Third-Party Administrator (TPA) Services for a Self-Funded Health Plan Featuring Preferred Provider Organization Networks and Wellness & Disease Management Program options

The Brownsville Independent School District (BISD) is seeking a Third-Party Administrator (TPA) to provide services for its self-funded health plan, featuring preferred provider organization networks and wellness & disease management program options. The selected TPA will be responsible for administering all plan design components, including claims administration, customer service, and provider network management. The TPA will also be required to provide performance guarantees, implementation services, and other value-added services. The contract is expected to be for a period of three years, with the option to renew. The proposal should include a detailed description of the services offered, pricing, and qualifications of the company. Some key aspects of the job include: • Administering all plan design components of the current plans • Providing customer service performance guarantees • Offering claims administration performance guarantees • Implementing services performance guarantees • Allowing a third-party selected by the District to conduct an on-site claims audit • Serving as fiduciary with respect to the District Employee benefits plan • Providing ACA reporting requirements under IRC Section 6055 and 6056 • Ensuring District remains ACA compliant • Having a repricing agreement for out-of-network benefits • Providing Consolidated Omnibus Budget Reconciliation Act ("COBRA") administration • Processing runout claims upon termination • Providing ID cards and other printed material • Offering disease management services • Providing actuarial services • Offering wellness services • Providing subrogation investigation and recovery services.