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Committee to probe health-plan administration and consider targeted audit after Cigna concerns
Summary
Committee members asked for more information on the town's self-insured fund administration, citing Cigna-related lawsuits and recommending brokered shopping for a third-party administrator and a targeted claims audit before committing to a formal RFP.
Committee members raised concerns about the town's self-insured health plan administration and discussed whether to solicit new bids for a third-party administrator (TPA).
A committee member (Committee member (S2)) said they supported shopping the TPA role, especially given "Cigna's, you know, recent lawsuit," and asked why the town was not shopping that function more actively. Members noted that a full formal RFP can be costly, requires detailed specifications, and can create procurement obligations, so they discussed a brokered approach (having an insurance broker gather quotes) rather than an immediate formal RFP.
Members proposed a pragmatic, lower-cost first step: conduct a targeted claims audit and a limited comparative review. One member (Committee member (S4)) suggested sampling three months in 2018, three months in 2021 and three months in 2025 and reconciling the results to look for discrepancies before deciding on a larger audit or an RFP.
The committee asked staff to provide more information about the current TPA arrangements, the cost and timing of a claims audit, and whether a brokered search could surface competitive options without immediately triggering a formal procurement process. No formal procurement decision was made at the meeting; members agreed to ask for additional information and to consider the matter at a future meeting.
The committee also discussed the role of the town's paid consultant/broker and the difference between a consultant's informal shopping and a formal RFP process; members requested a briefing from the consultant or an independent primer on procurement constraints and best practices before proceeding.
