Medical Benefits for Retirees
The County offers group medical and dental plans to approximately 8,000 retirees
plus their eligible dependents. Approximately 2,500 retirees and their eligible
dependents are enrolled in a County-sponsored medical plan.
The successful Medical Care Provider(s) will be expected to provide, as a
minimum, the following services.
1. Implement, maintain, and expand, as necessary, a network of primary care
medical providers as well as specialists and hospitals sufficient to provide the
benefits outlined in this RFP to the Countys eligible retirees.
2. Make prompt payment for claims for medical care benefits.
3. Provide, at minimum, monthly invoices and claims reports showing the
number and monetary amount of claims paid by retirees, spouses and
dependents for the PPO, and the number of enrollees and amount of
capitation paid for the HMO.
4. Provide assistance, technically and creatively, in the on-going development
and preparation of various employee communication materials.
5. Provide quarterly and annual utilization reports broken down by plan of
benefits, members, spouses and dependents, and type of service. Such
reports should also include details on the type of illnesses or injuries being
treated for retiree, spouse and dependent.
6. Attend all retiree open enrollment meetings (approximately 5) during the
month of November for retirees.
7. Assist in the design, implementation and administration of modifications to
the medical benefits.
8. Adhere to a set of agreed upon performance standards.
9. Maintain complete and accurate records with respect to all matters and
services provided to the County.
10. Provide complete and accurate electronic records of County medical,
hospital, and prescription drug claims paid to any succeeding Contractor in
the manner and format necessary to continue employee medical, hospital
and prescription drug coverage.
11. Provide claims processing for claims incurred during the contract, including
claims submitted after the termination date of the contract. Such continuance must continue for a minimum of 12 months after the termination of the
contract with the County.
12. Provide a final contract for the retiree plans to the County by November 1st of
each year, subject to any changes to be implemented by the County.
13. Periodically provide reasonable access to a County-appointed auditor(s) to
perform audits to determine accuracy of claims payments and appropriate
grievance administration. Make the County whole financially for errors
identified and, in the event errors are discovered that exceed industry
standards, pay for the cost of such audit.
14. Agree to performance guarantees for an adequate number of locations and
hours for urgent care and/or extended care facilities for County retirees. Is
this still an issue for retirees?
15. Attend, help staff, and provide resources to help support all County
Wellness Expos.
