A. Proposed Team & Resources Dedicated lead advisor and day-to-day service team. Specialists (indicate yes | no | sourced) for: o Financial: underwriting, actuarial, contribution modeling o Stop-loss: including consortium/proprietary arrangements o Prescription drugs: PBM, pharmacist, specialty drugs, rebates o Compliance: ERISA, ACA, HIPAA experts o Communications: enrollment guides, communication design o Plan administration: electronic enrollment, billing, benefit & technology integration specialist o Wellbeing programs o Voluntary benefits B. Market Presence & Carrier Access Monitor ratings of carriers and review provider networks for HMO/PPO savings opportunities. Demonstrate access and knowledge of carriers, TPAs, PBMs, and stop-loss providers. List your top insurance carriers in Connecticut by book of business (ranked). List your top three TPAs in Connecticut by book of business (ranked). Disclose any carriers/administrators with whom you cannot do business. Confirm willingness to support a direct Town-carrier partnership, including: o Joint periodic meetings (Town, broker, carrier) o Direct delivery of claims/utilization data to Town o Broker not serving as a “shield” from carrier access C. Financial & Underwriting Services Renewal estimates by mid-December, with monthly updates through April. Prospective budget and rate development. Retrospective plan accounting. Claim analysis, monthly reporting, and large-claim reporting (with confidentiality safeguards). Employee contribution analysis. Advise on stop-loss thresholds and attachment points. Reserve analysis and actuarial reviews (as required). Utilization and trend analysis (medical, Rx). Conduct a medical claims audit at least once every four years. Full disclosure of compensation tied to underwriting and renewals.
