Specifications include, but are not limited to: Prospective bidders must confirm that they will offer Health Care Plan Consulting and Management Services, including but not limited to: Provide Health Actuarial and Underwriting Services. Develop plan designs and set contribution rates for the self-insured Medicare and non-Medicare hospital, medical and major medical plans, non-Medicare prescription drug plans. Develop plan designs and set contribution rates for the self-funded Medicare Part D prescription drug plans. Review and evaluate insured rate renewals for Medicare Advantage plans, Invitation For Application (IFA) with managed care plans, voluntary dental & vision plans, fitness program and other insured benefits. Model and project/review/track and analyze results of PBM costs/fees, manufacturer rebates and activity and Federal subsidy payments, reinsurance, medical loss ratio and risk adjustments, and National Bid Payment impacts. Provide Health Consulting and Management Services. Support requests for proposals process for the HOP TPA, PBM, Prescription Drug Plan (PDP) Compliance Consultant and other consultants and service providers. Invitations for applications for managed care organizations and other insurers. Negotiate contract terms and service level agreements for service providers and insurers and assist PSERS in vendor management oversight. Draft policies and procedures relevant to Medicare, HOP, and the Premium Assistance Program. Prepare and lead routine and ad-hoc working groups with other HOP vendors when required. Contract with support vendors such as printers, survey organizations, Website design firms, etc. Evaluate the Medicare Supplement (Medigap), Medicare PDP, Medicare Advantage and pre-65 individual health insurance market in Pennsylvania and on a national scale. Assist PSERS in developing strategies to maintain and improve the enrollment of eligible retiree members in HOP...
