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MB-5220 - USA (Texas) - Health Plan Administration Services - Deadline June 2,2021

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-5220

Government Authority located in Texas; USA based organization looking for expert vendor for health plan administration services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide health plan administration services
- to provide Health Benefits Administration, Dental Administration, PBM (Pharmacy Benefits) Administration, Stop Loss Insurance, Section 125 Services, Health Savings Account Administration, COBRA Services, and Health Reimbursement Account Administrative Services,
- Self-Insured Medical and Dental Plans:
- Medical and dental plan design must mirror existing plan design as well as additional plan options for the dental plan,
- The cost analysis will itemize all expenses to include the expected claims cost, administration fees, and cost of additional programs that will be used to develop the premiums,
- Offeror shall provide a detailed explanation of out-of-network claims programs pertaining to the handling of claims related to Radiology, Anesthesiology, Pathology, Lab and Emergency
services,
- Stop Loss:
- Offeror should quote specific stop loss on a 24/12 basis,
- Specific stop loss covers medical and pharmacy claims. It is expected that the stop loss vendor will request pharmacy claims from the pharmacy vendor and to coordinate medical specific
claims,
- Section 125 POP Plan and Flexible Spending Account Administration:
- Development of Plan Documents and Summary Plan Descriptions as well as updates to these documents, as required,
- Employee communications, online website for accessing information about account balances, worksheets for calculations prior to elections, and other necessary access for administration of
the plan,
- Contractor shall provide claim forms, maintenance forms, substantiation, or verification forms online for participants as well as sponsor,
- Process payments weekly for reimbursements for both medical and dependent care accounts,
- Provide facsimile phone number as well as secure email process for claim processing,
- Customer Service assistance by phone with preferably 24-hour access but will accept normal work hours,
- Health Reimbursement Account (HRA) Administration for Special Retirees:
- Employee communications, online website for accessing information about account balances and other necessary access for administration of the plan to be available for the special
retirees,
- Contractor will provide claim forms, maintenance forms, substantiation, or verification forms online for participants as well as sponsor.
- Provide facsimile phone number as well as secure email process for claim processing,
- Sponsor Web Access and Electronic Interface Reporting:
- All reports as well as access to view individual participant accounts are to be available for all HIPAA approved Staff.
(2) A pre-proposal meeting will be held on May 11, 2021
(3) All the questions must be submitted no later than May 18, 2021.

[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 : Wednesday, 2 June, 2021

Pre-proposal Conference Date : Tuesday, 11 May, 2021

Question Answer Deadline : Tuesday, 18 May, 2021

Category : Medical Billing and Coding

Country : USA

State : Texas

Cost to Download This RFP Document : $ 5

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