MB-3370 - USA (California) - Administrative Service Only Self-Funded Vision Plan Services - Deadline September 9,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3370

Government Authority located in California; USA based organization looking for expert vendor for administrative service only self-funded vision plan services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide administrative service only self-funded vision plan services for current County employees, and their dependents include but not limited to vision claims adjudication, provider network maintenance and administrative services
-  Contractor shall provide benefits to covered persons as listed in the schedule of benefits,
- Benefit authorization must be obtained prior to a covered person obtaining plan benefits from a member doctor.
- Covered person is to identify themselves as a contractor covered person and member doctor will obtain authorization.
- Any benefit authorization issued by contractor shall constitute a certification to member doctor that payment will be made.
- Contractor shall not be held liable to county for any benefit authorization issued in error in reliance on the latest eligibility information available to contractor as provided by county,
- Pay or deny claims for plan benefits provided to covered persons, less any applicable co-payment, within a reasonable time but not more than thirty calendar days after contractor has received a completed claim,
- Plan benefits are covered only when deemed visually necessary or appropriate for the proper
treatment of covered persons condition. decisions of the doctor responsible for treatment
are subject to review and final determination by contractor,
- Covered person may object to claim decision made by contractor by requesting a full review of the denial. request for review must be made within one hundred eighty days following denial of claim,
- Provide all funds necessary to pay the claim amount associated with covered persons pursuant to this plan,
- The death of the covered employee.
- The termination or reduction of hours of the covered employee's employment, except that termination for gross misconduct does not constitute a qualifying event,
- The divorce or legal separation of the covered employee from the covered employee's spouse,
- The loss of dependent status by a dependent enrolled in the group benefit plan,
- With respect to dependent only, the covered employee's eligibility for coverage under act,
(2) All the questions must be submitted no later than August 22, 2019.
(3) A contract term will be for five years.

[C] Eligibility:

- Onshore (USA Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Monday, 9 September, 2019

Question Answer Deadline : Thursday, 22 August, 2019

Category : Medical Billing and Coding

Country : USA

State : California

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