Specifications include, but are not limited to: a. The primary objective of the Medical, Dental, Vision, Mental Health Programs, EAP, Life Insurance, and Long-Term Disability services is to provide access to the following services for benefit eligible employees and their household dependents: i. Provide eligible employees and dependents with quality and affordable plans. This includes retirees. ii. Ensure the Medical, Dental, Vision, Mental Health Programs, EAP, Life Insurance, and Long-Term Disability services offers the most competitive arrangement as measured by benefits, provider discounts, administrative costs, customer service and processing accuracy. iii. Maintain flexibility of plan design structure iv. When quoting Life & LTD, only provide plan designs that match or exceed the current benefit structure. v. Maintain current model with reinsurance and pharmacy carved out of medical. vi. Evaluate self-insured & Fully insured proposals. vii. Evaluate High Deductible Plan and H S A options. viii. Seek opportunities for carrier investment into a wellness fund to help establish and support ongoing health management and improve outcomes. ix. Evaluate specialty capabilities (disease management, population health management and wellness programs to ensure “Best in Class” programs are offered). x. Provide ease of administration for Falls Church City Government & Public Schools. xi. Process eligibility records accurately, efficiently, and timely and provides accurate billing on a timely basis. xii. Provide simplified communication resources. xiii. Provide timely, responsive customer service to the plan members and to the Falls Church City Government & Public Schools. xiv. Integrate and coordinates efficiently, timely and accurately with other related plan and service providers (i.e., reinsurance carrier, prescription drug plan, wellness, travel network, Insight Imaging Services etc.) xv. Provide fees associated with transfer of medical and pharmacy claims data to another vendor. xvi. Have meaningful financial and service performance guarantees. xvii. Maintain a dedicated account management team with highly skilled, qualified, and experienced personnel. xviii. Motivates employees and dependents to make and maintain healthy lifestyle choices and efficacious, cost-effective healthcare decisions. b. Products to be offered: i. Products should be offered in two different pricing models. The first pricing model will include Falls Church City Government and Public Schools combined. The Second pricing model will provide pricing for The City & Schools separately. 1. Medical Insurance 2. Dental Insurance 3. Vision Insurance 4. Mental Health Services 5. Life Insurance 6. Long-Term Disability 7. EAP Services c. Falls Church City Government & Public Schools will offer all benefits through payroll deduction. d. Medical must coordinate with pharmacy, Mental Health and wellness benefits.
