MB-3548 - USA (Hagerstown, Maryland) - Medical, Stop loss and Vision Program Administration Services - Deadline November 15,2019

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3548

Government Authority located in Hagerstown, Maryland; USA based organization looking for expert vendor for medical, stop loss and vision program administration services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide medical, stop loss and vision program administration services to the government authority located in Hagerstown, MD.
-  Provide or make available necessary, appropriate and high-quality prescription benefits to the eligible employees, retirees, and their dependents, must be capable of providing coverage to all eligible employees, retirees, and their dependents,
- Provide necessary and appropriate program administration and services, including but not limited to, maintaining central claims and membership files (including social security numbers, dates of coverage, type of coverage, etc.) for each covered member, by account or division number (i.e. county, schools, other agencies) maintaining payment record; capable of the wire transferring of funds; capable of making payment of providers directly; capable of providing state-of-the-art data tracking and claims paying services; furnish monthly accounting statements by benefit plan and employer showing enrollment, premiums or revenues received, amount of claims paid, capitation expenses charged, detailed list of expenses charged, network discounts earned, claims exceeding the specific stop-loss limit and an estimate of incurred but not reported claims,
- Furnish to each employee enrolled in the plan a benefit booklet outlining and defining all covered services, limitations and exclusions, procedures for receiving services, schedule of benefits, COBRA and other plan information requirements. The initial booklet proof must be provided to on a timely basis but not later than the contract effective date (July 1, 2020). The County shall review and approve the booklets prior to distribution,
- No Gain or Loss Provision: no participant (employees, retirees and dependents) currently covered by any of health care programs, including vision and prescription drug programs, shall suffer a loss of health benefit coverage as a result of changing insurance carriers. all pre-existing conditions and waiting periods shall be waived for those employees and dependents currently enrolled in each of health care programs. deductible and out-of-pocket expenses applied toward the current health care program contract are to be applied to the deductible and out-of-pocket expenses of the new health care program contract, if applicable,
- Meet with the appropriate management staff(s) within thirty days after the contract award date to review the health care plan or prescription drug program, to present the proposed communication material, and to jointly establish a preliminary implementation plan and open enrollment program and schedule,
-  Maintain a local or toll-free customer service number for employees and dependents,
- Provide a systematic procedure for appeal of claims.
(2) A pre-bid conference will be held on October 24,2019.
(3) All question must be submitted no later than October 29,2019.

[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 : Friday, 15 November, 2019

Pre-proposal Conference Date : Thursday, 24 October, 2019

Question Answer Deadline : Tuesday, 29 October, 2019

Category : Medical Billing and Coding, Medical Services

Country : USA

State : Maryland

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