UConn RFP#CDR083126 Reporting Process and Admin Serv Reqs.pdf
PDF 36 KB Posted
- Attached to
- Student Health Insurance Plan
- Solicitation number
- CDR083126
- Issued by
- Connecticut
About this file
This document is a Reporting, Processing, and Administrative Services Requirements specification issued by the University of Connecticut (UConn) for RFP#CDR083126, which seeks qualified student health insurance providers to deliver a comprehensive Student Health Insurance Plan for the 2027-28 academic year and beyond. The RFP requires the selected vendor to provide extensive reporting capabilities including semester-based participation reports detailing enrollment information by campus, monthly payment reports tracking claims and provider payments, weekly service reports monitoring claim status, and monthly plan performance reviews analyzing claim activity by benefit category. The vendor must issue ID cards upon enrollment completion containing specified student and policy information and must deliver claims servicing through online access, telephone support, and direct assistance during regular business hours. Additionally, the insurer must maintain an on-campus presence at UConn's Storrs campus for an agreed number of days annually to support international student insurance registration and enrollment processing, with additional regional campus support provided as requested.
The specification establishes strict service level requirements for claims processing and provider reimbursement, mandating that claims be processed or acknowledged within five business days of receipt and that medical providers be reimbursed within thirty days of claim assignment. The vendor must provide a toll-free customer service line and ensure that no more than ten percent of claims exceed the thirty-day reimbursement threshold, with failure to meet this standard triggering university audits and penalties of $250 per unnecessarily delayed claim. The document does not specify pricing terms, set-asides, contract amounts, or funding sources within the provided excerpt.
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Text version
UConn Student Health Insurance Plan
RFP# CDR083126
Reporting, Processing, and Administrative Services Requirements
Element Minimum Requirement
Participation
Report
Enrollment information by campus, including number of subscribers, number of spouses and number of dependents/children by campus
(Minimum Frequency: Semester)
Payment Reports
Number of claims, type of service, payments made, student loss report, and service providers receiving payment with year-to-date totals by provider (Minimum frequency: Monthly, with year-to-date totals by provider)
Service Reports Number of claims received; status of claims by date of submission;
state of claim payments (Minimum frequency: Weekly)
Plan
Performance
Review and
Revision
Overall claim activity by benefit category, with number of services for each category, total submitted charges, denied charges, any deductibles or coinsurance and the payment amount (Minimum frequency: Monthly, with year-to-date payment summary)
Plan
Performance
Review and
Revision
High Dollar Claim Report, payments exceeding $5,000.00 for one or more conditions (Minimum frequency: Monthly)
ID Cards
Upon completion of enrollment reconciliation, the insurer will provide
ID cards for each student covered indicating the name of the student, the name of the insurance company, address of claims service, toll free number for policy verification, claims assistance and information, and the policy number. Additionally, ID cards will be provided at the
University’s request prior to completed enrollment.
Claims Servicing
On-line access to claims filing and information covering claims in process and claims history for Student Health and Wellness sta< and students
Claims Servicing Claims processed within five (5) days or a response sent to claimant within five (5) days of receipt by the company
Claims Servicing Toll-free telephone number for policy/customer service
Claims Servicing
Provide direct claims service to policyholder during regular business hours for students who need assistance and for the Student Health and
Wellness Service business team sta<
Claims Servicing
Medical providers reimbursed within thirty (30) days of claim assignment to the vendor, exceptions to be documented in claim file and subject to audit on 72 hours written notice from University
Claims Servicing
If ten percent (10%) of all claims exceed the thirty-day medical provider reimbursement time frame, an audit will be instituted by the University of Connecticut. The insurer must agree to pay to the University of
Connecticut $250.00 per claim determined to be unnecessarily delayed. “Unnecessarily delayed” is to be defined as: The payment of the claim continues to be delayed beyond thirty days despite all required claim information having been submitted. Prior practice and all circumstances will be reviewed by the University in determining whether the claim was unnecessarily delayed.
On-Campus
Support
The insurer must provide a regional representative for an agreed number of days per year to deliver on-campus support at the Storrs campus. Coverage must include attendance at the university international student insurance registration for immediate processing of enrollment to include issuance of ID cards and collection of payment.
On-Campus
Support
The insurer must provide on-campus support at regional campuses as requested, including sta<ing booths during orientation programs and assisting with health insurance administration and claim problems.
Waiver Support
The insurer must provide processing support for approved Waiver
Requests received after the hard waiver deadline and assist with reconciliation of hard waiver reports.
Accounting
The insurer will maintain complete and accurate records of insurance transactions, in accordance with accepted industry practices. The
University of Connecticut must have the right to request inspection and/or audit of all records pertaining to student insurance claims at any or all reasonable times.
Publication The insurer must design brochures, enrollment cards, claim forms, etc., subject to University review and approval.
Publication
Brochures, enrollment cards, claim forms, etc., must be delivered in su<icient quantities to all UConn campuses without any additional financial consideration from the University.
Publication
Brochures must at a minimum include: date of availability, insurance cost, insurance coverage, duration of coverage, filing instructions, toll free number for claims processing, information, and clarification, full explanation of benefits.
Publication
Insurer to deliver the brochure and the master policy for approval by the
Connecticut State Insurance Department in time to comply with the distribution schedule. A copy of the state approval must be provided to the University.
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