The selected consultant will provide ongoing guidance and support in the following areas: Plan Design and Analysis: • Formulate benefit plan objectives and analyze existing plan design, including market trend reviews and plan design change recommendations with detailed cost analyses. • Analyze past claims experience and utilization data for medical, prescription drug, and dental plans, and recommend changes to plan design and service providers to maintain or reduce costs. This includes modeling plan design recommendations and ensuring accurate specifications are requested from our pharmacy benefit manager (PBM) and claims administrators. • Monitor and report on top claim areas. • Acting in a consultative capacity, assist in determining the premium level charged on selffunded plans. This includes collaborating & attending meetings with both management and labor groups at least monthly and preparing materials. • Prepare comprehensive and actionable written recommendations for changes projected to reduce the cost of health and dental benefits. • Recommend innovative benefit modifications that may result in cost savings and/or richer employee benefits. • Assist in determining the process for entities petitioning to enter our group plan, including reviewing claims loss experience and utilization data and attending related meetings. • Recommend Stop Loss coverage and monitor use, making recommendations as needed to ensure appropriate coverage levels and feasible costs. Compliance and Legal Updates: • Provide ongoing state and federal legislative updates related to the insurance and benefits industry (e.g., COBRA, HIPAA, FMLA, MNPL, ESST) and assist with legal compliance. This includes timely updates on pending legislation during congressional and legislative sessions.
