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AGENDA ITEM REVIEW FORM |
3.D.
Special Employee Benefit Trust Board Meeting
- Meeting Date:
- 05/04/2023
- Department Head:
- Adela Cortez
- Submitted By:
- Maria Barajas Gutierrez, Human Resources Coordinator, Human Resources Department
ITEM:
Discussion and possible action on any and all matters regarding the Service Agreement for HealthComp as the Third-Party Administrator. (Susan Posada, Benefits Consultant).
SUMMARY:
During the Employee Benefit Trust meeting held on April 5, 2023, the Board of Trustees approved the change of Third-Party Administrator (TPA). In addition, it was recommended to select HealthComp as the new TPA due to the extensive experience they have in administering benefits and optimizing savings.
Below is HealthComp’s Claim Fee Schedule:
Administrative fees
Medical Claims Administration - $25.00 Per Employee Per Month (PEPM)
Dental Claims Administration - $2.50 PEPM
Plan Renewal - $2,000 Annual fee
Implementation - $4,000 One-time fee
Network Fees
PCHS Wrap network (out-of-state provider) - 25% of Gross Savings
SIARMED network - Medical $3.00 PEPM and Dental $1.50 PEPM
Care Management
Utilization review - $3.16 PEPM
Large Case Manager - $160.00 per hour
Below is HealthComp’s Claim Fee Schedule:
Administrative fees
Medical Claims Administration - $25.00 Per Employee Per Month (PEPM)
Dental Claims Administration - $2.50 PEPM
Plan Renewal - $2,000 Annual fee
Implementation - $4,000 One-time fee
Network Fees
PCHS Wrap network (out-of-state provider) - 25% of Gross Savings
SIARMED network - Medical $3.00 PEPM and Dental $1.50 PEPM
Care Management
Utilization review - $3.16 PEPM
Large Case Manager - $160.00 per hour
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO APPROVE THE SERVICE AGREEMENT WITH HEALTHCOMP EFFECTIVE JULY 1, 2023 AS PRESENTED.
Fiscal Impact
Fiscal Impact:
Fiscal impact as shown in the summary and in the attachment.