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MB-4531 - USA (North Carolina) - Group Medical or Rx Insurance, Dental Insurance, and Administrative Services - Deadline October 13,2020

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-4531

Government Authority located in North Carolina; USA based organization looking for expert vendor for group medical or Rx insurance, dental insurance and administrative services.

[A] Budget: Looking for proposal

[B] Scope of Service:

(1) Vendor needs to provide group medical or Rx insurance, dental insurance and administrative services for its employees on a self-funded basis, administered by first state care.
Eligibility:
- Minimum hour requirement for medical or Rx is 30 hours per week in accordance with the affordable care act.
- Dental is 40 hours per week.
- Coverage is effective on the date of hire.
Provider network:
- The county will give strong consideration to plans that offer broad provider access unless a variance in network design is specifically requested.
- Plans that have provider restrictions will not be looked upon favorably as the county desires flexibility in a provider network.
Benefits:
- Present benefits are detailed in the included benefit summaries as well as a copy of first state care summary plan descriptions.
- In addition, please quote the following alternate plan designs.
Employee assistance program:
- Currently included as part of the first state care program. Please ensure your response includes an employee assistance program component and indicate the number of visits per occurrence.
- County preference is up to eight visits per occurrence.
Claims processing:
- The County would like respondents to provide data supporting their claims processing accuracy and claims processing time.
- The County is requesting that respondents provide performance guarantees surrounding these metrics that will offset administrative costs if the metrics are not satisfied.
Pharmacy program and rebates:
- Please disclose separately all dispensing fees, admin fees, discounts, and guaranteed rebates associated with the pharmacy program.
- The County would like to receive a full pharmacy rebate. If your proposal does not include pharmacy rebates, please be specific and transparent as to how the rebates offset administrative fees and costs.
- The County is also interested in reviewing any innovative cost-control programs you have available.
Plan year and deductible information:
- The plans in place are currently based on a plan year medical annual deductible and medical annual out-of-pocket maximum from July 1st – June 30th.
Group management and carrier communication:
- Please provide a detail of the service structure and team assigned to the county.
- The County will require a consistent team to manage their account and communicate with their members.
- Also, provide information on online administration capabilities and member apps/member experience.
Wellness center:
- County currently provides access to a wellness and occupational medicine facility to its employees with the goal of providing members with easy access to medical care and improving the overall health of our employees and their dependents.
(2) All questions must be submitted no later than September 15, 2020.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

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

Expiry Date : Tuesday, 13 October, 2020

Question Answer Deadline : Tuesday, 15 September, 2020

Category : Medical Billing and Coding

Country : USA

State : North Carolina

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