Flexible Spending Account, Health Reimbursement Account and COBRA Administration Services

The Vendor is required to provide services:
• COBRA Administration
• Flexible Spending Account (FSA) Administration
• Health Reimbursement Account (HRA) Administration
- The City employs over 2,850 benefit eligible employees. There are approximately 2,500 employees, retirees and COBRA beneficiaries enrolled on the medical plan.
- Employees enrolled in the Advantage Medical Plan (currently about 1,250 employees) are eligible for employer HRA contributions of up to $500 per year for those enrolled in employee only coverage and $1,000 per year for all other enrollment tiers.
- Employees have a maximum balance of $8,000, and may roll over up to $8,000 per year.
- The City’s medical third-party administrator, Ameriben, currently provides COBRA administration.
- Separately, the City provides a full service in-house pharmacy. In addition to dispensing a wide variety of prescription and over-the-counter medications and supplies, the in-house pharmacist runs two on-site disease management programs for plan members with diabetes and/or cardiovascular disease.
- The City continually strives for greater coordination and collaboration between our vendor partners.
- HRA/FSA Program Strategy & Plan Design Support
• Provide consultative support on plan design
• Advise on contribution strategies, eligibility rules, and plan structure
• Support alignment with overall benefits strategy
• Provide benchmarking against public sector and peer employers
• Assist with plan document development and updates
- HRA/FSA Plan Setup & Implementation
• Configure all plan parameters within the administrative platform:
o Eligibility rules
o Contribution limits
o Rollover or carryover provisions
o Run-out and grace periods
• Develop and manage implementation timeline
• Coordinate with employer systems:
o Payroll
o HRIS
o Benefits administration platforms
• Conduct file testing and validation (eligibility, payroll, claims)
• Provide training for HR and benefits staff
• Support open enrollment setup and readiness
- Enrollment & Contribution Management (FSA)
• Support open enrollment and mid-year election changes
• Manage participant elections and contribution tracking
• Validate qualifying life event changes
• Integrate with payroll systems for accurate deductions
• Monitor IRS annual limits and enforce contribution caps
- FSA Account Administration & Claims Processing
• Process and adjudicate claims in accordance with IRS Section 125 rules
• Substantiate expenses and manage receipt validation
• Administer debit card program, including:
o Auto-substantiation capabilities
o Merchant category code controls
• Manage run-out periods and claims deadlines
- HRA Funds Management & Compliance
• Track employer-funded balances and claims utilization
• Manage rollover provisions and account expirations
• Ensure compliance with IRS Section 105 requirements
• Support integration with medical plan
- Customer Service & Participant Support
• Provide participant support via:
o Phone
o Email
o Online tools
• Maintain defined service levels:
o Average speed to answer
o First-call resolution
• Assist participants with:
o Claims questions
o Reimbursement status
o Eligibility and account issues
• Provide multilingual support capabilities.