Specifications include, but are not limited to: The District is eligible to participate in the federal 340(b) program. Respondents will administer 340(b) eligible claims for participants. The District includes a pharmacy network (currently 11 locations). Respondents must include the in-house pharmacy locations as in-network. Respondents must own their own network of pharmacies in locations that serve participants in North Texas and nationally. The District currently uses TBX Employee Benefits (Selerix system) as its benefits administration application. Respondents must be able to accept file feeds from this application and other major HCM (Human Capital Management). The District has one medical plan administrator with cross-accumulation of deductible and maximum out of pocket between medical and pharmacy claims. Respondents must be able to receive and send this data with District’s chosen medical claims administrator. All participants covered by the current employee benefit plans are to receive immediate coverage under the new employee benefit plans. Continuity of coverage for current participants is to be on a “no loss-no gain” basis for all employee benefit plans. The basis for “take-over” of all employee benefit plans for each of the selected providers is to be the District’s current enrollment records. No commissions should be included in your rates. The successful Respondent must provide renewal rates each year at least six months prior to the renewal date. The Respondent’s contract will include performance guarantees as negotiated between the parties. Respondent’s claims processing must be confidential. Except as otherwise required for auditing and similar purposes, the successful Respondent must not transmit any claims information to the District or any other party except the employee and provider, that indicates the nature of any claim without written authorization of the employee. The District or its designee shall have access to all records for the purpose of auditing reimbursements in the detection and prevention of fraud. All data, documents, discussion or other information developed or received by the successful Respondent in performance of the services are confidential and are not to be disclosed to any person except as authorized by the District or as required by law...
