The City of Savannah uses this contract to provide self-funded health plan third-party administration (TPA) services to include medical claims processing, COBRA administration, and other plan administration services. The City offers a self-funded health plan for eligible active employees, pre-65 retirees, and eligible dependents. The plan coverage is for approximately 5,000 employees, retirees, and dependents. The contract would be effective from January 1, 2023, through December 31, 2023. 

The renewal would include two fee amendments. The first would include the additional fee of $0.50 per member per month for the development, maintenance, and administration of a chiropractic network to assist in controlling the medical plan's spend for chiropractic services. The second amendment would include an additional fee of $0.50 per member per month fee for the healthcare blue book (HCBB) fee for the transparency rule going into effect on January 1, 2023. All health plans are required to provide an Internet-based, self-service tool to obtain personalized out-of-pocket cost information to include the underlying negotiated rates for all covered health care services and prescription drugs. Because of this regulation, the industry had to work hard to collect and manage the machine-readable files (MRF) since the discounted pricing feeds the healthcare net cost portion of the tool. HPI must relay plan design, benefit tiers, and feed the ongoing updated accumulators.

Compliance requirements are as follows:

• For plan years that begin on or after January 1, 2023: An initial list of 500 shoppable services must be available.
• For plan years that begin on or after January 1, 2024: The remainder of all items and services must be available.  

HPI Member Services, along with Healthcare Bluebook, will be prepared to help members access Healthcare Bluebook’s branded “Bluebook Comply” self-service tool to search for detailed price information as well as a list of in-network medical facilities located in the member’s area. This information is intended to help members shop for the best price before scheduling medical procedures. Additional information including links to the Bluebook Comply as well as Member Service phone lines will be provided by the January 1, 2023, due date. Most TPAs are charging a compliance fee of between $2.50-$4 per employee per month (PEPM) which started with the MRF collection. HPI is doing the work as part of normal business and only passing along the cost for the tool itself. This contract was awarded by Council on October 28, 2021, to Health Plans, Inc. in the amount of $310,935. Estimated total cost for 2023: $337,000 annually.

Approval