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AGENDA ITEM REVIEW FORM |
3.C.
Special Employee Benefit Trust Board Meeting
- Meeting Date:
- 04/05/2023
- 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 Benefits Third-Party Administrator (Susan Posada, Benefits Consultant).
SUMMARY:
A Third Party Administrator (also known as TPA), is a company that performs administrative services for a health plan such as billing, plan design, claims processing, record keeping, and regulatory compliance activities. The City of San Luis has contracted the services of 90 Degrees Benefits since 2018 to provide administrative services for our health plan. Our current contract expires on June 30, 2023.
During the last year, we have experienced a decline in customer service provided by 90 Degrees. Furthermore, we were recently informed that their rates will be increasing for the coming fiscal year, going from current total fees of $103,572 to $148,638. For these reasons, research was conducted on other TPA options, which were reviewed with Human Resources and the City Administration.
Our recommendation is to select HealthComp as our new TPA for a total cost of fees in the amount of $118,641.33. HealthComp was founded in 1994 and offers full-service TPA administration and clinical programming. This company has more than 25 years of experience in administering benefits and optimizing savings and has established partnerships with the largest networks, such as Anthem, UHC, Aetna, and Cigna.
Following is a list of HealthComp Claim Administration fees:
During the last year, we have experienced a decline in customer service provided by 90 Degrees. Furthermore, we were recently informed that their rates will be increasing for the coming fiscal year, going from current total fees of $103,572 to $148,638. For these reasons, research was conducted on other TPA options, which were reviewed with Human Resources and the City Administration.
Our recommendation is to select HealthComp as our new TPA for a total cost of fees in the amount of $118,641.33. HealthComp was founded in 1994 and offers full-service TPA administration and clinical programming. This company has more than 25 years of experience in administering benefits and optimizing savings and has established partnerships with the largest networks, such as Anthem, UHC, Aetna, and Cigna.
Following is a list of HealthComp Claim Administration fees:
- Medical Claims Administration $25.00 Per Employee Per Month (PEPM)
- Utilization review (Includes pre-certification, concurrent review, discharge planning, retrospective review) $3.16 PEPM
- Dental Claims Administration $2.50 PEPM
- Direct Vision Reimbursement Administration $1.00 PEPM
- Supplemental Case Management $160.00 Hourly
- Administration Implementation $4,000
- Annual Plan Renewal $2,000
RECOMMENDATION / SUGGESTED MOTION:
I MOVE TO APPROVE HEALTHCOMP AS THIRD-PARTY ADMINISTRATOR FOR THE CITY OF SAN LUIS BENEFIT PLAN.
Fiscal Impact
Fiscal Impact:
- Total HealthComp fees will be $118,641.33 for the 1st and 2nd year. On the 3rd year, there will be an increase of a maximum of 3%.