What the buyer needs
AI summaryThe buyer seeks health insurance brokerage services for the government authority in East Orange, New Jersey. The vendor will review the district's current health benefits program and provide strategic recommendations to control costs while maintaining quality coverage. The vendor will identify opportunities to reduce expenses and improve efficiency. They will also monitor industry trends and provide guidance on market conditions and benefit strategies. Assistance may be provided during collective bargaining negotiations and in preparing long-term healthcare budget projections.
Scope of work
- Claims analysis and financial oversight, including monthly utilization and quarterly/annual reports
- Stop-loss insurance procurement, market comparisons, and renewal recommendations
- Pharmacy benefit management (PBM) review, pricing evaluation, and consulting
- Employee wellness and healthcare cost-containment program recommendations
- Annual renewal and long-term healthcare budget projections and financial planning
- Vendor evaluation and contract oversight for TPAs, stop-loss carriers, and PBMs
- Assistance during collective bargaining negotiations involving health benefit matters
- Employee coverage, claims, prescription access, and appeals support
How proposals are evaluated
| Criterion | Weight / scoring |
|---|---|
| Firm qualifications and relevant experience | 15 |
| Experience with self-funded health insurance programs | 20 |
| Claims analysis, financial oversight, and cost-containment capabilities | 15 |
| Cost proposal and compensation transparency | 15 |
Minimum qualifications
- Legally authorized and appropriately licensed for health insurance brokerage and consulting in New Jersey
- Minimum of five (5) years of experience providing employee health benefits brokerage or consulting services
- Demonstrated experience working with self-funded health insurance programs
- Demonstrated experience servicing public-sector employers, preferably New Jersey school districts
- Experience analyzing medical and prescription drug claims
- Demonstrated experience marketing and negotiating stop-loss coverage
- Knowledge of PBM contracts and prescription drug cost-containment strategies
- Maintain appropriate professional liability and other required insurance coverage
Documents to include with your response
- Affirmative Action Questionnaire or Certificate of Employee Information Report
- New Jersey Business Registration Certificate
- Disclosure of Investment Activities in Iran Form
- Chapter 271 Political Contribution Disclosure Form
- Russia-Belarus and Iran Prohibited Activities Certification
- Applicable New Jersey insurance producer or brokerage licenses
- Certificate of Insurance and professional liability insurance documentation
- Non-Collusion Affidavit
- Detailed annual pricing proposal
- Signed Proposal Certification
How to submit
- Method
- Sealed hard copy by mail, delivery service, or in person
- Instructions
- Submit one original and one duplicate copy in a clearly labeled sealed envelope to Dr. Melissa Simmons, Acting School Business Administrator, East Orange Board of Education, 199 4th Ave, East Orange, New Jersey 07017. Electronic submissions are not accepted.