Loading...
6414 - Administrative Servies Only (ASO) for Medical and Pharmacy Benefits, 3.Statement of Work/ Specifications SECTION I General Information and Instructions The scope of work shall be finalized upon the selection of the Firm. The respondent’s submission shall have accurately described your understanding of the objectives and scope of the requested products and services and provided an outline of your process to implement the requirements of the Scope of Work and Services. It is anticipated that the scope of work will include, at a minimum, the following: The City of Denton (City) is seeking qualified vendors to provide Administrative Services Only for Medical and Pharmacy Benefits, for the City’s employees, pre-65 retirees, and dependents that are enrolled in the City’s self-funded health plans. The City offers benefits to all full-time and ¾ time employees who are in a position budgeted to work at least 30 hours per week. Coverage begins the first of the month following the date paperwork is completed and turned into the Risk Management Division. The City also offers benefits to eligible dependents (legal spouses, declared common-law spouses, unmarried children up to 26 years of age, children of any age if mentally or physically incapacitated and dependent on the employee for financial support, and dependent grandchildren that qualify as defined by the IRS or Federal Income tax return). Retirees are covered if the retiree qualified for regular retirement benefits, or disability retirement benefits, as defined by the Texas Municipal Retirement System or the City’s Fire Pension Fund. Retirees must elect coverage at the time of retirement and are then only able to drop coverage due to a qualifying event and during the open enrollment period. The City currently offers employees and retirees the option of two self-funded medical plans, both administered through United Healthcare. The Gold Plan (PPO) has lower deductibles, out-of-pocket maximums, office co-pays and higher monthly premiums than the Silver Plan (PPO). Both medical plans include prescription drug benefits and mental health/substance abuse benefits. The medical plans are provided to all eligible employees and are funded by contributions from both the employer and the employee. Electronic versions of the current medical and prescription drug Summary Plan Descriptions (SPD’s) have been provided as attachments. SECTION II BACKGROUND AND PHILOSOPHY BACKGROUND The City of Denton (City) is requesting your proposal to provide Administrative Services Only (ASO) for Medical & Pharmacy Benefits for the employees, retirees, and dependents enrolled in the City’s self-funded dual option medical plan. The City offers medical benefits to all full-time employees (employees working 30 or more hours) and their eligible dependents. Additionally, the City extends medical benefits to our retirees, and their eligible dependents, if the retiree elects to maintain coverage at the time of separation. The City of Denton has an estimated population of 131,000 residents and was incorporated in 1866. Denton is located approximately 40 miles north of Dallas and Fort Worth. It sits at the apex of a triangle that encompasses the Dallas-Fort Worth metropolitan area. Although it benefits from the overall growth and expansion of the largest Consolidated Metropolitan Statistical Area in the state, Denton and its economy stand proudly independent. In general, Denton is a full-service city that provides law enforcement, fire safety, paramedics/rescue, refuse collection, sanitary landfill, electric distribution and transmission, water, wastewater, storm sewer, animal control, parks/recreation, library and airport services. Two major universities—University of North Texas and Texas Woman’s University—along with a fully accredited public school system, allow local citizens every educational advantage possible and a rich blend of cultures. The City of Denton has a work force of approximately 1,500 employees. The City has had an effective safety and risk management program since 1970, an active Wellness Program since 1990, an insured employee assistance program (EAP) since 1998, and became self-funded for the employee health plan in 2008. Additionally, the City has an Employee Insurance Committee (EIC) representing all departments, providing education and feedback as well as recommendations to City Management and City Council. The City has an active Wellness Committee and has developed a wellness incentive program that began in 2011. The City has approximately 1,413 full time employees with approximately 1,332 employees covered under one of the health plans. Additionally, approximately 62 retirees, including surviving spouses, are covered under the medical plans. There is currently 1 employee that has elected COBRA coverage under the medical plans. In total, the City’s medical plans have approximately 3,604 covered lives. The City’s benefit plan year is January 1 through December 31. PHILOSOPHY The City wants to provide high quality, cost effective medical care with a focus on wellness and prevention to our eligible employees, retirees, and dependents (“members”) that participate in the City’s self-funded health plan.