Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6670

Government Authority located in Connecticut; USA based organization looking for expert vendor for carrier for medicare supplement or medicare advantage plan services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

Vendor needs to provide insurance carriers or third-party administrators paying to administer its group medicare supplemental program for its medicare- eligible retired employees and eligible spouses on either a fully insured or a self-funded basis.
- Group Plan: This Plan will be a group Medicare supplement plan (retiree medical plan) And a group Medicare Advantage plan. Proposers able to provide responses for one or both should do so.
- Enrollment and Billing:
- Enrollment (initial eligibility, additions, terminations, changes) will be conducted through transmission of electronic eligibility files (in Excel) or via on-line capabilities. Proposer must have secure and HIPAA compliant data transmission capability. Proposer should specify capabilities relative to this benefit administration.
- For fully insured plans, carrier will provide claim data illustrating incurred and paid claims on a monthly basis and provided to the City on a quarterly basis and upon renewal. Reports will be provided in excel.
- For self-funded plans, Proposer will provide claim data illustrating incurred and paid claims on the same schedule with claims invoices. Reports will be provided in excel.
- Claims Adjudication: Proposer will process claims with the speed and accuracy that is consistent with industry standards.
- Proposer will prepare and issue member ID cards, certificate booklets and summary of benefits to each member upon enrollment into the plan.
- For fully insured proposals, Proposer will provide a per-member-per-month premium quote for a period of not less than 12 months; for self-insured proposals, per-member per- month administrative fee. Premiums or fees should be proposed net of commissions.
- Proposer will specify desired funding process relative to the flow of funds for self-insured claims administration in self-funded proposals.

[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 : Thursday, 18 August, 2022

Category : Medical Billing and Coding

Country : USA

State : Connecticut

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