Specifications include, but are not limited to: Provide all carrier plans with the options that would best meet the University’s needs for 6.2.2.1 and 6.2.2.2 below. Each plan must indicate the minimum enrollment requirements. Mandatory Plan Design Features: Level-funded or fully-insured funding model Plan coverage meets ACA Minimum Essential Coverage (MEC) Enrollment and coverage in-place by January 1, 2025, and each January 1 thereafter. Voluntary participation Risk mitigation and stop-loss coverage for level-funded plans, if applicable. Minimum provider networks/service areas that can deliver reasonable provider coverage for employees working at each University location. Pricing in a Per Employee Per Month (PEPM) format for employee-only coverage and employee plus dependent coverage, for each plan option proposed. Prior to each plan year, except for 2025 plan year, broker must provide carrier rates no later than August 15th, unless a later date has been agreed to by the University. Preferred Plan Design Features: MEC plan with enhanced medical coverage, e.g., hospital indemnity Perform direct account debit or direct billing for employee premium collection Minimum enrollment requirement of 10 or less. A.M. Best rating of A- rating or greater for a fully-insured health plan carrier or a commercial stop loss insurer. Describe the carrier's ability to allow retroactive coverage and terminations, and the timeframe allowed (i.e., 30 days, 60 days). Plan premiums for employee-only coverage meet ACA affordability. Accommodate a range of employer contribution strategies for employee-only premiums. National network/service coverage area Other optional voluntary benefit programs, e.g., dental, vision.
