1-RFP.Scope.WeberHS.xlsx
XLSX spreadsheet 80 KB Posted
- Attached to
- HRIS Software and Support
- Solicitation number
- 2026-11-04
- Issued by
- Utah
About this file
This is a Request for Proposal (RFP) Pricing Scope document for Weber Human Services in Utah seeking HRIS and payroll support services, with a due date of November 1, 2026. The RFP encompasses a comprehensive range of Human Resources services organized across multiple functional categories, including HR systems, payroll, talent management, time and attendance, benefits administration, leave of absence administration, and spending accounts. The scope details which services are in-scope, possibly in-scope, or out-of-scope, with specific services marked for potential inclusion such as background check services, payroll processing, performance management systems, succession planning systems, time and attendance systems, and various benefits administration functions including FSA administration, HSA administration, and COBRA administration. The document indicates this is anticipated to be a three-year contract term with pricing structured around various cost models including one-time implementation fees and ongoing per-employee-per-month (PEPM) charges. The RFP reflects Weber Human Services' current use of Great Plains for payroll and their preference for a co-sourced model that offers agile integrations, consultative partnership, and flexible system interfaces.
The pricing framework establishes multiple cost calculation methodologies based on employee counts, benefit-eligible employees, participants, retirees, and volume-based metrics such as new hires, terminations, and advocacy cases. All pricing submitted in the scope document currently reflects $0.00 for both one-time implementation fees and ongoing PEPM costs, indicating this is a template awaiting vendor proposals. The document includes detailed service definitions covering implementation, ongoing maintenance, data conversion, system interfaces, and specific operational functions across all service categories. Weber Human Services' selection criteria emphasize the vendor's ability to provide recommendations on platform optimization, deliver consultative services, and maintain open and flexible integrations with other systems to improve the experience for both administrators and employees.
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| 2-RFP.WeberHumanServices Updated.pdf |
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RFP Pricing
| Weber Human Services | DUE DATE : 11/01/2026 | |||||
| Service | In Scope, Possibly in Scope | Included in Pricing | One Time Implementation Fees | Ongoing PEPM | Client Notes | Vendor Notes |
| Human Resources | ||||||
| HR System | In Scope | Yes | $0.00 | $0.00 | ||
| HR Outsourcing Services | Out of Scope | Yes | $0.00 | $0.00 | ||
| Background Check Services | Possibly In Scope | 0 | $0.00 | $0.00 | Dax system for licensing w/ state - but interested if possible with Dax | |
| Substance Abuse Services | Out of Scope | 0 | $0.00 | $0.00 | ||
| Employment Reference Verification Services | Out of Scope | 0 | $0.00 | $0.00 | ||
| Employment & Income Verification | Out of Scope | 0 | $0.00 | $0.00 | ||
| Employment & Income Verification History Conversion | Out of Scope | 0 | $0.00 | $0.00 | ||
| HR System History Conversion | In Scope | 0 | $0.00 | $0.00 | ||
| HR System Interfaces | In Scope | 0 | $0.00 | $0.00 | ||
| Human Resources |
| Payroll | ||||
| Payroll System | In Scope | 0 | $0.00 | $0.00 |
| Payroll Outsourcing Services | Out of Scope | 0 | $0.00 | $0.00 |
| Payroll Processing | Possibly In Scope | 0 | $0.00 | $0.00 |
| Payroll Bank Check | In Scope | 0 | $0.00 | $0.00 |
| Check Printing Services | In Scope | 0 | $0.00 | $0.00 |
| W2 Processing | In Scope | 0 | $0.00 | $0.00 |
| Tax Filing | In Scope | 0 | $0.00 | $0.00 |
| Tax Credit Services | In Scope | 0 | $0.00 | $0.00 |
| New Hire Reporting | In Scope | 0 | $0.00 | $0.00 |
| GL Processing | In Scope | 0 | $0.00 | $0.00 |
| Unemployment Insurance Processing | Possibly In Scope | 0 | $0.00 | $0.00 |
| Garnishment Processing Services | Possibly In Scope | 0 | $0.00 | $0.00 |
| Garnishment Payment Services | Possibly In Scope | 0 | $0.00 | $0.00 |
| Payroll Check History Conversion | Out of Scope | 0 | $0.00 | $0.00 |
| Payroll Interfaces | In Scope | 0 | $0.00 | $0.00 |
| Payroll | Out of Scope |
| Talent Management | ||||
| Recruiting System | In Scope | 0 | $0.00 | $0.00 |
| Recruiting History Conversion | In Scope | 0 | $0.00 | $0.00 |
| Onboarding System | In Scope | 0 | $0.00 | $0.00 |
| Performance Management System | Possibly In Scope | 0 | $0.00 | $0.00 |
| Performance Management History | Out of Scope | 0 | $0.00 | $0.00 |
| Succession Planning System | Possibly In Scope | 0 | $0.00 | $0.00 |
| Compensation Planning System | Out of Scope | 0 | $0.00 | $0.00 |
| Learning Management System | Out of Scope | 0 | $0.00 | $0.00 |
| Learning Management History | Out of Scope | 0 | $0.00 | $0.00 |
| Talent Management |
| Time & Attendance | ||||
| Time & Attendance System | Possibly In Scope | 0 | $0.00 | $0.00 |
| Time & Attendance Collection Devices | Possibly In Scope | 0 | $0.00 | $0.00 |
| Time & Attendance History | Possibly In Scope | 0 | $0.00 | $0.00 |
| Time & Attendance |
| Leave of Absence | ||||
| LOA Administration | In Scope | 0 | $0.00 | $0.00 |
| LOA History Conversion | Out of Scope | 0 | $0.00 | $0.00 |
| Leave of Absence |
| Affordable Care Compliance | ||||
| ACA Compliance Services | Out of Scope | 0 | $0.00 | $0.00 |
| ACA Tracking Services | Out of Scope | 0 | $0.00 | $0.00 |
| 1095 Distribution | Out of Scope | 0 | $0.00 | $0.00 |
| 1094 Submission | Out of Scope | 0 | $0.00 | $0.00 |
| ACA Call Center Support | Out of Scope | 0 | $0.00 | $0.00 |
| Affordable Care Compliance |
| Benefits Administration | ||||
| Benefits Administration System | In Scope | 0 | $0.00 | $0.00 |
| Paper Fulfillment | Out of Scope | 0 | $0.00 | $0.00 |
| Communication Design Consulting | Out of Scope | 0 | $0.00 | $0.00 |
| H&W History Conversion | In Scope | 0 | $0.00 | $0.00 |
| Carrier File Feeds | In Scope | 0 | $0.00 | $0.00 |
| Non-Carrier File Feeds | In Scope | 0 | $0.00 | $0.00 |
| EOI Processing | In Scope | 0 | $0.00 | $0.00 |
| Direct Bill LOA | Possibly In Scope | 0 | $0.00 | $0.00 |
| Direct Bill Retiree | Out of Scope | 0 | $0.00 | $0.00 |
| QMCSO Administration | Possibly In Scope | 0 | $0.00 | $0.00 |
| QMCSO Qualification | Possibly In Scope | 0 | $0.00 | $0.00 |
| Dependent Status Initial Verification Audit | Possibly In Scope | 0 | $0.00 | $0.00 |
| Dependent Status Verifications | Possibly In Scope | 0 | $0.00 | $0.00 |
| Premium Reconciliation Services | Possibly In Scope | 0 | $0.00 | $0.00 |
| Premium Billing Reporting | Possibly In Scope | 0 | $0.00 | $0.00 |
| Premium Payment | Possibly In Scope | 0 | $0.00 | $0.00 |
| Decision Support Tools | Possibly In Scope | 0 | $0.00 | $0.00 |
| Death Claim Coordination | Out of Scope | 0 | $0.00 | $0.00 |
| Tier 1 Advocacy Services | Possibly In Scope | 0 | $0.00 | $0.00 |
| Tier 2 Advocacy Services | Out of Scope | 0 | $0.00 | $0.00 |
| Total Comp Statements | In Scope | 0 | $0.00 | $0.00 |
| Pre Hire Website | 0 | 0 | $0.00 | $0.00 |
| Benefits Administration | In Scope |
| Spending Accounts | ||||
| FSA Administration | Possibly In Scope | 0 | $0.00 | $0.00 |
| FSA Debit Card | Possibly In Scope | 0 | $0.00 | $0.00 |
| HSA Administration | Possibly In Scope | 0 | $0.00 | $0.00 |
| HRA Administration | Possibly In Scope | 0 | $0.00 | $0.00 |
| Spending Accounts |
| COBRA | ||||
| COBRA Administration | 0 | 0 | $0.00 | $0.00 |
| New Hire HIPAA Notification | 0 | 0 | $0.00 | $0.00 |
| COBRA Takeover Notices | 0 | 0 | $0.00 | $0.00 |
| COBRA | Possibly In Scope |
| Miscellaneous | ||||
| Single Sign On | Out of Scope | 0 | $0.00 | $0.00 |
| Service Call Center | 0 | 0 | $0.00 | $0.00 |
| Technical Call Center | 0 | 0 | $0.00 | $0.00 |
| Expanded Service Call Center | 0 | 0 | $0.00 | $0.00 |
| Spanish Service Call Center | 0 | 0 | $0.00 | $0.00 |
| Language Translation Services | 0 | 0 | $0.00 | $0.00 |
| Expense Management | 0 | 0 | $0.00 | $0.00 |
| e-Document Management | In Scope | 0 | $0.00 | $0.00 |
| Reporting & Analytics | In Scope | 0 | $0.00 | $0.00 |
| Training | In Scope | 0 | $0.00 | $0.00 |
| Miscellaneous |
Interface
| [Item 2] | 0 | 0 | $0.00 | $0.00 |
| [Item 3] | 0 | 0 | $0.00 | $0.00 |
| [Item 4] | 0 | 0 | $0.00 | $0.00 |
| Interface |
Confidential: GBS-Client Privileged Communication
GBS Work Product:
This document contains GBS’s proprietary work product and is provided to [insert client or prospect here] on a confidential basis.
| This document contains Lockton’s proprietary work product and is provided to [insert client or prospect here] on a confidential basis. |
| GBS has certain confidentiality obligations to the vendors identified in this report. As such, any reproduction, disclosure or distribution to any third party without first securing written permission from GBS is prohibited. |
Warranty Disclaimer:
GBS MAKES NO WARRANTY, EXPRESS, IMPLIED OR STATUTORY, WITH RESPECT TO THE VENDORS IDENTIFITED IN THIS REPORT AND/OR THEIR ABILITY TO PERFORM THE CONTEMPLATED SERVICES, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTY OF RELIABILITY, USEFULNESS, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NONINFRINGEMENT, OR THOSE ARISING FROM THE COURSE OF PERFORMANCE, DEALING, USAGE OR TRADE.
LOCKTON MAKES NO WARRANTY, EXPRESS, IMPLIED OR STATUTORY, WITH RESPECT TO THE VENDORS IDENTIFITED IN THIS REPORT AND/OR THEIR ABILITY TO PERFORM THE CONTEMPLATED SERVICES, INCLUDING WITHOUT LIMITATION ANY IMPLIED WARRANTY OF RELIABILITY, USEFULNESS, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NONINFRINGEMENT, OR THOSE ARISING FROM THE COURSE OF PERFORMANCE, DEALING, USAGE OR TRADE.
RFP Definitions
| RFP Definitions | |
| Cost Types and Key Assumptions Associated | |
| PEPM (Total) | Refers to the total number of employees (benefit eligible, full time, part time, etc.). |
| PEPM (Variable Hour) | Refers to number of employees who average a different number of hours worked during a measurement period. Added to account for ACA calculations |
| PEPM (FT/30 Hour) | Refers to the employees who are now deemed "full time" under ACA. Added to clarify with clients, as definition of FT to them may be different. |
| PRPM | Refers to the number of retirees |
| PPPM | Used as a reference to any participant in a certain category (FSA, health savings account, etc.) |
| PEEPM | Generally refers to all benefit eligible employees |
| Each | Differs from monthly charges. Represents a single per key assumption charge. Ex. New Hire HIPAA Notification charges "EACH" new hire |
| Fixed | Non-variable cost. Can be one-time, monthly, or annual. |
| Pricing/Key Assumption Details | |
| Turnover Percentage | Percentage of turnover client expects in one year; Active employees less Terms divided by Active |
| Growth Percentage | Percentage of growth client expects in one year. |
| Contract Term in Years | Generally this is a 3 year contract RFP |
| Annual number of terminations | Number of Terminations equals the Turnover Percent multiplied by the number of employees |
| Annual number of new hires | Number of New Hires equals the Growth Percent multiplied by the number of employees plus terminations |
| Tier 1 Advocacy Cases | Number of cases where serving as intermediary, navigating clients through health care system |
| Tier 2 Advocacy Services with claims appeals | Number of cases where providing in depth education on health care, serving as intermediary with escalated issues. "White Glove" service |
| Number of Monthly Self Bills | |
| Number of Monthly List Bills | |
| Annual Number of COBRA elections | Typically an "EACH", multiplies number of COBRA elections over a year and the given price |
| Annual Number of COBRA events | Typically an "EACH", multiplies number of COBRA events (terminations) over a year and the given price |
| Services Definitions | |
| PRICING DETAILS | |
| Number of Employees | Number of active employees included in this RFP (includes benefit eligible and non-benefit eligible employees) |
| Turnover Percentage | Percentage of turnover client expects in one year; Active employees less Terms divided by Active |
| Growth Percentage | Percentage of growth client expects in one year |
| Contract Term in Years | Generally this is a 3 year contract RFP |
| Annual number of terminations | Number of Terminations equals the Turnover Percent multiplied by the number of employees |
| Annual number of new hires | Number of New Hires equals the Growth Percent multiplied by the number of employees plus terminations |
| PEPM | Per Employee Per Month |
| PEEPM | Per Eligible Employee Per Month |
| PPPM | Per Participant Per Month |
| HR SYSTEM | |
| Implementation | The processes and cost involved in getting new HR software or hardware operating properly in its environment, including installation, configuration, running, testing and making necessary changes. |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining data within the system for a specific time period. |
| HR Outsourcing | An outside party performs some or all of their HR functions i.e. all HR data entry. Also known as HROs. |
| HR System Initial Conversion | Vendors cost to convert clients data from current system to new system. CURRENT data ONLY. |
| HR System History Conversion | Cost to convert clients historical data beyond CURRENT data. |
| HR Interfaces | |
| Configuration | Development of required interfaces into or out of the HR system |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining/running the required interfaces |
| PAYROLL SYSTEM | |
| Implementation | The processes and cost involved in getting new payroll software or hardware operating properly in its environment, including installation, configuration, running, testing and making necessary changes. |
| Payroll Initial Conversion - Payroll History | Vendors cost to convert clients data from current system to new system. CURRENT data ONLY. Payroll indicative data. |
| Payroll Initial Conversion - Check History | Vendors cost to convert clients data from current system to new system. CURRENT data ONLY. Check history Only. |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining data within the system for a specific time period. |
| Payroll Outsourcing | An outside party performs some or all of their Payroll functions. Usually includes the 3rd party making all time and payroll entries and processing the payroll (running and reconciling) on behalf of the client. |
| Payroll Processing | Gross to net vendor payroll processing on the vendor system. |
| W2 Processing | Cost to create and run annual W2s including processing and preparing paper copies and electronic access for Self Service. |
| Tax Filing | Quarterly and Annual completion and submission of taxes to the national, state or municipality imposing the taxes and the filing of federal, state, and local payroll tax returns. |
| Unemployment Insurance Processing | Management of the entire unemployment insurance (UI) claim process including: |
*Claims administration *Timely appeals *Auditing of benefit charges *Hearing representation Garnishment Payment Garnishments include: child support, defaulted student loans, taxes, unpaid court fines. Basic services should include the payment of collected employee deductions to payee or state agencies. Client is responsible for receiving, reviewing and setup of garnishments.
Garnishment Processing The process of deducting money from an employee's monetary compensation (including salary), sometimes as a result of a court order. Wage garnishments continue until the entire debt is paid or arrangements are made to pay off the debt. Garnishments can be taken for any type of debt but common examples of debt that result in garnishments include: child support, defaulted student loans, taxes, unpaid court fines. We need the service to include:
Document retention for cataloging purposes Accurate and timely court order or lien analysis Prompt payments and required correspondence to payee or state agencies Timely generation of garnishment status notification letters
| General Ledger | Data interface from the payroll system to the client's financial system of all payroll related debits and credits. |
| Implementation | The processes involved in getting new software or hardware operating properly in its environment, including installation, configuration, running, testing and making necessary changes. |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining data within the system for a specific time period. |
| Payroll Interfaces | |
| Configuration | Establishment of interfaces into or out of the Payroll System |
| Ongoing Costs | The continuous costs of preparing, processing and maintaining/running the interface |
| EMPLOYEE SELF SERVICE | |
| Employee Self Service | Online access over the Internet to system information that allows client employees to perform routine tasks, without requiring any interaction with a representative of the client. |
| MANAGER SELF SERVICE | |
| Manager Self Service | Online access over the Internet to system information that allows client managers to perform routine tasks, without requiring any interaction with a representative of the client. |
| TALENT MANAGEMENT | |
| Implementation | The processes involved in getting new software or hardware operating properly in its environment, including installation, configuration, running, testing and making necessary changes. |
| Ongoing Costs | The continuous costs of preparing, processing and maintaining data within the system for a specific time period. |
| Talent Management Interfaces | |
| Configuration | Development of required interfaces into or out of the Talent Management System, if not integrated with HR |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining/running the required interfaces |
| Recruiting | System to allow candidates (employees and outside potential employees) to apply for jobs online; allow resumes to be automatically screened and searched; allow administrators to house job descriptions to manage applicants in relation to job postings, comply with applicable employment regulations. |
| Recruiting Initial Conversion | Vendors cost to convert clients data from current system to new system. CURRENT data ONLY. |
| Recruiting History | Vendors cost to convert any closed requisitions or applicant information for current or previous plan years, i.e. to support AAP plans. |
| ON BOARDING | |
| On boarding | The process/system that adds new employees (usually starting from the recruiting system) to the client's organization. Usually involves completing new hire paperwork online(I-9, W-4, etc.) to transfer automatically to the HR/Payroll system. In addition, it often contains workflow to other client groups (IT, Finance, etc.) to notify them of the new hire in order to complete the new hire process. |
| PERFORMANCE MANAGEMENT | |
| Performance Management | System used to track and manage competency assessments, performance appraisals, goal achievement, development plans and individual career goals. |
| Performance Management Conversion | Importing of all performance management data from a previous system |
| Performance Management Interfaces | |
| Configuration | Establishment of interfaces into or out of the Performance Management System, if not integrated with HR |
| Ongoing Costs | The continuous costs of preparing, processing and maintaining/running the interface |
| SUCCESSION PLANNING | |
| Succession Planning | System used to fulfill near-term and long-term talent needs, by identifying and developing existing talent and solicit outside talent when needed. |
| Succession Planning Conversion | Importing of all succession planning data from a previous system |
| COMPENSATION PLANNING | |
| Compensation Planning | System used to identify current employee compensation trends, identify fair employee compensation for all career levels, plan for increases corresponding to budget allocations and align compensation directly to performance. |
| Compensation Planning Conversion | Importing of all compensation planning data from a previous system. |
| Compensation Planning Interfaces | |
| Configuration | Development of required interfaces into or out of the Compensation Planning System, if not integrated with HR |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining/running the required interfaces |
| LEARNING MANAGEMENT | |
| Learning Management System | System used to plan, implement, and assess a specific learning process. This typically includes the ability to publish and deploy media-rich content, which includes online learning classes, automated workflow, assignment and tracking capabilities. It also usually includes instructor led training, social collaboration, compliance and certification management. |
| Learning Management Conversion | Importing of all learning management data from a previous system |
| Learning Management Interfaces | |
| Configuration | Development of required interfaces into or out of the Learning Management System, if not integrated with HR |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining/running the required interfaces |
| TIME AND ATTENDANCE | |
| Implementation | The processes involved in getting new software or hardware operating properly in its environment, including installation, configuration, running, testing and making necessary changes. |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining data within the system for a specific time period. |
| Time and Attendance Ongoing Fees | This service includes maintaining accurate records on hours worked, overtime status, and schedules using a variety of collection methods. |
| Time and Attendance Time Collection Devices | The price of the device(s) used to collect time, i.e. time clocks, biometric clocks, IVR, wireless devices, etc. |
| Time and Attendance Conversion | Importing of all time and attendance data from a previous system. |
| Time and Attendance Interfaces | |
| Configuration | Establishment of interfaces into or out of the Time and Attendance system, if not integrated with Payroll |
| Ongoing Costs | The continuous costs of preparing, processing and maintaining/running the interface |
| EMPLOYMENT AND INCOME VERIFICATION | |
| Employment & Income Verification | Service that provides 3rd parties (government entities, mortgage companies, etc.) with employment and income information about current or former client employees. |
| LEAVE OF ABSENCE ADMINISTRATION | |
| Leave of Absence Administration | This service includes necessary compliance with FMLA, ADA and individual state Workers Compensation regulations. It includes the application or regulations and company policies, complete record keeping and reporting, complete and efficient processing of LOA requests. |
| Leave of Absence Administration Initial Conversion | Vendors cost to convert clients data from current system to new system. CURRENT data ONLY. |
| Leave of Absence Administration History Conversion | Cost to convert clients historical data beyond CURRENT data. |
| Leave of Absence Administration | |
| Configuration | Development of required interfaces into or out of the Leave of Absence Administration system, if not integrated with HR |
| Ongoing Costs | The ongoing costs of preparing, processing and maintaining/running the required interfaces |
| WEB ENROLLMENT/BENEFITS ADMINISTRATION | |
| Ongoing Life Event Processing | Benefit life event processing for new hires and employees who have changes in family status throughout the year. |
| Paper Fulfillment Costs | Cost of distributing paper Enrollment Booklets/Forms and/or paper Confirmation Statements |
| Communication Design Consulting | Consulting on the design of benefit enrollment materials (Enrollment booklets, etc.) |
| Health and Welfare Administration Initial Conversion | Conversion of current year employee data and benefit elections. |
| Health and Welfare Administration History Conversion | Conversion of employee data and benefit elections prior to the current year. |
| Health and Welfare Carrier Feeds | Number of interfaces that are set up TO AND FROM the carriers and sent per month These are mainly vendor feeds. For example, if 5 carrier feeds exists and they are sent twice a month, this number would be 10. This mainly includes Medical, Dental, Vision, EAP and are very commonly eligibility feeds. |
| Health and Welfare Administration Non-Carrier Feeds | Interfaces that are NOT to carriers, i.e. TO AND FROM the HR system or Payroll system; NOT to a provider. Examples are indicative data feeds from HR system and benefit deduction feed to payroll. |
| EOI Processing - Electronic submission | EOI (Evidence of Insurability) means that you must provide medical information (which may include medical records and a physical exam) that requires review and approval before coverage becomes effective. |
| EOI Processing - Paper ONLY | EOI (Evidence of Insurability) means that employees must provide medical information (which may include medical records and a physical exam) that requires review and approval from a vendor before coverage becomes effective. Employee completes documentation on ben admin site or via a paper form and ben admin vendor responsible for submitting documentation to vendor. Once approved, ben admin vendor manually updates the ben admin system. |
| HSA Processing | Health Savings Account - a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). |
| HRA Processing | Health Reimbursement Account - an IRS sanctioned programs that allow an employer to set aside funds to reimburse medical expenses paid by participating employees |
| Direct Bill LOA Processing | Direct Bill Leave of Absence Processing includes all or some of the following: |
*Monthly Invoicing to the Employee on LOA *Tracking of collected premiums while on LOA *Disbursement of collected premiums while on LOA *Employee option to pay by ACH of Funds
Direct Bill Retiree Processing Direct Bill Retiree Processing includes all or some of the following:
*Monthly Invoicing to the Retired Employee *Tracking of collected premiums *Disbursement of collected premiums *Retiree option to pay by ACH of Funds
| QMCSO Administration (excluding Qualification) | Service provides updating of ben admin system when a Qualified Medical Child Support Order is received and goes into effect or ends. |
| QMCSO Qualification | Service provides legal evaluation of Qualified Medical Child Support Order to determine if it is valid and should be followed by client. |
| Dependent Status Verification | Verifying the status/validity of dependents through reviewing the appropriate documentation (birth certificate, marriage license, etc.). Occurs when an Ongoing Life Events or New Hire is processed. |
| Premium Reconciliation Services | A service in which the vendor calculates and provides reconciliation of carrier monthly bills, including "wash rules" generally for carrier list bills. Client outsources reconciliation activities to the vendor who is responsible for working with the carrier to resolve billing discrepancies. |
| Premium Bill Reporting | Vendor calculates and provides reports of carrier monthly bills, including "wash rules" to create a ready-to-pay invoice for client self-billing. Vendor does not provide ongoing reconciliation services after the monthly billing reports are setup during implementation. Client provides any reconciliation activities. |
| Premium Payments | Payment of premiums to client vendors usually after drawing funds from the client's account. |
| Carrier/Payroll File Audit Reconciliation | Vendor is responsible for reconciling data between carrier/payroll and vendor systems and resolving discrepancies between the systems. Frequency may vary depending on contract (e.g. weekly, monthly, quarterly, etc.) |
| Decision Support Tools | Online tools provided that assist with comparison/selection of primarily medical plans, (i.e. calculators, plan cost estimators, modeling tools, etc.) |
| Death Claim Coordination | Upon the death of an employee provide the following services: |
*Take death reports from survivors *Complete employer portion of life insurance claim form for survivor *Send condolence letter and life insurance claim forms to beneficiaries *Collect completed claim forms and death certificate from beneficiaries *Facilitate survivor interaction with life insurance carrier as needed *Create survivor account on ben admin system if survivor benefits are available *Notify other administrators (e.g., 401(k)) of participant’s death
Advocacy Services Tier 1 - Core Advocacy
* Assist the participant in navigating the health care system •Provide explanations on how the participant's health plan works (e.g., use of a physician care provider, referral and emergency procedures, etc.)
•Proactively discuss questions to ask health plans •Assist the participant in understanding information that the health plan is requesting (e.g., documentation) •Enable participants to become better health care consumers through price transparency, education on use of reimbursement accounts, and enrollment support, particularly when selecting a consumer driven health plan
* Serve as an intermediary with health plans •Facilitate paperwork to support appropriate billing and claims processing as well as in leave/disability situations •Maintaining a current list of contacts at each carrier for critical and noncritical issues
* Report summaries of Advocate call statistics and health plan call issue trends to the client identifying patterns as causal factors Tier 2 - Advocacy with claims appeals
* Provide education and guidance on health and preventative care issues •Enable participants to become better health care consumers through price transparency, education on use of reimbursement accounts, and enrollment support, particularly when selecting a consumer driven health plan •Provide unbiased education and decision support on diagnoses, treatment options, prescriptions and medication interactions •Prepare for medical appointments, expedite appointments with hard-to-reach specialists, assist in transferring medical records, and obtain approval for drug and medical trials •Find appropriate care facilities and understand instructions post-facility discharge including obtaining Durable Medical Equipment or other necessary resources •Connect participants to appropriate resources and foster positive life-style changes by promoting and supporting wellness and disease management programs, use of community resources, and employee assistance programs •Coordinate care among health plans, physicians and medical institutions •Help participants understand test results and assist in obtaining second opinions
* Serve as an intermediary with health plans for escalated issues •Work with the health plan to confirm that claims are processed with all pertinent facts •Work with the physician's office or provider of services to ensure accurate accounting •Facilitate additional paperwork to support appropriate billing and claims processing as well as in leave/disability situations •Explain a health plan's response to the participant •Support participants through the formal appeals process
* Report summaries of Advocate call statistics and health plan call issue trends to the client identifying patterns
* Advocates take complete ownership of the case and interact directly with the participant and the applicable carrier until the case is resolved. This includes all follow up activity and courtesy calls to the participant throughout the claims appeal and resolution
| Total Compensation Statements | Details the value of the total compensation and benefits package received by employees. |
| FSA ADMINISTRATION | |
| FSA Administration | Cost of administering the FSA |
| FSA Debit Card | Costs associated with the issuing and servicing of the Debit Cards associated with the FSA accounts. |
| COBRA ADMINISTRATION | |
| Cobra Administration | Costs associated with tracking and verifying COBRA claims and various COBRA admin functions. |
| HIPAA Notification | Costs associated with HIPAA Notifications given to the Employee |
| HIPAA Certification | Certification of HIPPA coverage, typically provided by the carrier, occasionally by the employer |
| OTHER COSTS | |
| Single Sign On | A direct link that automatically signs them into another system without having to reenter login and password information. Single sign on is most common from the client's intranet to HR/Payroll/Benefits system but can also be setup from a HR/Payroll/Benefits system to 3rd party carriers (Medical/Dental Life carriers, 401k carrier, etc.). |
| Service Call Center | Call center where employees can call in to get service related questions answered. |
| Technical Call Center | Call center where Client/employees can call in to have passwords reset or receive basic system navigation questions answered. |
| Expanded Service Call Center | Call center support outside of a standard 10 hour support day. |
| Spanish Language Service Call Center | Call center where employees can call in to get service related questions answered, in Spanish |
| Reporting Costs | Costs associated with the reporting tools in the system . Usually we would assume there is no additional cost for reporting tools. |
| Training Costs | Standard system training costs for client administrative employees. Usually we would assume there is no cost for this training. |
| Pre-Hire Website | Pre-hire website provides online calculation of benefits for specified client applicants prior to being hired. The site is for sample calculations only and does not flow to the live system after hire. |
| OTHER DEFINTIONS | |
| BOR | Broker of Record |
| ASO | Administrative Services Outsourcing |
| SLA | Service Level Agreements |
| RPO | Recruiting Process Outsourcing |
File details come from the government source that posted it. Updated .