Exhibit A
Scope of Services
The City’s broker is expected to provide the following services for the benefit programs.
Benefit Program Current Provider(s)
Medical Insurance Anthem Blue Cross of California PPO
Anthem Blue Cross HDHP
Anthem California Care
Kaiser Permanente Traditional and Deductible HMO
Dental Insurance Guardian
Vision Insurance VSP
Life/Accidental Death and
Dismemberment (ADD)
Standard Insurance
Long Term Disability (LTD) Standard Insurance
Cobra Administrator PayFlex
Flexible Spending Account
(FSA)
PayPro Administrators
The following scope of services applies to all benefit programs unless specifically stated otherwise.
1) Research, identify, develop, and present alternative benefit programs, plan/rate designs, insurers, or providers in the local marketplace, specifically including the following:
a) Group medical insurance programs that are competitive, cost effective, and comparable to or exceed CalPERS PEMHCA programs in benefit levels.
Detailed descriptions of CalPERS PEMHCA programs can be found at Plans & Rates - CalPERS. Examples of current CalPERS plan provisions that must be included in the new medical plans include, but are not limited to, coverage for dependent children up to age 26, regardless of student or resident status, and coverage for adult disabled economic dependents, after age 26, if on a medical plan prior to the 26th birthday.
b) Group Life/ADD insurance coverage that exceeds the City’s current benefit levels and is more cost effective. The City will provide initial portability notification; the carrier should administer post-employment coverage thereafter.
c) Group LTD insurance coverage that exceeds the City’s current benefit levels and is more cost effective.
d) Identify options for Deferred Compensation and Health Savings plans and providers that provide enrollment services; ongoing enrollment and educational programs, including on-site services; quality on-line services for participants and the City; quality call-center services; a broad range of investment options for participants; appropriate monthly and annual reporting to both participants and the City; electronic interfacing with the City’s Human Resources/Benefits/Payroll system, Tyler MUNIS; competitive fees, commissions, and charges for plan administration and selected investment options; full and explicit disclosure of all fees, commission, and charges for plan administration and selected investment options, including the cost difference between proprietary and non-proprietary investment funds. 2) Analyze carriers/providers in terms of premium rates, policy provisions, plan designs, administrative services and fees, financial strength, claims handling, customer service, flexibility, and stability of performance; make recommendations for maximizing benefits within cost constraints.
3) Upon request from the City, and potentially upon short notice, produce probable cost of actual or hypothetical changes in the benefit programs. 4) Develop, evaluate, present, and assist in the implementation of alternative, creative, or “out of the box” options for plan design, funding options, and service provision. Such options could include, but are not limited to, self-funding to a certain level combined with the purchase of umbrella coverage or directly providing services that may reduce medical rates. The City is open to and would like to explore any and all alternative options.
5) Represent the City in negotiations with providers on all issues related to benefits including premiums, benefit levels, plan design, claims resolution, and special terms and conditions; monitor and report on group experience, provide renewal projections, market benefit programs annually, or as requested, and assist with benefit program renewals.
6) Assist with implementation of selected benefit programs. The City’s benefit plan year is June 1st through May 31st of the following year. The selected broker will be expected to negotiate rates for renewals effective for the next benefit plan year for June 1, 2024 through May 31, 2025, with final rates and options provided to the City by March 15, 2024. Please note, the Flexible Spending Account benefit is on a calendar year.
7) For medical insurance, provide/identify and negotiate services and fees with a qualified Third-Party Administrator. The Third-Party Administrator services will include, but are not limited to:
a) Coordinate transition of existing employee/retiree/dependent data to medical providers during initial open enrollment.
b) Coordinate employee/retiree/dependent data transfer to medical providers during subsequent open enrollments and qualifying Life Event changes throughout the plan year.
c) Interface electronically with the City’s Human Resources/Benefits/Payroll system, Tyler MUNIS, for open enrollments and qualifying Life Event changes throughout the plan year.
d) Maintain accurate database of employees, retirees, and dependents. e) Administer all billing functions and produce a monthly consolidated billing report for City staff.
f) Track and initiate Medicare eligibility and dependent age-out notices monthly. g) Administer all COBRA requirements, including, but not limited to, billing, premium remittance, and mailing of general notices.
h) Provide outstanding customer service to participants and City staff by assisting with claim disputes, billing/eligibility issues, and compliance-related requirements.
8) Assist City staff with budget estimates and provide information to support the labor relations process as needed.
9) Provide customer service support to participants and City staff by acting as an interface between the City and the providers; assist with claim disputes and billing/eligibility issues; provide contract compliance monitoring; create employee communications; and assist with other issues as they arise. 10) Meet with City staff and the Health Benefits Committee as needed.