2.1 BACKGROUND AND CURRENT ENVIRONMENT EBD is responsible for administering the State and Public-School employees’ health insurance benefits as a self-funded insurance plan. A fundamental financial objective of EBD is to ensure due diligence in managing the plan in a fiscally sustainable manner. EBD uses their current Plan Administration System to house all member historical information, as a communication tool between vendors, and a form repository. The system sends confidential information between HR in the state and public-school systems that are associated with members to look at eligibility for coverage and set up/make changes. TPA and PBMs pull up info on members and their accounts and share files on members. There is a repository of documents for every member – EOB and claims from TPA; EBD documents that system generates on timelines and other criteria.
