TPA SERVICES & MEDICAL NETWORK: MEDICAL PLAN ADMINISTRATION General Administration Pay all fees to all vendors for the medical, PBM, vision, utilization management, dental plans, and Consultant fees, and provide an accounting of the payment of these fees monthly to the Client, their consultant and the Trust’s accountant/administrator. Please include an implementation credit of $20,000 to be paid to the District within 60 days after the effective date. Account Management Provide a designated Account Manager and Account Management Team. Customer Service Provide customer service to answer inquiries on claims, eligibility, provider network, services, coverages, or other inquiries from participants Monday through Friday from 8:00 AM to 4:30 PM (AZ time). Provide prompt response to all telephone inquiries from plan participants and service providers. Provide a toll-free number. Open Enrollment Support Prepare and provide Benefit Presentations and materials (Summary of Benefits documents, other pertinent plan information, as requested). Attend Open Enrollment Meetings in Gilbert, Arizona, if needed, as requested. Provide employee giveaways and raffle items at a quantity as requested by the District. Telemedicine Provide 24/7 telemedicine. Booklets, Identification Cards, Certificates, Forms & Communication/Education Materials Prepare Plan Document and amendments, as needed. Prepare the Summary of Benefits and coverage (SBC’s) for all plans and provide Benefit Plan Booklets which describe the benefits and provide claims filing instructions. Provide enrollment materials and claim forms. Produce and mail medical ID cards. Provide bilingual communication/educational materials. Provide data to the Prescription Benefit Manager (PBM) for Identification Card generation. Provide HIPAA Privacy Notices.
