Title
Selection of Blue Cross and Blue Shield of Florida, Inc. as Administrator and Gallagher Benefits Services as Agent of Record for the City of Gainesville’s Self-Funded Group Health Plan (B)
This item is a request for the City Commission to approve the rankings and selection of Blue Cross and Blue Shield of Florida, Inc. and Gallagher Benefits Services to administer and act as agent of record for the City’s self-funded group health plan, respectively.
Explanation
Recently, the City conducted a comprehensive request for proposal (RFP) process to select the administrator for the City of Gainesville’s Group Health Benefit. The City received four responses from health insurance providers. To best understand the evaluation process, a general knowledge of the various cost and risk financing components associated providing the group health benefit are essential. The total cost of providing the health benefit can be summarized into three components: Administration, Claims and Risk Transfer Costs. This evaluation focused on the two major cost components, administration and the related network discounts impact on the cost of claims. Risk Transfer costs were evaluated in a separate process.
For the purposes of this RFP process, administration refers to the external administration of the group health plan. Services associated with administration include, but are not limited to, network development, access and administration, claims processing, customer service, plan document distribution and utilization review. The claims component can be further separated into three separate groups: inpatient services, outpatient services and physician office services. Based on our past experience, it was decided to include pharmacy benefit management as a component of the administration of the plan. The separation of the pharmacy benefit is typically referred to as a “carve out.” That is, pharmacy is a separately administered and accounted for benefit. There was no discern...
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