● ● ● ❍ ● ● ● ❍ ❍ ❍ Compliance with local, state and federal regulations that impact health and wellness programs Assistance with ACA requirements Evaluation of changes to local, state and federal regulations and recommendations on actions to take to ensure compliance Including but not limited to ARPA, transparency in coverage regulations, and other benefit related regulations. Annual Compliance Review of all policies, procedures and documents related to Health and Wellness benefits Ensure discrimination testing, and any other compliance related testing, is completed as required for Health and Wellness plans Strategic Planning for Health and Wellness benefits Semi-annual presentations to CNM Finance Committee on plans Annual strategic planning session with CNM Leadership Benchmarking of plan design and costs based on geographic location, industry and local market (APS, NMSU, UNM and NMPSIA at a minimum) Cost analysis to ensure cost effective programs Recommendation on cost containment strategies Evaluation of and recommendation for Reserve levels Plan Reviews and Updates Evaluation of claims: utilization, trends, costs, challenges, changes Quarterly review of plans Ad hoc analysis of program changes and impact to plan costs and compliance Assist with issuance, evaluation and recommendation for Requests for Proposals Annual evaluation of potential increases based on claims experience Recommendations on when to go out to bid on products and services Creation, evaluation and implementation of Requests for Proposals Including but not limited to network disruption, specific impact to covered members from proposed changes, geographical restrictions/limitations of proposed networks, service limits/restrictions of network providers, etc. Vendor contract/agreement review and negotiations to ensure CNM needs are met and plans are compliant Implementation of Health and Wellness Programs Assist with new plan implementations and annual open enrollment planning and execution Including, but not limited to, securing current/updated documents and marketing materials Creating communication and education plans for new programs Assist in securing annual renewal documents and agreements from benefit vendors and negotiating favorable renewal rates Assist with tracking and updating vendor documents that need updating or signatures Self-funded plan analysis and establishment of rates for each plan year to cover expected costs Provide daily support and advisory services to CNM Benefits Team and CNM Leadership regarding Health and Wellness plan maintenance and compliance Include any publications/communications/resources you provide clients Secure and track performance guarantees from benefit vendors, track payments for noncompliance and report as part of the quarterly updates Track stop loss claims and payments and report as part of quarterly and annual updates Provide recommendations on Health and Wellness plan designs and supplemental plans to provide comprehensive and competitive benefits to CNM employees and their families Recommend innovative ideas and new products, programs and services to ensure a competitive, valued and cost effective benefits program. Introduce proven programs and ideas to aggressively manage healthcare costs. Assist with targeted benefit/customer service surveys for the CNM Benefits Team at least annually.
