Specifications include, but are not limited to: Provide and/or make available necessary, appropriate and high-quality service related to the Vision Plan to eligible employees and their dependents. Any proposed plan must be capable of providing coverage to all eligible employees and their dependents. The County reserves the right to extend the Vision Plan to eligible retirees. Retirees have been identified in the census. Provide necessary and appropriate program administration and services, including but not limited to, maintaining central claims and membership files (including dates of coverage, type of coverage, etc.) for each covered member, by account/division number; maintaining payment record; capable of the wire transferring of funds; capable of making payment of providers directly; capable of providing state-of-the-art data tracking and claims paying services; furnish monthly bills by plan and employer showing enrollment and premiums received. Meet with the appropriate management staff(s) within fifteen days after the contract award date to review the Contractor’s plan, to present the proposed communication material, and to jointly establish a preliminary implementation plan and open enrollment program and schedule. Furnish to each employee enrolled in the plan a benefit booklet outlining and defining all covered services, limitations and exclusions, procedures for receiving services, schedule of benefits, and other plan information requirements. The initial booklet proof must be provided to a timely basis but not later than August 1, 2024. The County shall review and approve the booklets prior to distribution. In addition, furnish sufficient copies of a plan summary for each employee during the open enrollment period. Each year, no later than July 1, provide County a renewal (or earlier at County’s request). Each year, no later than October 1st or the first business day of October after the contract effective date, provide the County with the following year’s contract agreement, complete with original negotiated changes to the contract, so that review of initial agreed-upon terms is not required each and every contract year. Once an acceptable form of contract is mutually agreed upon, the Contractor is required to clearly outline any contract modifications prior to contract renewal, for the County’s legal review and input; will not entertain the review of a completely new contract format/agreement upon each annual renewal of the resulting contract. If a renewal letter stating updated proposed rates serves as the official renewal, such letter shall be provided within the same timeline. Provide a single point of contact responsible for quality control, resolving problems, and expediting services related to the overall performance of the contract. Maintain a local or toll-free customer service number for employees and dependents. Provide a systematic procedure for appeal of claims. All other related tasks which may be required in order to provide for the smooth operation of the program.
