Specifications include, but are not limited to: a. The primary objective of the Medical, Dental, Vision, and EAP services is to provide access to the following services for benefit eligible employees and their household dependents: i. Provides eligible employees and dependents with quality and affordable plans. ii. Ensure the Medical, Dental, Vision, and EAP services offers the most competitive arrangement as measured by benefits, provider discounts, administrative costs, customer service and processing accuracy. iii. Maintain flexibility of plan design structure iv. Maintain current model with reinsurance and pharmacy carved out of medical. v. Maintain flexible preferred providers. vi. Evaluate fully insured proposals. vii. Evaluate High Deductible Plan and HSA options. viii. Seek opportunities for carrier investment into a wellness fund to help establish and support ongoing health management and improve outcomes. ix. Evaluate specialty capabilities (disease management, population health management and wellness programs to ensure “Best in Class” programs are offered). x. Provide ease of administration for the Group. xi. Process eligibility records accurately, efficiently, and timely and provides accurate billing on a timely basis. xii. Provide simplified communication resources. xiii. Provide timely, responsive customer service to the plan members and to the Group. xiv. Integrate and coordinate efficiently, timely and accurately with other related plan and service providers (i.e., reinsurance carrier, prescription drug plan, wellness, travel network, Insight Imaging Services etc.) xv. Provide fees associated with transfer of medical and pharmacy claims data to another vendor. xvi. Have meaningful financial and service performance guarantees. xvii. Maintain a dedicated account management team with highly skilled, qualified, and experienced personnel. xviii. Motivate employees and dependents to make and maintain healthy lifestyle choices and efficacious, cost-effective healthcare decisions. b. Products to be offered: i. Medical Insurance ii. Dental Insurance iii. Vision Insurance iv. EAP Services c. The Group will offer all benefits through payroll deduction. d. Medical must coordinate with pharmacy and wellness benefits.
