A. The overall scope of services for this project is the successful and timely processing of Health Insurance Premium payments to insurance companies, and the payments to medical providers, pharmacies, laboratories for co-pays, deductibles, and coinsurance. No payment can be made directly to a client as this is unallowable. B. The selected Vendor must designate and identify a HIPAA Privacy Officer, who is authorized to act on behalf of the Vendor. The HIPAA Privacy Officer is responsible for the development and implementation of the privacy and security requirements of federal and state privacy laws. C. The selected Vendor must provide client education on cost sharing assistance and responsibilities to maintain health insurance. D. The selected Vendor must track the number of clients served, the number of units of service and the premiums/copayments made. The selected Vendor must provide the data on a scheduled basis that corresponds to the program reporting periods specified. Client and service information must be consistent with the information submitted in programmatic reports and other submissions to TC-HIVAA. E. The selected Vendor should be able to provide a benefits card to clients for payment of co-pays. F. The selected Vendor will be responsible for the following: 1) Insurance Premium Payment Assistance a) Process and pay monthly insurance premiums for eligible clients enrolled in private health insurance (employer-sponsored or Marketplace), Medicare, or Medicare Supplemental plans. b) Ensure timely payment to avoid coverage lapses and provide tracking to monitor premium payment schedules. c) Submit regular reports, including client-level and aggregate data on payments made, services provided, and financial utilization of funds. d) Monitor and collect refunds from overpayments or terminated insurance coverage.
