Employee Benefits Brokerage & Consulting Services

WAYNE COUNTY, GEORGIA

 

Wayne County is soliciting proposals from qualified employee benefits brokerage and consulting firms to provide strategic, financial, compliance, renewal, marketing, employee-support, and day-to-day advisory services for the County’s employee benefit programs.

This RFP selects the County’s broker/consultant. It does not authorize proposers to contact insurance carriers or vendors on Wayne County’s behalf during this procurement.

 

I. Wayne County Background, Benefit Information and Goals

Wayne County is a local government in southeast Georgia governed by a five-member Board of Commissioners. The County provides public services through multiple departments and constitutional offices and offers employee benefit programs as part of its compensation package. The County seeks a broker/consultant that can serve as an independent advisor, advocate for the County and its covered members, and provide clear, practical recommendations to County administration and the Board of Commissioners.

A. Current Demographic and Plan Information

Wayne County may provide additional plan, census, claims, contribution, and contract information to proposers as appropriate and subject to confidentiality requirements.

B. Procurement Restriction - No Market Contact

This RFP is for brokerage and consulting services only. Proposers shall not contact, solicit quotations from, reserve markets with, or otherwise approach Wayne County’s current or prospective insurance carriers, networks, pharmacy benefit managers, stop-loss carriers, administrators, or benefit vendors concerning Wayne County during this RFP process unless specifically authorized in writing by the County. Unauthorized market contact may result in disqualification.

C. County Goals

1.     Select a broker/consultant that will act as an independent, knowledgeable advisor to Wayne County.

2.     Control the total cost of employee benefits while maintaining competitive and valued benefit offerings.

3.     Provide strong claims advocacy and problem resolution for the County, employees, retirees, and covered dependents, as applicable.

4.     Improve financial reporting, claims analysis, forecasting, benchmarking, and decision support.

5.     Provide timely renewal projections and sufficient lead time for County budgeting and Board consideration.

6.     Provide complete transparency regarding all broker compensation, commissions, bonuses, overrides, contingencies, revenue sharing, vendor payments, and other remuneration connected to Wayne County’s business.

7.     Ensure access to knowledgeable compliance resources and timely notice of material federal and Georgia legal or regulatory changes affecting the County’s benefit programs.

8.     Evaluate carriers, vendors, networks, pharmacy arrangements, stop-loss coverage, plan design, and funding alternatives when appropriate.

9.     Improve employee communication, education, enrollment support, and understanding of benefits.

10.  Provide objective recommendations supported by data and explain complex benefit issues in practical terms to County staff and elected officials.

II. Submission of Proposals and Procurement Process

All proposals shall be prepared at the proposer’s expense. Wayne County reserves the right to reject any or all proposals, waive informalities when lawful, request clarification, negotiate with one or more proposers, and select the proposal determined to be in the best interest of the County, subject to applicable law and County policy.

A. Public Records Notice

Wayne County is a Georgia public entity. Proposals and procurement records may be subject to disclosure under the Georgia Open Records Act. A proposer should clearly identify information it contends is protected from disclosure and state the legal basis for that position. Wayne County cannot guarantee confidentiality of proposal materials when disclosure is required by law.

B. Proposed Schedule

All dates are subject to change by written addendum. Questions shall be directed only to the County contact identified in the solicitation. Proposers shall not lobby or contact County Commissioners, employees, or other County representatives regarding this procurement except through the designated process.

C. Broker of Record

Following award and execution of an agreement, Wayne County may issue Broker of Record or similar authorization letters. No proposer has authority to represent the County to any carrier or vendor before such authorization.

III. Scope of Services

The selected broker/consultant shall work as an extension of Wayne County administration and Human Resources and shall provide, at a minimum, the following services.

A. Strategic Planning and Financial Consulting

·         Conduct at least one annual strategic planning session addressing plan performance, cost drivers, objectives, unresolved issues, funding strategy, plan design, workforce trends, and future options.

·         Analyze historical plan costs, utilization, claims trends, large claims, prescription drug costs, stop-loss performance when applicable, employee contributions, and other material cost drivers.

·         Benchmark Wayne County against relevant peer groups, with emphasis on Georgia counties, municipalities, other public employers, employers of similar size, and appropriate regional/national benchmarks.

·         Provide actuarial or underwriting support sufficient to project costs and quantify the expected financial impact of material plan changes.

·         Develop annual budget projections for medical, prescription, stop-loss, administrative, and ancillary benefit costs.

·         Identify practical cost-containment opportunities without automatically shifting costs to employees.

·         Provide monthly or quarterly claims and financial reporting appropriate to the County’s plan structure, plus an annual total-benefit-cost summary.

·         Translate analyses into understandable recommendations for County administration and, when requested, the Board of Commissioners.

B. Renewal, Marketing and Negotiation Services

·         Establish a written annual renewal work plan and timeline.

·         Provide preliminary renewal projections as early as reasonably possible and target at least 90 days’ advance notice of material renewal rate changes whenever carrier/vendor timing permits.

·         Analyze proposed renewals using claims experience, trend, underwriting, actuarial information, benchmarks, market conditions, and contract terms.

·         When authorized by Wayne County, market appropriate coverages and services to qualified carriers and vendors and negotiate rates, fees, guarantees, contract terms, commissions, and other financial provisions.

·         Evaluate fully insured, self-funded, level-funded, alternative funding, stop-loss, pharmacy, network, and other arrangements when relevant to the County.

·         Provide a clear written comparison showing initial renewal terms, negotiated terms, alternatives considered, estimated County and employee impact, and the broker’s recommendation.

·         Develop COBRA rates and fully insured equivalent rates when applicable.

·         Review policies, contracts, endorsements, summaries of benefits and coverage, Summary Plan Descriptions, administrative service agreements, stop-loss contracts, PBM terms, and related documents for consistency with negotiated terms.

·         Assist with implementation of approved changes and coordinate transition activities with carriers and vendors.

C. Day-to-Day Service and Claims Advocacy

·         Serve as the County’s primary liaison with benefit carriers, administrators, networks, PBMs, stop-loss carriers, and other benefit vendors.

·         Provide a defined process for resolving administrative problems, eligibility issues, billing issues, coverage questions, claim denials, prescription issues, network disputes, and other escalated matters.

·         Provide direct or coordinated assistance to employees and covered dependents with benefit and claim issues while complying with HIPAA and privacy requirements.

·         Track significant escalated issues through resolution and provide status updates to designated County staff.

·         Attend carrier/vendor performance meetings and claims reviews as requested.

·         Provide day-to-day interpretation of plan documents, contracts, policies, and benefit provisions.

·         Assist with annual enrollment, employee communications, benefit guides, meetings, and educational materials.

·         Meet with County administration at least quarterly, or more frequently when material issues require attention.

D. Service Standards and Performance Accountability

Each proposer shall state its normal service standards and identify the standards it will contractually commit to for Wayne County. At minimum, address response time for routine County inquiries, urgent/escalated matters, employee claim issues, renewal deliverables, financial/claims reporting, and compliance notices. Proposers should explain how service performance is tracked and how persistent service failures are corrected.

E. Compliance and Regulatory Support

·         Provide timely alerts and practical guidance regarding material federal and Georgia requirements affecting the County’s employee benefit programs.

·         Provide access to qualified benefits compliance professionals and identify whether legal advice is provided by in-house counsel, outside counsel, or another resource.

·         Assist the County with required notices, reporting, plan documentation, and compliance calendars within the scope of broker services.

·         Support compliance involving HIPAA, COBRA, ACA, ERISA to the extent applicable, Medicare-related reporting, and other benefit requirements applicable to Wayne County.

·         Clearly distinguish general compliance guidance from legal advice and identify any services requiring separate legal counsel or additional fees.

F. Data Analytics, Technology and Security

·         Provide meaningful data analytics that identify cost drivers, utilization trends, high-cost claim patterns, pharmacy trends, network performance, and actionable opportunities.

·         Explain what data is required, how it will be obtained, and how analytics will be translated into recommendations.

·         Describe available benefit administration, enrollment, HRIS, payroll integration, employee portal, price-transparency, telehealth, and decision-support technology.

·         Maintain appropriate administrative, technical, and physical safeguards for protected health information and confidential County data and describe relevant cybersecurity practices.

G. County Ownership and Portability of Data and Work Product

To the extent permitted by law and third-party licensing restrictions, Wayne County shall retain ownership of County-specific data supplied by or generated for the County, including claims datasets obtained on the County’s behalf, renewal analyses, benchmarking reports, financial models, plan comparisons, implementation records, and other County-specific work product paid for by the County. Upon termination, the broker shall reasonably cooperate in transferring County information and records to the County or its successor broker in a usable format. The proposer shall identify any exceptions, proprietary tools, licensing restrictions, or additional charges.

H. Board and County Meeting Support

The broker/consultant shall be available to attend budget workshops, renewal meetings, Board of Commissioners meetings, employee meetings, and other County meetings when reasonably requested. The broker must be able to explain complex insurance and benefit matters in plain language suitable for public officials and employees.

IV. Proposal Response Requirements

Proposers should follow the order below and answer each item directly. Marketing brochures may be included as supplemental material but should not substitute for a specific response.

A. Firm Qualifications and Public-Sector Experience

11.  Provide a brief history, ownership structure, size, locations, and employee-benefits specialties of the firm.

12.  Describe the firm’s experience serving Georgia counties, municipalities, constitutional offices, authorities, school systems, or comparable public employers. Identify the number of current Georgia public-sector benefit clients and typical client size.

13.  Describe experience with both self-funded and fully insured health plans, stop-loss coverage, PBMs, ancillary benefits, and public-sector procurement.

14.  Describe the firm’s relationships with major insurers, networks, PBMs, stop-loss carriers, and vendors, including any relationships that could create an actual or perceived conflict of interest.

15.  Provide client retention statistics for the past three years and turnover information for the benefits practice.

16.  Provide evidence of Professional Liability / Errors and Omissions insurance and state the coverage limits.

B. Proposed Wayne County Service Team

17.  Identify the lead consultant/account executive and every key team member expected to serve Wayne County. Provide role, location, credentials, experience, and anticipated responsibilities.

18.  State the average number of clients assigned to the proposed lead consultant and primary account manager.

19.  Identify who will respond when the primary team member is unavailable.

20.  Describe access to actuarial, underwriting, pharmacy, stop-loss, compliance, legal, analytics, communication, and technology specialists.

21.  State whether any material service will be outsourced and identify the provider and any additional cost.

C. Claims Advocacy and Day-to-Day Service

22.  Describe the process for handling an employee or dependent claim problem from initial contact through final resolution.

23.  Provide an example, without identifying confidential client information, of a difficult claim, eligibility, carrier, PBM, stop-loss, or provider dispute your firm helped resolve.

24.  State normal response times for routine questions, urgent matters, and escalated claim issues.

25.  Describe how unresolved issues are escalated within your firm and with carriers/vendors.

26.  Describe support provided during annual enrollment and throughout the plan year.

D. Strategic Planning, Analytics and Renewal

27.  Describe your annual strategic planning and renewal process.

28.  Describe benchmarking resources, particularly data relevant to Georgia public employers and employers of similar size.

29.  Describe actuarial/underwriting capabilities and whether they are in-house or outsourced.

30.  Describe your data analytics platform and the reports Wayne County would routinely receive.

31.  Explain how your firm evaluates medical claims, pharmacy spend, stop-loss, networks, plan design, and vendor performance.

32.  Describe your approach to identifying cost savings while considering employee impact, recruitment, retention, and benefit competitiveness.

33.  Describe how you would present renewal alternatives and recommendations to a County Board whose members may not have insurance expertise.

E. Marketing, Vendor Negotiation and Performance Guarantees

34.  Describe your process for marketing benefit programs after receiving County authorization.

35.  Explain how you prevent market blocking and ensure the County receives a fair and competitive market review.

36.  Describe your approach to negotiating rates, administrative fees, stop-loss terms, PBM economics, commissions, performance guarantees, and contract provisions.

37.  Provide examples of measurable performance guarantees you commonly negotiate with carriers/vendors.

38.  Describe implementation support following a carrier, vendor, or plan change.

F. Compliance, Technology and Security

39.  Identify benefits compliance resources and any in-house or outside benefits counsel.

40.  Describe how Wayne County will be notified of relevant federal and Georgia legal or regulatory developments.

41.  Describe tools or calendars used to help clients manage benefit compliance obligations.

42.  Describe HIPAA privacy/security practices and cybersecurity safeguards applicable to County data.

43.  Describe benefit administration, enrollment, HRIS/payroll integration, employee communication, transparency, telehealth, or other technology available to Wayne County, clearly distinguishing included services from additional-cost services.

G. Compensation and Complete Financial Disclosure

Wayne County requires complete compensation transparency. The proposer shall disclose all direct and indirect compensation associated with Wayne County’s business, whether paid by the County, employees, carriers, vendors, affiliates, or other third parties.

44.  State the proposed annual broker/consulting fee and identify whether compensation is a flat fee, retainer, hourly fee, commission, capped amount, or combination.

45.  Itemize all services included in the base compensation and all services that may result in additional charges.

46.  Disclose all commissions expected from medical, stop-loss, dental, vision, life, disability, voluntary benefits, PBMs, administrators, or other products. State the commission percentage and/or expected dollar amount where reasonably calculable.

47.  Disclose any contingent commissions, bonuses, overrides, supplemental commissions, revenue sharing, placement fees, referral fees, marketing allowances, data fees, technology payments, vendor incentives, or other remuneration that could be connected directly or indirectly to Wayne County’s business.

48.  Identify any affiliate or ownership relationship with a carrier, administrator, PBM, vendor, consultant, technology provider, or other entity that may receive compensation from Wayne County’s benefit programs.

49.  Explain whether any compensation will change based on the carrier/vendor selected, premium volume, number of products placed, retention, profitability, or other factors.

50.  State whether the proposed fee/commission structure can be guaranteed for three years and identify any exceptions.

51.  Agree to provide Wayne County an annual written compensation disclosure and a final accounting upon termination.

H. Conflicts of Interest and Fiduciary/Advisory Approach

52.  Describe how the firm identifies, discloses, and manages conflicts of interest.

53.  State whether the firm will recommend a carrier/vendor from which it receives greater compensation than an alternative and, if so, how that difference will be disclosed before County action.

54.  Describe the firm’s approach to acting in the County’s best interest when compensation incentives or affiliate relationships are present.

I. Transition Plan

55.  Provide a 60- to 90-day transition plan showing key steps, responsible parties, data/contract collection, carrier/vendor introductions, open-issue review, compliance review, and communication with County staff.

56.  Describe how the firm will identify and take responsibility for unresolved claims, eligibility issues, renewal matters, stop-loss issues, and other open items during transition.

57.  Describe the transition-out assistance the firm will provide if Wayne County later selects another broker.

J. References

Provide at least three current client references. Preference will be given to Georgia counties, municipalities, or comparable public employers with similar employee counts, geography, funding arrangements, or plan complexity. Include client name, contact person, title, telephone number, email, services provided, approximate covered population, and year the relationship began.

K. Required Documents

·         Certificate of Insurance for Professional Liability / Errors and Omissions coverage.

·         Sample client service agreement, with confidential client information removed.

·         Sample annual service calendar.

·         Sample claims/financial reporting package.

·         Sample renewal comparison or executive summary, with confidential information removed.

·         Sample compensation disclosure.

·         Any proposed exceptions to this RFP or proposed contract terms.

V. Evaluation and Selection

Wayne County intends to select the firm offering the best overall value, qualifications, service capability, transparency, and fit for the County rather than selecting solely on the lowest broker fee.

Wayne County may shortlist firms for interviews. If interviews are conducted, the County may use the interview to confirm or refine its evaluation and may request a best-and-final proposal. The County reserves the right to verify references and information submitted.

VI. Proposed Contract Expectations

·         The selected firm will enter into a written agreement acceptable to Wayne County and approved through the County’s normal contracting process.

·         The final agreement should clearly identify included services, compensation, term, termination rights, insurance requirements, confidentiality/privacy obligations, data rights, transition obligations, and service expectations.

·         The broker shall not bind Wayne County to insurance coverage, vendor contracts, plan changes, or financial commitments without express County authorization.

·         Any material change in compensation, ownership, assigned lead personnel, conflicts of interest, or subcontractors affecting Wayne County shall be disclosed promptly.

·         The selected broker shall comply with applicable law and County policies.

VII. Proposal Certification

By submitting a proposal, the proposer certifies that the information provided is accurate to the best of its knowledge; that all material compensation and conflicts requested by this RFP have been disclosed; that no unauthorized market contact has occurred; and that the proposer is prepared to provide the services described if selected.