Posted Date : May 08,2019
Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3098
Government Authority located in Connecticut; USA based organization looking for expert vendors for Medicare Supplement Services
[A] Budget: Looking for proposal
[B] Scope of Service:
(1) Vendor needs to provide medicare supplement services will provide services necessary for the reimbursement of member claims in excess of Medicare and the customer service function that is consistent with such services. While this service has historically been provided on a fee per member per month basis with TRB funding the risk the Board is also interested in receiving proposals from licensed insurers to provide the service for a fixed premium in addition to self-funded proposals.
- The TRB is a governmental plan with approximately 100,000 members that participate in the plan in a number of different ways. This includes approximately 36,000 retired members as well as 54,000 active members.
- In addition to the pension program provided to retired teachers (including: classroom teachers, school administrators, some college professors etc.) the TRB also offers two Medicare plans (a Medicare Advantage plan and a Medicare Supplement plan, plus a single EGWP that provides services for members of each the two offerings) to eligible retired members and eligible dependents (counted as members in their own right) that may at their option elect to participate. Total enrolment is approximately 30,000 members between the two medical plans. Additionally, members participate in a vision and hearing program offered by the medical plan that they select.
-Medicare Advantage plan became the base plan and the Medicare Supplement plan administered by Stirling Benefits became the buy up plan. The buy up plan members pay the contribution of the base plan plus the estimated premium differential between the two plans. The vision and hearing and dental plans are entirely paid for by participants and thus have no cost to the Board.
- The subject of this proposal is the Medicare Supplement buy up plan and the Vision and Hearing programs for members of the Medicare Supplement plan. Again, we are seeking either insured or self-funded offerings for such a program.
- The claims under the plan were recalculated using the new plan payment algorithm such that the plan cost presented equalizes the costs over the three plan regimes. The costs are presented in terms of the number of claims that are generated using the current regime.
- The call center staff is expected to use scripts to answer questions posed by individuals calling on a recorded line. TRB does expect that the call center associates understand basic Medicare issues and coverages. The time to answer standard is based upon the period of time from the receipt of call to the time when a qualified customer service representative provides a live voice response to the member or other TRB related call.
-Provide managed care/utilization review services for portions of the plan requiring such services (generally, the plan pays in excess of Medicare and uses Medicare managed care protocols).
(2) All question must be submitted no later than May 13, 2019.
(3) The contract term will be for two years.
[C] Eligibility:
Onshore (USA Only)
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: May 27,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$
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Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID : MB-3098
Government Authority located in Connecticut; USA based organization looking for expert vendors for Medicare Supplement Services
[A] Budget: Looking for proposal
[B] Scope of Service:
(1) Vendor needs to provide medicare supplement services will provide services necessary for the reimbursement of member claims in excess of Medicare and the customer service function that is consistent with such services. While this service has historically been provided on a fee per member per month basis with TRB funding the risk the Board is also interested in receiving proposals from licensed insurers to provide the service for a fixed premium in addition to self-funded proposals.
- The TRB is a governmental plan with approximately 100,000 members that participate in the plan in a number of different ways. This includes approximately 36,000 retired members as well as 54,000 active members.
- In addition to the pension program provided to retired teachers (including: classroom teachers, school administrators, some college professors etc.) the TRB also offers two Medicare plans (a Medicare Advantage plan and a Medicare Supplement plan, plus a single EGWP that provides services for members of each the two offerings) to eligible retired members and eligible dependents (counted as members in their own right) that may at their option elect to participate. Total enrolment is approximately 30,000 members between the two medical plans. Additionally, members participate in a vision and hearing program offered by the medical plan that they select.
-Medicare Advantage plan became the base plan and the Medicare Supplement plan administered by Stirling Benefits became the buy up plan. The buy up plan members pay the contribution of the base plan plus the estimated premium differential between the two plans. The vision and hearing and dental plans are entirely paid for by participants and thus have no cost to the Board.
- The subject of this proposal is the Medicare Supplement buy up plan and the Vision and Hearing programs for members of the Medicare Supplement plan. Again, we are seeking either insured or self-funded offerings for such a program.
- The claims under the plan were recalculated using the new plan payment algorithm such that the plan cost presented equalizes the costs over the three plan regimes. The costs are presented in terms of the number of claims that are generated using the current regime.
- The call center staff is expected to use scripts to answer questions posed by individuals calling on a recorded line. TRB does expect that the call center associates understand basic Medicare issues and coverages. The time to answer standard is based upon the period of time from the receipt of call to the time when a qualified customer service representative provides a live voice response to the member or other TRB related call.
-Provide managed care/utilization review services for portions of the plan requiring such services (generally, the plan pays in excess of Medicare and uses Medicare managed care protocols).
(2) All question must be submitted no later than May 13, 2019.
(3) The contract term will be for two years.
[C] Eligibility:
Onshore (USA Only)
[D] Work Performance:
Performance of the work will be Offsite. Vendor needs to carry work in their office location.
Budget :
Deadline to Submit Proposals: May 27,2019
Cost to Download This RFP/RFQ/RFI/Solicitation/Tender/Bid Document : 5 US$