“The school district is formulating an additional health care plan option for the employees. This additional option is a managed care plan. The school district will be utilizing their own direct contracting rates. This plan will provide additional cost savings to the school district and provide an affordable option to access health care for the employees. Please see the attached schedule of benefits on the proposed managed care plan. This new proposed plan will require the services of a Third Party Administrator to provide traditional services and the additional requirements of the school district, in order to implement the execution of the new plan.”
Editor’s Note: The current plan administrator is Blue Cross whose PPO network is proprietary. Will Blue Cross be able to meet the specifications? Will current stop loss cover be affected should another plan through another administrator be implemented? Or will the current stop loss carrier agree to cover the risk? How will interested stop loss carriers be able to quote on this proposed separate plan without knowing who will be on it, and the risk to be assumed? Will competing stop loss carriers necessarily want the entire risk to be assumed, on both plans? Why would San Benito want to employ two TPA’s to administer their self-funded health plan? What direct contracts have already been negotiated and by whom? Are these direct contracts better than those negotiated by Blue Cross? Are these contracts available through an Open Records Request? Will the current Blue Cross contract with the district allow the district to offer a competing plan or is that contractually prohibited? Has San Benito employed an insurance consultant to assist in this RFP process?
San Benito ISD may be on to something here – taking control and managing costs.