How to Shop for Benefits Vendors



If you are shopping for a new medical, dental, vision or other healthcare benefits vendor, you may want to think about the questions you will ask in your Request for Proposal (RFP). While some organizations outsource RFPs, not everyone has the budget to hire a vendor to assist in the process. When identifying what to put in the document that you send to the prospective vendors, ask yourself some questions.


What, Who, How?

What services are you asking the vendor to provide? Brainstorm the ideal scenario with your benefits team. Are compliance questions weighing you down? Is your team handling too many customer servicing issues that should be going to the carrier? Do you need help with analytics? These services become your scope of services section.

Who are some of the key players in the industry providing these services? Do you have a recommendation from a friend at another organization? Did you attend a conference and hear about a new provider? Develop a list of vendors who you think can provide the services you need.

How do they compare to each other? This is where the carefully crafted RFP question come to play. Develop a list of questions and ask for examples.


Overview of Your Organization

Start your document with a high-level overview of your organization. List your headquarters and any satellite locations. Provide some insight about your organization’s benefit philosophy and organizational culture. Describe your industry type as well as your employee population. Give numbers of employees, retirees, union members as well as the location. Ideally, provide a map detailing this information.

Scope of Services

Using the list of services that you discussed with your team, list them in your scope of services section. Here is a list that I have used in the past but of course you will want to customize based on your needs:

  • Assist HR and Finance teams with administration of all group insurance plans, respond to questions from staff.
  • Provide Excellent Customer Service to HR/Finance teams.
  • Assist XYC Co with compliance laws and regulations related to employee benefits including ERISA, ACA, DOL, HIPAA, etc.
  • Review claims experience, claim service and claim administration to ensure maximum benefit to XYZ on a quarterly basis.
  • Determine and recommend the most economical funding arrangements for benefit plans optimizing cost and benefit.
  • Develop and distribute Requests for Proposal from insurance carriers.
  • Develop negotiation strategy and participate with XYZ Company in negotiations with providers on issues with providers including but not limited to premiums, benefit levels and plan design.
  • Assist XYZ Company with implementation and communication of benefit programs including attending and presenting information to all Open Enrollment meetings and Board of Directors Meetings.
  • Provide ERISA counsel and guidance.
  • Research and share new developments surrounding employee benefits law and offer XYZ HR and Finance teams educational programs on an ongoing basis.
  • Interface with insurance carriers as needed to assist XYZ in the resolution of problems associated with benefit programs.
  • Develop and edit employee benefits materials used for Open Enrollment Meetings and other employee meetings such as new employee orientation. (list comparison grids, plan summary booklet, educational materials, webpage updates, etc.)
  • Assist with data collection and filing for 5500, PCORI, Medicare Drug Subsidy etc.
  • Develop and maintain website/enrollment.
  • Support enrollment process.
  • Assist/advise/Assess use of comprehensive online enrollment for both annual enrollment and qualified life changes.

Vendor Response Section

This section contains the questions that your vendors will answer. Keep in mind that you will need to score the responses when the vendors return them to you. (Often a scale of 1-5 with 5 being best is used and each question and response is entered into a spreadsheet organized by vendor.)

Describe your company’s history, number of employees, years of operation, locations.

Provide details of your company’s financial status and stability.

Discuss any pending changes in your organization that could impact the delivery of services.

Describe your company’s employee communications capabilities both web and print. Provide examples.

Will your organization provide all services requested in this proposal or do you plan to outsource some services? Which services will be outsourced and to whom?

Describe how you handle the renewal process including timeline, project plan and staff resources.

Describe your analytics and actuarial teams and give examples of the type of staff who would be assigned to our account.

Give an example of how you supported a current customer with analytics and actuarial analysis.

Provide examples of compliance updates that your organization shares with existing customers. Highlight any unique means of training your customers on compliance.

Other Considerations

Be sure to give details on how to submit the RFP response, include e-mail address of contact person. If requesting written materials, provide a mailing address. You will want to give a deadline and include a time line of activities such as when questions from the vendors are due, when you will provide a response to their questions, tentative on-site finalist presentations, tentative selection date and tentative announcement of winner. Your company may require a nondisclosure agreement and the prospective vendors may require one as well. Check with your legal team for the policy.



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