Specifications include, but are not limited to: CONTRACTOR SHALL PROVIDE THE FOLLOWING PROGRAM REQUIREMENTS AT A MINIMUM: • Renewal rates provided 180 days in advance • 180-day notification process for any changes • Claim adjudication and claim payment including all necessary investigation and analysis • Appeals – First and Second Level • Coordination with vendors Second Level Appeal information • Subrogation Services • Coordination of Benefits • Monthly, quarterly, and annual management and financial reports • Weekly check registers and transactions reports • Eligibility verification – weekly electronic file feeds • Identification cards • Large case and disease management services • Web resources • Underwriting and actuarial services • SPD services (preparation and distribution), plan document writing services, subsequent amendments, Healthcare Reform Legislation • Turnkey compliance and assistance with the federal surprise billing, transparency acts, RxDC reporting and any additional federal regulations passed in the future. • Design administrative forms necessary to administer the plan (i.e. claim forms, Explanation Of Benefits forms, etc.) • COBRA coordination and/or administration
