Title
Long Term Disability Program Medical Review Physician Services
Description
This report requests City Council approval to issue a Request for Proposals (RFP) for Long Term Disability Medical Review Physicians Services.
Report
Summary
The City's Long Term Disability (LTD) plan is self-funded through the LTD Trust and is self-administered by the Human Resources Department Benefits & Wellness Division. The LTD plan provides a percentage of income continuation when the employee is unable to work due to serious and sustained personal injury or illness. Initial and ongoing eligibility is determined through regular certification from the employee's medical provider specialized in the diagnosis and treatment of the injury or illness.
Staff is requesting issuance of an RFP for a Medical Review Physician or Physicians to assist in determining eligibility for newly submitted and ongoing LTD claims. The Medical Review Physician also will confer with medical staff treating employees, as needed, for purposes of determining eligibility. A medical review physician or physicians would review medical documents and records, reach out to treating physicians on a peer-to-peer basis, and provide clinical insight about an employee's ability to continue working, to return to work, or to perform other types of work.
Financial Impact
The LTD Trust provides payment for benefits to eligible participants and administrative costs for the program, such as independent medical examinations. Trust funds are available to support the cost of a physician or physicians to provide second opinion claims review. The annual cost would not exceed $100,000 for these services.
Concurrence
This item was recommended for approval at the May 16, 2017, Sustainability, Housing, Efficiency and Neighborhoods Subcommittee meeting by a vote of 4-0.
Department
Responsible Department
This item is submitted by Assistant City Manager Milton Dohoney, Jr. and the Human Resources Department.