MB-3692 - USA (Texas) - Self-Insured Employee Group Health Plan Administration Services - Deadline January 28,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-3692

Government authority located in Texas; USA based organization looking for expert vendor for self-insured employee group health plan administration services.

[A] Budget: Looking for Proposal

[B] Scope of Service:

(1) Vendor needs to provide claims and network administration services for employees, graduate student employees, retirees, and their dependents enrolled in the city care plan, a self-insured preferred provider organization (PPO) employee group health plan beginning September 1, 2020.
- COBRA premiums will be set at 102% of the normal premium. In addition, premiums for
disability COBRA extension participants are 150% of the normal premium. - Process eligibility information on a weekly basis via secure FTP. Provide SBA with a discrepancy report for each file. - Claim management and processing.
- Communication materials necessary for the proper administration of the plans (including but
not limited to claim forms, identification cards, Explanation of Benefits forms) subject to
editing of format, content and final approval by the A&M System.
- Benefit contracts, affirmed by the A&M System as to form and content and approved by the
State Board of Insurance in accordance with state and federal statutes, and technical and legal
assistance in the administration thereof.
- Management agreements, in addition to any benefit contracts, which formalize the A&M
System’s relationship with any carrier.
- Current Funding: - The contract shall be for administrative services, claims processing, network management and credentialing, utilization review, and disease management services. The cost to meet the requirements described in this RFP shall be recovered by the vendor only by making provision for such expense in the vendor’s Price Proposal Worksheet included in Section
l. Funding for all health plans is derived from the statutory contribution from the State of Texas
and personal payments by participants (payroll deduction or billing/bank draft for retirees).
- Administrative Fee: - The Proposer shall propose an administrative fee which will be guaranteed for three years. The administrative fee proposed should be adequate to cover costs incurred for the performance of all services.
- Payment Methodology for Administrative Fees and Claims: - The Proposer shall process and pay all claims submitted under the A&M Care Health Plan as described herein. The Proposer shall pay claims from the Proposer’s account prior to seeking reimbursement from the A&M System. The Proposer shall be responsible for maintaining its own funds which are sufficient to provide for the costs incurred under the A&M Care Health Plan.
- Other categories of individuals eligible for coverage include COBRA participants, survivors, and
postdoctoral fellows as described in Chapter 1601 of the Texas Insurance Code.
- For more information describe in documents.
(2) All question must be submitted no later than January 3, 2020.

[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 : Tuesday, 28 January, 2020

Question Answer Deadline : Friday, 3 January, 2020

Category : Medical Billing and Coding

Country : USA

State : Texas

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