Benefits Vision Plan Administrator Services

The Vendor is required to provide benefits vision plan administrator services for include:
1. Technology and data integration
•    Support secure, encrypted eligibility file transfers and ongoing data exchange with workday, including future upgrades or system changes.
•    Maintain systems that comply with all applicable federal privacy and security requirements, including the protection of individually identifiable health information
2. Enrollment and eligibility administration
•    Accept all new and transferring enrollers during the initial enrollment period without evidence of insurability.
•    Waive waiting periods for employees transferring from the incumbent district-sponsored plan, ensuring immediate access to all benefits.
•    Allow new hires to enroll within 31 days of their service entrance date, with effective coverage on the employee’s date of service.
3. Provider network requirements
•    Provide a stable, high quality national network of general vision providers and appropriate specialty providers.
•    Ensure all enrollers have reasonable access to participating providers and can obtain timely appointments.
•    Maintain network adequacy standards consistent with industry benchmarks.
4. Customer service and member support
•    Operate a fully staffed call center with:
o    Toll-free access lines
o    Standard operating hours of 8:00 a.m. – 5:00 p.m. cst, Monday–Friday
o    Multi lingual and hearing impaired certified staff
o    Emergency after hours support for authorizations
•    Be fully operational no later than one week prior to the start of initial open enrollment.
5. District engagement and onsite support
•    Participate in district hosted health fairs and employee engagement events in the area at the contractor’s sole cost.
•    Provide onsite or virtual support as requested to resolve employee issues and promote program understanding.
6. District engagement and onsite support
•    Participate in district hosted health fairs and employee engagement events in the area at the contractor’s sole cost.
•    Provide onsite or virtual support as requested to resolve employee issues and promote program understanding.
- Management plan requirements
1. Plan administration
•    Detailed descriptions of each plan offering and associated administrative processes.
•    Enrollment, termination, and eligibility management procedures.
2. Reporting requirements
•    Enrollment activity reports
•    Claims reports
•    Utilization reports
•    Network adequacy and access reports
•    Premium and financial reports
•    Customer service and complaint resolution reports
•    Any additional reporting deemed necessary by the district to evaluate program performance
3. Call center operations
•    Description of call center structure, staffing, training, and escalation protocols.
•    Details on toll free access, after hours support, and language capabilities.
4. Clinical management and member education
•    Vision health education programs
•    Preventive care engagement strategies
•    Programs designed to improve member vision health and overall wellness.