Claims processing and administrative services for the Medical Insurance Plan (MIP) of the United ...

This request is intended for the establishment in the fall of 2013 of a contract for the provision of claims processing and administrative services for the Medical Insurance Plan (MIP) of the United Nations (UN). The United Nations Development Programme (UNDP) may also participate in the procurement exercise. The MIP is a self-funded programme of medical and dental benefits offered to locally-recruited staff and retirees in various duty stations around the world outside of the main headquarters duty stations. The proposed contract to be established for the related administrative fees only for an initial two-year period with option to extend annually for up to three additional years based on satisfactory performance. If UNDP decides to participate, the contract will be managed separately by the UN and UNDP. The services of a third-party administrator are required for the following: 1) General administration of the UN Medical Insurance Programme (MIP) including claims adjudication based on rules and schedule of benefits established by both organizations, and eligibility data of covered plan participants to be provided on a monthly basis by both organizations; 2) Dedicated team for claims processing in various regions of the world with multilingual staff and 24/7 customer service centers with toll-free telephone lines and email addresses capable of settling claims via cheques, electronic fund transfers or other payment methods to be agreed with the organizations; 3) Provision of networks of hospitals, clinics and other health care providers in the various countries of operation offering negotiated rates and direct billing arrangements; 4) Provision of professional medical expertise in connection with claims reimbursement, emergency medical treatments, medical evacuation, regional centers of care, appeal and fraud cases, etc.; 5) Fraud detection systems and investigation capabilities for further referral to the organizations for action; 6) Communication services for education and awareness-building of members in print and electronic media; 7) Account management to liaise with UN Headquarters, offices away from Headquarters, country offices and peacekeeping missions to ensure maintenance of quality services and resolution of medical network issues; 8) Underwriting support on analysis of expenses and on plan design issues, including on recommendations for plan design modifications to support efficient preventive care and reduce fraud risks. The expected deliverables of services include but are not limited to: 1) Established global health care network of hospitals, doctors and pharmacies that provide quality access to quality care to active and retired staff members and their eligible family members; 2) Timely issuance and replacement of identification cards for all plan members; 3) Quick turnaround time for processing claims with metrics for processing and financial accuracy to be agreed with the organization (at least English, French and Spanish with secondary capabilities in Arabic, Chinese and Russian, as well as the capacity to process claims for which the supporting documents are written in a number of additional languages as required by the location of the UN offices); 3) Excellent customer service center/s with metrics for speed of response and timely resolution of problems to be agreed with the organization; 4) Monthly, annual and ad hoc reports on plan utilization and demographics, including those required for auditors, actuary, claims review board, etc. 5) Printed and electronic communication materials including dedicated website, participant guides for members and human resources staff, newsletters, special announcements, etc.; 6) Investigation reports on suspected and confirmed fraudulent claims; 7) Bi-annual meetings with UN Headquarters to review plan performance, discuss special projects and assess vendor performance; 8) Regular missions to local offices to consult with local human resources offices and staff, conduct town hall meetings, and address issues with local health care providers in the networks; 9) Client satisfaction surveys every two years and related service improvement reports.