Label
Medical Third-Party Administrator-Anthem
Human Resources
Michael Niedzielski (x2182)
Revised
Title
Authorizing the Mayor to enter into an Agreement for third party administrator (TPA) services for the City's self-funded medical insurance plan, to include providing claims administration, compliance, member support, reporting, and other related services for covered employees and their dependents, for a term of three (3) years with two (2), one (1) year optional renewals; authorizing the expenditure of funds from the Healthcare Internal Service Fund; and declaring an emergency.
Body
SUMMARY & BACKGROUND:
The Department of Human Resources sought competitive proposals for medical TPA services from October 3, 2025 through November 18, 2025. Three (3) proposals were received: Anthem, Medical Mutual of Ohio, and United Healthcare. Hylant, the City's benefit consultant, reviewed and analyzed the proposals and presented these results to the Healthcare Cost Containment Committee (HCCC) and the administration. In addition, all three (3) vendors presented their proposals to the HCCC. Based on this thorough process, we recommend Anthem as the City's TPA for medical services. Anthem is the City's current medical TPA, with the current contract term ending June 1, 2026. It is estimated that the administrative cost associated with this new agreement will be approximately $950,000 per year.
Summary
NOW THEREFORE Be it ordained by the Council of the City of Toledo:
SECTION 1. That the Mayor is authorized to enter into a three (3) year agreement with two (2), one (1) year optional renewals for third party administrator (TPA) services for the City's self-funded medical insurance plan, to include providing claims administration, compliance, member support, reporting, and other related services. Such Agreement shall contain terms and conditions deemed proper and requisite according to the Director of Law and Director of Human Resources.
SECTION 2....
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