HEALTH PLAN ADMINISTRATION. The Contractor agrees to maintain sufficient administrative staff and organizational components to comply with all program standards described herein. At a minimum, the Contractor agrees to include each of the functions noted herein. The Contractor agrees to staff qualified persons in numbers appropriate to its size of enrollment. The Contractor may combine functions or split the responsibility for a function across multiple departments, if it can demonstrate that the duties of the function are being carried out. Similarly, the Contractor may contract with a third party (subcontractor) to perform one or more of these functions, subject to the subcontractor conditions described in this Agreement.
HEALTH PLAN ADMINISTRATION. (a) Administer Health Plan - Communicate and administer plan designs. - Evaluate plans for compliance with Section 125, federal and state requirements. - Update and distribute Summary Plan Descriptions. - Field and resolve complex employee benefit related issues that can not be resolved by the customer service desk. - Assist the health plans insurance broker in the development of accruals. - Track enrollment information to ensure compliance and that employees are enrolled in a timely manner. - COBRA administration. Develop information packets; send notifications to terminated employees in the required time frame. Collect and track premium payments. - Reconcile premium statements, prepare wires and allocate costs appropriately. - Conduct enrollment meetings in the El Paso office for all Company employees. - Develop, distribute and convey annual employee benefits survey results to management. - Coordinate and conduct Train the Trainer sessions. - Develop and distribute employee communication packets and forms. Develop and produce health plan videos for annual enrollment and new hires. - Develop presentation materials for all companies on medical plans. - Prepare and distribute employee communication packets and forms for annual enrollment.
(b) Leaves of Absence Administration - Administer leave plans. - Determine eligibility for leaves. - Ensure all proper notifications are processed and employee is placed on appropriate leave. - Ensure legal compliance with any FMLA leave. - Ensure premium payments for benefits are tracked and received. - Monitor leave status. - Process and forward claim paperwork for STD and LTD. - Work with carriers to ensure claims processed timely and correctly.
(c) Vendor Management - Negotiate contract and rate renewals. - Manage vendors and ensure services provided are meeting company standards.
(d) Items Not Covered - Prepare presentation materials and videos in foreign languages. - Conduct welfare plan presentations outside of El Paso. - Ensure all name changes and mergers are accurately reflected in benefit documents and are handled properly and timely. - Facilitate new companies joining plans. - Coordinate and research alternate benefit plans. - Develop new plan designs or summary plan descriptions.
