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 a self-funded health plan featuring preferred provider organization networks and wellness & disease management program options. The selected TPA will be responsible for administering the plan, including claims processing, eligibility determination, and customer service. The TPA will also be required to provide performance guarantees, including customer service and claims administration performance guarantees. The contract will be for a period of three years, with the option to renew for an additional two years. The BISD is looking for a TPA that can provide high-quality services, competitive pricing, and excellent customer service. Some key aspects of the job include: • Administering all plan design components of the current plans • Providing customer service performance guarantees • Providing claims administration performance guarantees • Providing implementation 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 • Facilitating and administering direct provider contacts under the proposed fee schedule • Providing a full-time, trained, on-site representative to be housed at District's administration office at no additional cost to the District • Including the cost of providing ID cards and all other printed material in the cost of the service • Providing a repricing agreement for out-of-network benefits • Providing Consolidated Omnibus Budget Reconciliation Act (COBRA) administration • Processing runout claims for a certain period after termination • Providing ACA reporting requirements under IRC Section 6055 and 6056 • Ensuring District remains ACA compliant • Providing disease management services, including diabetes and hypertension management • Providing wellness services, including gym aid and other wellness programs • Providing actuarial services • Providing other additional services, including single case agreements with providers and enrollment services.