Audit of claims of the United Nations health insurance plans administered by New York Headquarte ...

The United Nations Headquarters in New York offers comprehensive health insurance coverage including prescription drug coverage to its staff and retirees across the globe under five self-insured health insurance plans -- (two US based medical plans, one US dental plan, and two medical/dental plans for staff serving elsewhere) -- and a fully insured plan. Over 51,000 staff and retirees of the UN and its funds and programmes are enrolled in these plans with coverage also extended to their eligible dependents. For the self-insured plans, the UN currently contracts with four separate third-party administrators (TPAs) under long-standing ASO agreements to administer health insurance claims on behalf of the Organization. The approximate breakdown of subscribers to the self-insured plans are: US plans Aetna (medical only): 5,030 Empire Blue Cross (medical only): 10,606 Cigna (dental only): 15,703* International plans The UN Worldwide Plan (medical/dental) for international staff members: 20,678 The UN Medical Insurance Plan - MIP (medical/dental) for local staff members in duty stations away from headquarters: 14,774 * It should be noted that most of the subscribers to the Cigna dental plan are also enrolled in one of the two US medical plans. The UN is seeking to engage a contractor for a multi-year period (a minimum of five years) for the purpose of conducting claims audit of the TPAs of its five self-insured plans only on an as-needed basis in order to assess: (a) the accuracy and completeness of claim adjudications, (b) whether claims are processed in accordance with plan provisions; (c) the accuracy of the TPA’s billing to the United Nations of claims it paid for reimbursement by the Organization; and (d) whether the overall performance of the administrators meets desired operational standards according to industry standards. The selected contractor is expected to audit the TPAs in a staggered manner; however, the audits Of US and non-US plans may be done concurrently. It is expected that two rounds of audits per TPA will be completed during the multi-year contract period. The contractor is expected to be available for further consultation by the UN or its internal and external auditors following the completion of the audits. The selected company, and its employees, shall be clear of any conflict of interest with the TPAs.The UN is seeking expressions of interest from qualified service providers. Details of the requirement including Terms of Reference will be provided at a later stage under the Request for Proposal.