Broker-Cons_Scope_of_Svcs.pdf

RFP: BENEFITS BROKER-CONSULTANT

SCOPE OF SERVICES

The Scope of Services outlines Consulting/Brokerage services to be provided for the County’s Employee Benefits program for each of the following core group benefits:

• Medical insurance plans

• Pharmacy insurance plans

• Dental insurance plans

• Vision insurance plans

• Employee Assistance Programs

• Life and Accident insurance plans

• Disability insurance plans

• Administrative plans (does not include provision of actual TPA services)

— Flexible Spending Accounts

— Health Savings Accounts (HSA)

— COBRA

— Commuter/Transit

• Wellness plans

• Voluntary benefit plans

SERVICE FREQUENCY

STRATEGY DEVELOPMENT

1. Set/review goals and objectives Annually

2. Evaluate market trends, competitive environment, culture and industry best practices Annually

3. Develop/refresh multi-year strategic glide path and financial plan to support goals and objectives

Annually

4. Develop benchmarking analysis to include plan designs, costs and contributions

As Needed

5. Facilitate planning meetings, provide strategic guidance and recommendations, and prepare executive-level documents as necessary

Annually

6. Evaluate funding and risk retention strategies As Needed

7. Develop and manage service/benefit calendar Annually

8. Conduct regular service/planning meetings with Benefits Team Biweekly and As

Needed

9. Provide Diversity, Equity & Inclusion (DEI) resources and analysis As Needed

FINANCIAL AND RENEWAL MANAGEMENT

1. Deliver budget-versus-actual reports including claim experience, fixed fees, and high cost claims

Quarterly

2. Analyze factors driving plan costs and recommend opportunities to better manage cost, quality and outcomes

Annually

3. Develop pre-renewal strategy 6 - 8 months prior to renewal by working with County stakeholders

3 Annual planning meetings

4. Determine collective bargaining strategies and analysis needed to support County

Annually

5. Initiate renewals with vendors, negotiate annual rates and terms and conditions per County guidance

Annually

6. Conduct self-insured underwriting analysis Annually

7. Price plan design alternatives As Needed

8. Develop employer premiums and calculate COBRA rates Annually

9. Model employee contributions As Needed

10. Develop rate modeling (Blending/Re-balancing) As Needed

11. Develop budget projections Annually

12. Calculate annual reserve (IBNR) estimates Annually

13. Support Risk Analysis development As Needed

MARKETING AND PROCUREMENT SUPPORT

1. Develop RFP (by line of coverage) that is aligned with the

County's procurement requirements, including process, scope, objectives, evaluation criteria/scorecard, and identification of potential bidders

2 to 4 RFP’s annually, as needed

2. Conduct detailed bid analysis - compare financial and quality responses, review plan designs, evaluate alternative cost and funding alternatives, discount and disruption analysis, negotiate performance guarantees, evaluate contract terms & conditions, evaluate financial stability of carriers (AM Best ratings) and provide cost projections and funding analysis to include employer cost and employee contributions (based on the annual procurement calendar - 2 to 4 RFPs annually)

Annually

3. Facilitate finalist meetings and scorecard analysis; negotiate best and final rates (Based on the annual procurement calendar - 2 to 4 RFPs annually)

Annually

4. Prepare Executive Summaries for committees & management Annually and As Needed

5. Support implementation planning and transition activities following vendor selection to help ensure a successful implementation; provide implementation support: facilitate project plan management, review administrative agreements and contract terms and conditions

As needed

VENDOR MANAGEMENT

1. Manage and regularly evaluate insurance carrier and service provider relationships

Ongoing

2. Coordinate regular carrier and vendor service meetings (Fluctuates based on vendor and time of year)

Carrier - 8 monthly meetings TPA - weekly meeting

3. Support employee issue resolution, escalated billing, claim and/or plan design issues

Weekly/Monthly

4. Review plan document changes (contracts, policies, SBCs, benefit summaries)

5. Manage and regularly evaluate insurance carrier and service provider relationships

6. Conduct/Facilitate utilization review meetings Quarterly

HEALTH, WELL-BEING AND PRODUCTIVITY

1. Provide a dedicated Health and Productivity consultant serving as strategic advisor and primary point of contact

Ongoing

2. Develop health & well-being strategy, including annual goal setting, incentive design, and alignment with organizational objectives

Annually

3. Advise on the health & well-being vendor landscape, market trends, emerging solutions, and program best practices

Ongoing

4. Facilitate strategic discussions with wellness vendors and support vendor evaluations, demonstrations, and implementation considerations

As Needed

5. Participate in weekly recurring wellness platform vendor meetings, providing strategic consultation, guidance, and recommendations related to program strategy, engagement initiatives, communications, and wellness activities to support the County's health & well-being objectives

Weekly

6. Participate in annual strategic meetings with the client's wellness platform, medical carrier, and Employee Assistance Program (EAP) partners to support alignment of health & well-being initiatives

Annually

7. Share evidence-based health education, industry insights, benchmarking, and resources on topics such as preventive care, cancer, diabetes, stress management, financial well-being, and other emerging health priorities

As Needed

8. Review available carrier, wellness vendor, and population health reporting to identify trends and inform health & well-being strategy

As Needed

9. Provide ongoing consultation regarding wellness program design, incentive strategy, compliance considerations, and industry best practices

Ongoing

10. Facilitate vendor marketing strategies and procurement operations

COMPLIANCE

1. Offer ongoing education through webcasts, podcasts, white papers, and legislative alerts

Ongoing

2. Provide daily Q&A support with compliance questions, e.g.

ERISA, COBRA, HIPAA, ACA, section 125, etc.

Ongoing

3. Provide consolidated annual notices package that includes the main Federal requirements including Medical Part D, HIPAA privacy, Women's Healthcare Rights Act

Annually

4. Provide templates documents for ERISA compliance including wrap plan documents, SPD's, Summary Material Modifications, COBRA model notices, customizable HIPAA Privacy and Security policies and procedures

As Needed

5. Provide quarterly legislative updates to Benefits Committee Quarterly

6. Access to Human Resources Support Services, e.g.

Mineral or similar service Ongoing

COMMUNICATIONS

1. Develop and support communication strategies tailored to the

County’s workforce, demographics, bargaining units, and communication needs for open enrollment and other benefit initiatives.

Anticipated annual deliverables include approximately four benefit guides, one benefits presentation and speaker script, approximately 14 Benefits-at-a-Glance summaries, a value-added benefits flyer, and a wellbeing flyer.

As Needed

2. Assess current communication materials provided by vendors to develop/update in-house communications

Annually

3. Provide consolidated annual notices packet that includes the main Federal requirements including Medicare Part D, HIPAA privacy, and Women's Healthcare Rights Act

Annually

4. Coordinate Benefits & Wellness monthly wellness communications, calendar, and webinars; request and provide relevant flyers that align with monthly focus

Annually/Ongoing

BENEFITS COMMITTEE SUPPORT

1. Attend quarterly Benefit Committee Meetings (including legislative updates, financial reporting, market updates, carrier updates, RFP updates) and participate in two support calls (preparation and follow-up) for each of the quarterly meetings

Quarterly – in person

2. Attend Ad Hoc Sub-Committee Meetings for special projects As Needed

3. Attend RFP Sub-Committees specific to line of coverage

(including Wellness):

• Participate in RFP Sub-committee selection

• Facilitate Kick-off Meeting to review current benefits, market trends, alternative benefit strategies, and establish project objectives and consensus

• Conduct the Marketing Results Meeting to review proposal responses and marketing results

• Coordinate Finalist Meetings, including agenda development and finalist preparation

• Present to the Full Benefits Committee, summarizing the RFP process, evaluation results, and final recommendation

2-4 RFPs per year 4-5 Meetings Annually per RFP

FINANCIAL SERVICES

1. Provide underwriting service and support on self-funded dental and vision plans, including models and assumption recommendations

As needed

2. Provide underwriting service and support on fully-insured medical, dental, and vision plans, including models and assumption recommendations

As needed based on data availability

3. Provide IBNR development and reporting Annually

4. Analyze migration issues, including advice on potential enrollment changes based on plan structure Annually

5. Analyze contributions, including advice on potential employee contribution structure to achieve strategic goals

Annually and as needed

6. Analyze plan design changes As needed

7. Provide financial impact of new regulations/legislation As needed