Fully Insured, Level Funded Medical Benefits Service

The County is seeking a vendor to provide a fully insured, level-funded medical benefits service for its plan participants. The agency needs to solve the administrative burden of managing healthcare claims by outsourcing operations to a provider that can limit the County's involvement in day-to-day inquiries. The selected partner must maintain a fully automated claims adjudication system that complies with HIPAA electronic transmission standards and security requirements. The scope of work requires the provider to offer web access for plan participants to check claim status and access customer service functions. The provider must maintain comprehensive records and management reports, including claims and accounting information, while delivering utilization reports and online access to standard or ad hoc reports. Additionally, the vendor must prepare and print summary plan documents, mail employee insurance ID cards directly to home addresses, attend annual open enrollment events, and meet with County representatives as necessary. Eligibility is limited to onshore organizations based in the United States of America. The agency requires the performance of all contract work to occur offsite. The contract period will span one year, and the agency is looking for proposals to establish the budget for these services. Bidders must submit all questions regarding this opportunity no later than July 2, 2026.