Medicare Advantage Third Party Administrative Services

The Vendor is required to provide third-party administration services for the county-sponsored medical and pharmacy fully-insured Medicare advantage plan to retired county employees and dependents.
- Requirement:
• A group Medicare advantage insurance plan that includes prescription drug coverage, for all Medicare-eligible retired employees and their Medicare-eligible dependents, with access to national and local contracted networks of providers, including primary care and specialist physicians, hospitals and ancillary providers, including diagnostic and imaging centers.
• A local or toll-free telephone call-in number for member inquiries, as well as a secure online website.
• The telephone call-in number shall provide access for hearing impaired members and access to retirees in and outside the state.
• An internet-accessible, secure website for purposes of account information, reporting, and management by the county and members.
• Identification cards for each member at no charge to either the county or the member.
• Plan brochures and informational materials for the county for distribution to members at no charge to the county.
• Assistance to the county with the communication of the plan to employees/retirees, including conducting enrollment meetings.
• Certificates of coverage to be mailed or delivered by a means chosen by the county at no additional charge.
• Stable contractual relationships with practicing providers.
• Case management for complex cases.
• Clinical management for members with chronic conditions.
• Wellness programs to support sustained and improved health status.
• Nurse line to respond to member health inquiries.
• Timely and accurate claims processing.
• Participate in monthly service calls with the county and its consultant.
• Annual experience reports to the county and its consultant.
• A dedicated account management team, as well as a dedicated select group of customer service representatives, will answer member inquiries.
• The county's goal is to have only representatives who are familiar with the county and its benefits plan and can assist county employees.
• Dedicated billing and eligibility specialist is also required.
• Communication allowance of up to $5,000.00 on an annual basis that may be used towards communication-related expenses.
• Implementation budget of up to $5,000.00 in the first year towards costs associated with implementing a new vendor or revising the eligibility files sent.
• Participate in informational meetings, virtual or in-person, during annual enrollment.
• House the appropriate technology to accept implementation files, enrollment files, provide weekly and monthly file status, and accept integration with work day.
• Collecting late enrollment penalties from the member.
• Paying the member any low income subsidies.