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MB-6565 - USA (Texas) - Third Party Administration Service - Deadline August 9,2022

Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6565

Government Authority located in Texas; USA based organization looking for expert vendor for third party administration service.

[A] Budget: Looking for Proposal

[B] Scope of Service:


(1) Vendor needs to provide third party administration service.
- Provide a qualified entity to provide third-party administration of the self-funded state vision plan, a group vision plans available under the employees group benefits program.
- Provides comprehensive group vision care benefits to Members through the Plan. The Plan has been available under the Texas Employees Group Benefits Program beginning September 1, 2016. The Plan is an optional benefit and is available under a self-funded arrangement.
- Benefits are available for the Plan Year, unless otherwise indicated by agency. The frequency of vison care benefits is once every Plan Year, per person. In-network (Network) services are covered in full after the copay is met.
- A newly hired active employee can enroll in the plan during their first 31 days of employment.  otherwise, eligible members can enroll during their benefits enrollment period, or within 31 days of a qualifying life event.
- Administrator shall support a process whereby administrator shall electronically access agency’ sftp site and interface with agency’ enrollment system for any applicable employees responsible for verifying Plan coverage and enrollment.
- Administrator shall also provide the services described herein for COBRA Participants. All enrollments, billing, collection, and other administrative matters related to COBRA shall be handled directly.
- If a claim for benefits is denied or reduced, Administrator shall provide the appealing Participant with a written explanation, including the specific reasons for the denial or reduction.
- TexFlex is an Internal Revenue Code Section 125 cafeteria plan that allows Subscribers to establish health care reimbursement accounts and to pay certain unreimbursed charges with pre-tax funds. ERS currently uses PayFlex Systems USA, Inc. as the administrator for TexFlex.
- The consulting actuary also assists and advises the Board on benefit plan designs, proposal reviews, and rating analysis, as well as certain audit-related activities.
- Provider network requirements
- Provider accessibility and availability requirements and required format
- Network and provider management requirements
- Communication requirements
- Information systems requirements
- Implementation and project management requirements
- Operational specifications and requirements
- Funding, payment and accounting methodology requirements
(2) All the questions must be submitted no later than July 12, 2022
(3) The contract period will be for six years.

[C] Eligibility:

- Onshore (USA ONLY);

[D] Work Performance:

Performance of the work will be Offsite.

Expiry Date : Tuesday, 9 August, 2022

Question Answer Deadline : Tuesday, 12 July, 2022

Category : Medical Billing and Coding, Networking Services and Supplies, Professional, Consulting, Administrative or Management Support Services, Web Design and Development

Country : USA

State : Texas

Cost to Download This RFP Document : $ 5

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