Private Medical Benefits Administrator

Description

Transport for London (TfL) are reviewing the existing Private Medical Benefit and will be appointing an Administrator with a new contract commencing on 1 December 2026. The contract will run for an initial three-year period with an option to extend for a further two years. The Administrator will be expected to manage the Private Medical Benefit on behalf of TfL including assessing claims and paying treatment costs. The Private Medical Benefit is currently financed via a Trust with c. 6,900 employees included within the plan plus their eligible dependants. Administration service is extremely important to TfL. TfL's chosen administrator needs to provide excellent service to both TfL and the Private Medical Benefit members. This includes offering a quality claims helpline and claims process for plan members as well as a proactive account management service to TfL. TfL are keen to work with an administrator who can procure and manage medical treatment spend appropriately. The selected provider should be able to demonstrate that they can control costs effectively and work with TfL to manage the claims spend. This includes the use of claims pathways such as direct access musculoskeletal services and open referral networks that are mandated within the benefit design to facilitate an efficient claims journey for plan members whilst controlling costs. Administrators must demonstrate their ability to manage the transition of the scheme effectively and seamlessly, with no disruption to TfL or members of the Private Medical Benefit.