Request for Proposals

Seeking proposals for benefit consulting services for the Oregon Essential Workforce Health Care Fund

Summary

The Oregon Essential Workforce Health Care Fund (“Fund”) is a newly established Taft-Hartley ERISA Trust that desires to provide self-insured health benefits to employees and dependents of eligible long term care employers. Eligible long term care employers can be a long-term care facility licensed under ORS 441.020, a residential facility as defined in ORS 443.400, or an in-home care agency licensed under ORS 443.315. Non-union employers are eligible to participate. The Fund’s Board of Trustees are jointly appointed by the long term care employers and the Service Employees International Union (SEIU) Local 503. Click here to read/download Trust Agreement.

The Fund goal is to provide quality, affordable health benefits for primarily low-wage workers who are unable to afford their employers’ current plan and are currently or soon to be ineligible for the Oregon Health Plan (Medicaid).

The Oregon Essential Workforce Health Care Fund is requesting proposals from qualified firms to provide benefit consulting services, including:

  • Analyze employers’ current health benefits
  • Design and implement a new benefit plan for specified employees of participating employers and their dependents in accordance with Trust priorities, including, but not limited to, improvement upon current options, Affordable Care Act (ACA) silver-level actuarial value at minimum, improved affordability of out-of-pocket costs for employees, and others as defined
  • Manage the RFP for the Administrative Services Only (ASO) contract for network maintenance, claims processing, rate setting, and plan administration
  • Manage the RFP for the preferred provider organization (PPO) contract
  • Provide ongoing advice and management education on industry trends and legal and regulatory compliance, market benchmarks, best practices, and act as a resource to management in employee training.

The ideal firm will combine depth of knowledge and breadth of services with a special level of intuition and human insight to identify potential solutions and guide competing interests to common goals.

Download complete RFP

Frequently Asked Questions

Is the Oregon Essential Workforce Health Care Fund already established?
The Trust Fund has been established effective December 15, 2021 and the Board of Trustees has been appointed. The Board is seeking the assistance of a benefit consultant in order to develop the benefits to be provided based on the expected funding. No benefits are currently being provided.
Is there a Trust Agreement available?
Yes. Click here to read/download Trust Agreement.
Who will be covered by the Fund?
The purpose of the Fund is to deliver a health benefit for low wage nursing home and other long term care workers. Approximately 3,500 – 7,000 low wage workers who are currently unable to afford their employer’s current plan or are ineligible for Medicaid are intended to be eligible for the Fund benefits. Only active employees will be covered; there is no retiree coverage.
What is the current breakdown between collectively bargained employees and non-collectively bargained employees in the Fund?

Currently, all employees work for employers in employment covered by a collective bargaining
agreement. The Fund anticipates that some collectively bargained employers will seek to cover their noncollectively bargained employees. In addition, employers without a collective bargaining agreement will have an opportunity to participate once the Fund is operational and the benefit is designed.

We note that it is anticipated that the Fund will not be a MEWA for the first several years of operation
and will remain a Taft-Hartley joint labor management Trust under the Senate Bill 800 exemption from the Oregon MEWA regulations.

Where are these employees currently receiving health benefits?
Employees may be covered by their employer’s single employer plans. It is the intent for the Fund and the consultant to request the historical claims, eligibility, enrollment, and financial data from these employer plans to assist in establishing initial rates, reserve levels, etc.
What is the expected funding?
The State has committed $30 million in the 2021-2023 biennium and is currently seeking federal approval for additional federal funds which would result in $90 million over the biennium to the Fund. Employer and member contributions are also expected, but amounts are currently unknown.
What is the intended structure of the benefits to be offered?
It is expected that all benefit offerings will be self-funded. The Fund expects a medical benefits delivery
model where the Fund’s PPO network also handles claims processing, customer service, etc. in a full ASO model with a single PPO vendor network. Our preference is a separate network for prescription drugs.
When are benefits expected to be offered?
The Fund desires to begin offering benefits during the third quarter of calendar year 2022. However,
delays with the government funding are possible and would necessitate a delay in the start of the
program.
Has the Fund already retained the other Fund professionals?
The Fund has retained RISE Partnership as the Administrative Manager and a dedicated Fund Manager is being hired currently. Fund counsel Slevin & Hart has been retained. The Fund will begin the process of retaining an Auditor in 2022.
How many plans designs will be offered?
We’d prefer a single design for at least the first year. Employers will have a lock-in period for participation to prevent adverse selection and churn in the Fund.
What request for proposals will need to be conducted by the selected Benefit Consultant?
We expect the benefits consultant to conduct a search for a PPO/TPA for medical benefits and a PBM to administer prescription drug benefits.
What other benefits will be offered by the Fund?
We are focused on core medical and prescription drug benefits but would like to consider dental and
vision. Mental health benefits will be part of the medical benefits.
What are the current benefit Plan Years for each of the 4 participating employers?

10/1/2021 to 9/30/2022
11/1/2021 to 10/31/2022
1/1/2022 to 12/31/2022
3/1/2022 to 2/28/2023

Are there any metrics on employee turnover?
The Fund has been created to offer health benefits as a strategy to improve retention and recruitment.
Current annual turnover among non-management staff is estimated at 56%.
Where are the participants located?
The employee population is located throughout the State of Oregon, but the majority of the population is in the Portland metropolitan area.
What is the Fund’s fiscal year?
This is a calendar year plan.
How many meetings does the Fund anticipate holding per year with attendance by the selected Benefits Consultant? How many would be in-person meetings?
Due to COVID, meetings have been virtual and likely will continue to be virtual for the foreseeable future. We anticipate 3 meetings per year typically.
How does the Fund expect services to be billed by the benefit consultant?
Given the wide range of services that could be included in the implementation and communication of new programs/benefits and/or changes to existing programs/benefits, the Fund anticipates that cost and work hours for these services will be provided by the consultant as the needs are defined during the design phase.

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