.