DEPARTMENT
Finance
REQUESTED ACTION (Identify appropriate Action or Motion, purpose, cost, timeframe, etc.)
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Request approval to amend an existing contract - Finance Department, 19RFP10172019C-BKJ, Health Benefits Consulting in the amount of $180,000.00 with Segal Company, Inc. (Atlanta, GA) to amend the scope of work to include benefits claims audit services for the Anthem medical and pharmacy plans, Aetna dental PPO, and Kaiser HMO plan. Effective upon BOC approval. (APPROVED)
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REQUIREMENT FOR BOARD ACTION (Cite specific Board policy, statute or code requirement)
In accordance with Purchasing Code Section 102-420, contract modifications within the scope of the contract and necessary for contract completion of the contract, in the specifications, services, time of performance or terms and conditions of the contract shall be forwarded to the Board of Commissioners for approval.
STRATEGIC PRIORITY AREA RELATED TO THIS ITEM
Open and Responsible Government
SUMMARY & BACKGROUND
Scope of Work: This request is to amend the scope of work of the existing Health Benefits Consulting Services contract with Segal to include audits of benefit claims and administration services for the self-funded medical and Pharmacy plans administered by Anthem/IngenioRx; self-funded dental PPO, administered by Aetna; and, the Fully-Insured Kaiser HMO Plan. The scope of the audit service will include but is not limited to: adjudication procedures review, statistical and target sample claims review, performance standard validation, financial review (only for self-funded plans) and a Report of Findings. Audits taking place during the 2021 plan year will evaluate claims paid during the 2020 plan year. Audits taking place during the 2022 plan year will evaluate claims paid during the 2021 plan year. Segal will perform each audit using evaluation protocols specific to the type of benefits under review. The terms of the County's Agreement with the Administrator, the Administ...
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