DAS Vision Program for Exempt State of Ohio Employees

Purpose and Background The purpose of this RFP is to solicit proposals for a third-party administrator (TPA) for the State’s self-insured vision program for exempt state of Ohio employees. Pursuant to Ohio Revised Code Sections 124.81, 124.82, and 124.87, and Ohio Administrative Code Chapter 123:1-71, the Agency is responsible for contracts pertaining to health benefits.  The Agency seeks to explore and implement innovative, cost-effective approaches to maximize the value of State benefit programs, as well as promote healthy lifestyles to improve the productivity of the workforce and improve the health of State employees and their families.  The State, through the Agency, offers vision benefits to approximately 16,087 eligible union exempt (exempt) State employees and their eligible dependents residing throughout the state of Ohio and surrounding states.  Exempt employees are eligible to participate in the vision plan effective the first day of the month following their date of hire or promotion. Currently, the State pays for the entire cost of vision coverage for employees and their dependents. Approximately 14,500 State employees are currently enrolled in the vision program.  The vision program also includes coverage for approximately 73 State employees who reside outside of the State.  Approximately 120 former State employees participate in the vision program through a continuation of benefits COBRA program.  The State also covers approximately 135 people through Senate Bill 296 which covers surviving spouses and children from the Ohio Public Safety Officers Death Benefit Fund. EyeMed Vision Care is the State’s current vision plan TPA. Currently, the State offers a self-insured plan on a two-tier basis (single and/or family).  The plan also features an out-of-network benefit.  State employees who are members of a bargaining unit receive vision benefits through a union sponsored benefits trust plan.  This group is not included in this RFP.The current TPA’s administrative fee is billed on a per employee per month  basis.  Claims and administrative fees are currently paid monthly.  Additional information and resources are available on the State of Ohio Benefits Administration Services website at http://das.ohio.gov/benefits.A copy of the fiscal year 2025 annual enrollment guide provided to employees of the State, is available at the following website: https://das.ohio.gov/employee-relations/benefits-administration/benefits-open-enrollment Scope of Work Overview An overview of the Work is provided below.  The scope of work and requirements are provided in greater detail within Part 1, Scope of Work.The Contractor must provide the services of a vision program TPA for the State. The Contractor must provide expert TPA service, reporting, and advice to the Agency regarding its vision program. While performing the Work, the Contractor must provide excellent customer service to Members and Agency human resources professionals.  The Work must include:  Account Management Implementation Management Communications Program Administration Member Services Enrollment Data Web Portal Data Integration Claims Administration Appeals Administration and Management Network Structure Provider Network Characteristics Reporting Financial Requirements Recordkeeping Performance Guarantees Transition Management
The requested services for the proposed programs are to be based on the administration of all vision claims incurred on or after July 1, 2025.  If this RFP process results in a change of TPA, the Contractor must make all arrangements necessary to ensure a seamless transition of prior authorizations, administrative services, enrollment data, and claims history from the current TPA.   Objectives The Agency has the following objectives that it expects this Work to fulfill, and it will be the Contractor’s obligation to ensure that the personnel the Contractor provides are qualified to perform their portions of the Work:  Provide expert vision program services to the State; Provide expert service, reporting and advice to the Agency; and Recommend innovative vision benefit strategies to the Agency.