Loading...
HomeMy WebLinkAboutRFP - P682 BENEFITSCity of Fort Collins Adminh native Services Purchasing Division REQUEST FOR PROPOSAL CITY OF FORT COLLINS BENEFITS PROPOSAL NO. P-682 The City of Fort Collins is requesting proposals from sums reflecting fees for providing a Preferred Provider Organization (PPO) network, Point -of -Service (POS) network, Exclusive Provider Organization (EPO) network, third party administration services, utilization review services, stop-1 oss insurance and prescription drug coverage. Single service as well as multiple service providers are encouraged to respond. Proposers may bid on one or multiple services. The City currently provides all eligible employees and their dependents medical benefits on a self - funded basis. Prescription drug coverage is provided to employees and their dependents participating in the PPO options through a carve -out card program. Proposals are being solicited by the City to obtain the most competitive benefits for i is employees and their eligible dependents. Current plan designs are to be replicated. Plan documents are available upon request. Written proposals, four (4) copies will be received at the City of Fort Collins' Purchasing Division, 256 West Mountain Avenue, Fort Collins, Colorado 80521. Proposals will be received before 3:00 p.m. (our clock), July 29, 1998. Proposal No. P-682. Proposals must be valid for ninety days. Proposals received after this time will be considered non -responsive and will be ineligible for consideration. Copies of the proposal documents may be obtained at the office of the Director of Purchasing and Risk Management, 256 West Mountain Avenue, Fort Collins, Colorado, 80521 or by calling (970) 221-6775. Fax requests may be faxed on Fax Request Form to (970) 221-6707. Questions regarding the proposal submittal or process should be directed to James B. O'Neill II, CPPO, Director of Purchasing and Risk Management (970) 221-6775. Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall have a financial interest in the sale to the City of any real or personal property, equipment, material, supplies or services where such officer or employee exercises directly or indirectly any decision - making authority concerning such sale or any supervisory authority over the services to be rendered. 256 W. Mountain Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 City of Fort Collins Admini, -.ative Services Purchasing Division CITY OF FORT COLLINS ADDENDUM No. 1 June 24, 1998 SPECIFICATIONS AND CONTRACT DOCUMENTS Description of Proposal P-682 - BENEFITS OPENING DATE: 3:00 p.m. (our clock) July 29, 1998 To all prospective proposers under the specifications and contract documents described above, the following changes are hereby made. Section IV - Census Health Insurance Codes RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE BID/QUOTE STATING THAT THIS ADDENDUM HAS BEEN RECEIVED. 256 W. Mountain Avenue • P.O. Box 580 9 Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 0aaac b �° m ae• co a 0 o � ° x3�;do CD co m tm m ° Co Z m, °• m ° H trA o metro \ m r C m ° 3m\ e m CD o •� H 3 O N C 0 \ M 'W� 0 N m m o m c�mm C. 0� Z O 0 m N �Nm� m \ N � g oTM m ° m 0 CD 3 a 2. m o co �• M m 0 R N m w y .�► ib Z3 ° 9 m m ° 3 c f,1 m 0 a CL m m a N C7 '-� ° o m FA Ix o 0 O m c w c m o D O w T=0 = 2C Vi 07 2 0 7 m C w d m .Ci 0 y C� C) S 09 p a m to n�m Z to m m N C M d CD Z d O y yj m O 7 r N T w C CD to m 7 to CD W CD ' .7i 20 N 20 m p d o m O m CD c y 0 Q W m c y C m .ci m o �1 ti m 00 7 C) <'d CD y a a, Z2 Q3 w o CD a - m H 0 0(D a ° m v°s. .m m va m m m CD �my��� ��° �vc��a S��a �Om ma o< ma 03 y.a� x.� N.o 7 cD ya 7 ° R°'0-' a o i o m p. o 0 m �. rr 3 0 0. tr m -« C. o• CD m w< S 0 ma4m1 G fSD '00 .7•t 7< c C c 7 'G m C 7< CD C W r d CL CD t0 m 7 m �, t0 m 7 mCL �-�' y< ty/i CD 7 y m 3w 0._ 3y 37• 0 0 n.003mS 3d7 m °«>T CD °—' a : cn a< CD cn 7 w .2 Ro 7 G Ro 7 w < 0 # < < 3 0 # # # # 3 CD m CDCDt0 -y m m S # m X # 0 # CG) # ) CG x'O O .: 0 O <aC m w m C w m m m 3 a° 1 a T a 1 CD a i 0 d m m O en o < m m -oi. VJ m .. .-' i '+ l O O ih 7 NOCD S a W 7 1 O o a O o O o O -� 0 m -0 OR z Z 0 7 y? m y S c * C"DC * C N * to m # v X m 0 00 y ;: m X d Cl) 00 00) rt 0 0 Gm) ti N C) .yi N n O C O N • t0 C O S a ye O O O O O O 7< 0 0 0 7< N Ci Q 3 CD .Ne m 0 m m 7< 3 m m 3 m m 3 m m c 0 o 7 C y 0 m 3 c 3 o ,' �' d Q m Q� Z C. _. 3.ad «team ma <ma ma 0 O In N d 1 p y S�rmi S�.m+ S�� "M 0 0 o m 0 y 0 O 0 m 0 y m CO m is cc �' c0 O 0 N I m 7 CD CA) O m m 7 m m Oo - m OQ y o m 00 N --i a a� y O 3 a m ° ° ° O r 3� 0 m 3 0 CD m O ^'x•� y m 0 0 o m Q'3m0 w0x•fm P3mo < < < c y c N CD CD CD D r c° 3-0 o 0 �_Da 0 m a m a m a M _ m m `1 CD O 0 0 o d m 0 0 ° a m m .•+ .� r+ O r D N7 a 00� a o o O -I z Sol 0 0 y m ofZ O7 7 N M f? < 3 0 O 00 N m m 7' c o < < 3 0 0 co N• m d S c O O � # c d w O � # C C� # n � * c C� # N O 0 X N N ti X .y+ 'to .y+ Co C) O O ryt y n 0 0 0 ryI (n C7 0 0 0CL O O m C y�° N O m c w 30 O 3 m 3 3 7m m w d �Q 0 CD �g CD g z c �� •cp < N a N m O. '< m •Z m a 7 CD M 0 y tp '+ O N O Ro p� o Ro m S O Ro m S M 0 0 0 �. N 7 O 0 0 0 '� y 0)m 7 S ,* 01 CD .. w CD .f 0)CDO M m< 0CA) lS 7 �w O co to O Ro Ra 0 0 0 Z C Z m w m m n 0 9 D Z E=3 V k 0 ai a0 N( m CD SOS y> MGc $ (D =— d0 "! m O r- 2) a m m Z o �� Q D r a (lo ^' D m DD `D 0» a` 0 N m Z00 D o 3 g 0 0 o s m m m „ s ° =� 0 0 C 0 m m o o vCL (oc uu d o 0 o va 03 ^' 0 as m $ 0< CD 0 0 0 M o Q9 �ca''D o °o CD =4 CD3 cNno 0 N _ < m �'0m N »' ---_x� 0 01 as d to a°3 o y m < O O � Z2 G d O N 0�f ((A •< •< wcD 7� cD -' 3 3 a o d •O a 3 '= 0 m 0. c O0 N m •O m y N C— ff .'i 07 � m a) 0 CD ° c 0 M c� o�� v ) a j w cm CD y O m Q• � N O r: a 7 m N m 0 0 a< 'y O m d 0 � yac y a y -- C) Om * m ono * ;:a O (0 < O < co * p 0 =o Om O G p`O� m 7 •• 00CL _00. 0 5m xCD $o'gm� �; 3d dim cm0l<to °<� o O M� C "O" f< - .�. o 3 O m O O 0 0 o 7 " O O O Z S aim 3 0 uy 0 0 *-� N 0 0 * � c CD m .�� v 3 G k, UI 3• cC O O 0 �• 3 N N * • 0 0 00 O o .< co m° y 3 m o y 3 o m 01 3 0 0., m g0 ,', m �_ Z a QD� 00 a' Oo fps m CD 0 O u o .i 0 � 7 o a 0 y CDy o CL O 0 =, tap O O O 0 < O O r y; ':�;h0 * 0 0 O * a0 * m 0� 0 a r Z C * :: O A < to * < O (n <CD (O N 3 �_ oo`, O Oc� o x `CDD G m m 0 CL .y; � OO CDCD CL m ~ m p N m S �` M 3 d 0. O 9m xcv'3m� �,_:3D,_« y 2 y C a C p co rA 0 K co H o m CA c ,d. O, w m .« (Ava O r D m d a7 3® N -v O O '� Om _I < O 3. O 0O O Z Vs S 0 C a N 3 0 u 0 0 * C N d S C m * a C') 0* m u s e m m O +� N pD m mp, a m 0 .�' tC 0 0 0 y� 0 cc o 0 o O 0 0 C m O. y 0 o �• p `N° 3 �a m C70 m o ; —� �0 o m a m 3 m m 33 <m-^ 0 RD 3 m o m o R°w <0 w 0 co m O m 7 0o�m N a �' OS CDN =w m O O CD a O C � O O 9 m ci D Z Cl) c m n m W m m n n 0 Z E # a T % .( •_ E �E {E _ ® g \ C q■ sI �■ CD w; \ $ z» 32 ■ � o �z z @ z § C- , 2 co 0 i3. 2 @ « 9 03 % a C E o. ��a �2 o00 . Ems§ EI X. �- ■-00 . ] % ; CL kt § »I CD CD ; g» ; CL §� #'a Q �o 0 .ci `CD ) 0 IL 2� ;; �� 3 T ° o n t ] �gm 0 x= /; °`■ \ k \ / § r to � D pr — d - (so 0 �k(A k LT ;� `_ 2� �E$ 0 30 [ §- CD n _ ; § z ■ E E z k ) | | 2 7'e a| ;& § o �m Inc r } o m jig ° 2 rA CL CD I \ (D 2 � = C & § 2M ) % §0 M ■ , C e [ '< X. E | k 7 E o§ o f A i ■• § 0 �(A �� mc% = Ao io o■o n . a e§� ° i ` ®m k CD CD M M 0 ■ gg; ° o k i \` ��« z 0 a 0 mg c _9 W CL0 z k ki / i i � � �E ƒ U2 of 3 ] 2 2 CL § so■CL E \ o -o � CL z $ e § .,; '0 § . M ¥ ® § §E o E a fE � _ � CENSUS M 480510 80526 B157 5762 F 620202 80521 B159 4360 F 421023 80525 B150 6900 M 740614 80525 B158 8080 M 390824 80521 B157 7570 F 570125 80525 8155 1865 M 521218 80521 B153 5975 F 580330 80521 B504 2370 M 551129 80521 B161 8106 M 411117 80302 B159 6740 M 570512 80521 B150 1832 M 520723 80522 B160 6240 M 520907 80525 B158 9030 F 680719 80525 B158 6890 F 590918 80525 B156 4780 F 520825 80526 B155 4400 M 520505 80525 B158 8110 M 441102 80521 B160 7810 M 511112 80535 B154 7650 M 550610 80537 B162 7450 F 470210 80535 B156 4370 M 511109 80526 B161 9510 M 540213 80525 B157 4860 M 510313 80526 B157 9090 M 660219 80525 8158 5810 M 540315 80525 B157 9600 F 531108 80538 B158 9090 F 430521 80524 B155 6440 F 500106 80537 B158 7610 M 700511 80521 B154 3044 F 620103 80538 B150 6420 F 550924 80538 B155 6820 M 690619 80525 B160 7430 F 460829 80610 B403 4740 M 650928 69361 B156 9310 M 440806 80521 B156 9020 F 571109 80537 B160 3028 M 560622 80521 B150 3030 F 440605 80549 B157 4400 F 520201 80521 B157 4170 M 450410 80512 B157 7810 M 461219 80525 B161 4876 M 560526 80526 8153 9510 M 600911 80526 B157 9390 M 541211 80526 B157 9150 M 510621 80524 B155 6450 M 590912 80521 81,61 7560 M 620820 80525 B151 9130 M 471008 80526 B404 6880 F 500724 80525 B160 4470 M 510814 80526 B154 9090 M 550905 80526 B157 5365 M 500906 80526 B163 5310 F 510707 80538 B161 4500 M 670609 80526 B161 3065 F 691022 80525 B161 9030 M 570419 80525 B154 5546 F 580311 80526 B304 4170 M 590214 80525 B158 3038 F 670303 80526 B161 5550 F 670714 80525 IB161 5542 . onwnn onrnn A7BA 1 1708 rvI F 580425 80547 B155 8405 M 581205 80526 8161 1817 M 610213 80526 6153 5365 M 431008 60525 B157 1870 M 500805 80521 6165 1003 F 540723 80525 B165 4330 M 611031 80526 B165 9370 M 600822 80526 8158 9370 F 420619 80525 B154 6860 F 581007 80524 B152 4160 F 611008 80521 B158 6880 F 520508 80521 B201 4740 M 530313 80535 8165 8106 F 601109 80634 B161 5554 M 411224 80524 B154 9010 M 570817 80524 B157 7450 M 460221 80537 B155 7210 M 550125 80549 B158 9090 M 571012 80537 B163 8330 M 580213 80521 B156 7650 F 561107 80525 B401 4735 M 520120 80524 B150 5503 M 530523 80525 B157 9090 F 501002 80526 B163 4330 M 670613 80525 B501 2007 M 390117 80538 B156 8260 M 410705 80525 B159 7810 F 580613 80525 B161 4470 M 550716 80525 B155 1005 F 550814 80525 B150 1814 F 640908 80526 B156 4360 M 560605 80526 B161 7920 M 481023 80521 B152 7735 M 390322 80525 B156 9090 M 630416 80524 B158 8060 M 530617 80538 B157 9090 M 610816 80526 B161 8080 M 441103 80521 B155 6890 F 611109 80549 B160 7020 M 421020 80526 B158 6340 F 400325 80521 B201 4740 M 540604 80525 B152 7920 M 410418 80526 B165 1260 M 540929 80525 B161 7810 F 671026 80524 B158 4480 F 600521 80526 B153 4030 M 540603 80525 B157 9130 F 670913 80526 8160 6851 M 470911 80537 B159 4190 M M 491210 510224 80525 80526 B154 B161 7170 7120 F 570515 80537 8155 7810 F 600114 80020 B154 5517 F 441119 80521 B163 6850 M 450729 80525 B156 9370 F 550904 80526 B151 5236 M 611226 80521 B153 7200 M 360916 80535 B156 7275 F 640620 80525 B157 4780 F 600218 80615 B154 9370 F 551018 80526 B157 7830 F 691021 80521 B154 5360 M 481130 80525 B150 6440 M 521025 80525 B156 9130 M 480519 80526 B157 5340 F 511209 80526 B161 4740 M 521117 80521 B151 1765 M 730623 80003 8154 9356 M 501010 80526 B153 1020 F 500509 80512 B153 6355 F 531215 80526 B153 4230 F 600602 80526 B159 5532 M 650708 80524 B161 8106 M 460531 80524 B156 1770 F 470715 80524 B401 4740 M 521005 80526 B161 6484 M 610613 80526 B153 9090 M 500719 80526 B161 1155 M 330308 80526 B154 4790 F 510307 80526 B160 5880 F 550212 80526 B162 8120 M 671214 80526 B158 9110 M 531025 80524 B157 7733 F 491222 80525 B154 1831 F 520321 80526 B156 6880 F 411121 80521 8164 4330 M 440408 80526 B158 7420 M 510421 80526 B159 8380 F 700716 80540 B160 6157 M 530703 80525 8154 6910 F 400513 80526 B160 4120 F 691218 80525 B158 6315 M 670731 80525 8161 8020 M 400722 80538 B157 7810 M 491125 80524 B152 8380 M 491229 80526 B161 1575 M 501204 80524 8154 7970 M 500310 80526 B159 9090 M 500928 80524 B150 9510 M 511128 80526 B502 2290 F 500126 80524 B158 6110 M 490514 80526 B155 9510 F 590623 80526 B157 7990 F 280907 80525 B162 4740 F 580320 80524 B157 6420 F 570210 80524 B158 4740 F 571209 80535 B161 4120 M 640723 80545 B154 9130 M 580302 80535 B161 7940 F 510221 80521 B154 9090 F 710826 80634 B158 5525 M 600109 80524 B159 1160 M 460923 80538 B152 5260 M 530306 80634 B151 4850 F 650602 80537 B161 4120 M 530121 80525 B157 1290 M 670220 80525 B161 9090 M 440903 80526 B156 1582 M 590524 80525 B157 9090 F 621011 80525 B154 5560 M 651202 80525 18158 9020 1 9370 rvi M ..... --- 541030 ----- 80538 B159 9350 F 431024 80524 B154 4170 M 510601 80535 6157 9370 M 600518 80525 B158 4055 M 491106 80526 B158 9370 M 640321 80525 B150 9370 M 560404 80525 B155 9090 M 580921 80524 B157 9090 F 680406 80521 B401 3204 F 510625 80526 B159 1165 M 440813 80526 B161 7810 F 491021 80526 B303 4070 M 661221 80524 B158 8070 M 561220 80525 B150 1819 F 590420 80521 B160 3048 F 631022 80525 B158 9085 M 431130 80525 B157 7520 F 700530 80524 B160 6420 M 591214 80550 B161 7560 M 650417 80526 B161 5940 M 450510 80525 B156 1855 F 570626 80535 B150 3006 F 591231 80524 B160 3022 M 440511 80541 B158 5090 M 631003 80524 B158 7810 M 510404 80521 B159 6852 F 510109 80526 B155 5120 M 510830 80524 8157 9510 M 550109 80526 B161 9390 M 570329 80536 8160 7340 F 630816 80550 B150 9370 F 690425 60526 B160 9010 M 460820 80512 B160 5130 F 550227 80526 B159 3046 M 630826 80526 B158 7860 F 630121 80524 B154 4830 F 481022 80525 B504 2058 M 500306 80524 8150 1025 M 530506 80521 B156 9090 M 441017 80526 B160 9020 F 611106 80525 B161 4260 F 591013 80521 B160 5765 M 561115 80526 B156 7360 F 540327 80521 B157 7810 M 510706 80545 B157 7095 F 470924 80524 B160 4360 M 680724 80521 B158 9310 M 470506 80524 B157 9090 M 560127 80526 5161 8060 M 510731 80526 B165 9030 F 591117 80512 B151 5945 m 580607 80526 B155 9090 M 501126 80525 B157 7748 F 560620 80537 B161 7020 M 430823 80550 B157 7730 F 470126 80526 B156 4780 M 430406 80524 B162 7940 M 460327 80525 B154 4830 M 530826 80524 B161 8355 F 560512 80521 B159 7930 F 610723 80521 B161 6851 M 610801 80538 B157 5220 M 580721 80521 B154 8090 M 480723 80537 B160 7810 F 590226 80526 B160 4120 F 561202 80525 B161 6200 M 721224 80521 B158 3048 M 501102 80512 B161 7260 F 551116 80521 8156 8392 M 620509 80522 B502 2370 F 641006 80550 B159 5940 F 440817 80537 B154 4330 M 611129 80525 B155 7520 M 490320 80526 B161 7385 M 690401 80521 B162 6820 M 550430 80521 8157 5760 M 590729 80521 8157 9370 M 590729 80526 B157 9370 F 621207 80527 B158 7810 F 500208 80525 B150 6385 M 680214 80524 B150 4830 F 420827 80525 B154 6850 M 521122 80525 B159 7940 M 530226 8052.1 B153 6025 F 531002 80538 B153 5550 M 571103 80515 B157 7810 M 530223 80521 B150 6880 M 550225 80526 B157 9540 F 510413 80526 B158 4020 M 510725 80526 8161 7390 F 541029 80526 8160 5825 M 481105 80522 B150 1285 M 510205 80526 B159 9510 F 480425 80536 B156 4450 M 500622 80535 B158 9090 M 560206 80526 B161 9310 F 490524 80535 B201 4785 M 510331 80526 B161 6190 M 540331 80525 B160 7520 M 470227 80525 B150 5569 M 600406 80521 B158 8060 M 471202 80521 B156 1170 M 530212 80537 8151 7560 M 620626 80252 B159 6157 M 581006 80014 B150 9370 M 480503 80526 B159 7260 M 511127 80525 B150 5770 F 561110 80521 8154 6861 F 550112 80525 B160 4400 M 751207 80526 B158 7430 M 480320 80526 B157 6910 F 491216 80521 B160 4450 F 580924 80525 B159 4120 F 610427 80524 B401 1816 M 660927 80525 B150 5562 M 460930 80526 B159 5940 F 661108 80526 B162 6155 F 720130 80525 B160 6420 F 451121 80526 B156 4360 M 470723 80526 B161 7650 M 471215 80526 IBI59 5460 F 650211 80526 IB157 6745 M 570901 80526 B159 7450 F 590921 80526 B404 3020 M 361226 $0524 B156 7520 M 480209 80525 B159 9160 M 650115 80536 B161 9090 M 571117 80524 6157 7560 M 490720 80521 B158 6900 M 500828 80526 B159 1805 M 491213 80538 B160 9370 M 500122 80525 B155 9090 M 691023 80524 B158 7200 M 700403 80526 B150 6890 M 480324 80521 B159 5280 F 510527 80535 B159 9370 M 510705 80526 B157 7970 M 500203 80525 B159 4876 M 571124 80525 B165 6390 F 630301 80631 B155 5290 F 601007 80524 B158 9370 M 410904 80524 6156 0 F 610603 80521 B161 552 520 F 640615 80526 B161 4860 F 560309 80537 B161 9135 M 700312 80525 B160 7120 M 370622 80545 B160 6190 M 490704 80526 B156 9120 M 430626 80524 IbIbU 7540 F 571124 80535 B158 4072 M 450624 80526 B157 1590 F 591112 80524 8157 5365 F 550526 80535 B162 4400 F 600430 80621 B158 1830 M 660767 80524 B158 30 F 750101 80527 B401 78108 M 561067 80525 8157 9130 M 451002 80525 B156 1660 M 520418 80538 IB161 1830 M 450820 80525 IB157 1860 M 450106 80526 B156 9160 M 430729 80526 8157 7980 M 570404 80536 8155 9510 F 610713 80526 B163 6460 F 530604 80512 6154 7645 M 590706 80526 B162 9020 M 590212 B0525 B161 9370 MFE 370618 80521 B156 7725 M 490320 80526 B157 5567 F 601161 80526 B159 9020 FM 530611 80521 B157 4780 490528 80535 B157 5990 M 520828 80525 B159 7980 M 670429 80525 B160 7 M 641222 80526 B161 720000 M 660928 80525 B154 7560 M 711005 80526 B158 7120 F 410919 80525 B158 4055 M 500530 80524 B502 2370 M 581225 80524 B157 9370 F 590906 80524 IB150 4100 M 421024 80524 6150 6040 F 421230 80521 B164 4170 F 470318 80526 B154 3008 F 480729 80524 B158 4380 F 470107 80524 B158 6862 M 450713 80620 B155 7415 F 530722 80526 B161 5515 M 370610 80524 B156 1175 F 521130 80525 B157 4480 M 480201 80524 B153 1035 M 480523 80521 B157 5320 M 491001 80526 B152 6195 F 580712 80524 B157 7520 M 600319 80524 B158 7120 F 660108 80526 B158 9030 M 390904 80525 B156 6160 F 410904 80524 B152 1825 M 401019 80525 B156 7970 M 511114 80526 8156 8370 M 510926 80525 B165 5420 F 670212 80521 B154 5320 M 660818 80526 B157 9090 F 550924 80547 B161 6110 M 541210 80526 B161 9090 M 550427 80521 B156 8060 F 620620 80526 B153 4470 F 630601 80525 B158 4400 M 590221 80525 B155 7980 M 630628 80525 B157 8245 M 690425 80538 B158 5030 F 710310 80525 B161 1806 M 490913 80538 B158 5365 M 490220 80526 B163 6190 M 510626 80526 B165 7920 M 520405 80525 B161 7570 M 510315 80525 8153 7830 F 511216 80521 B155 5170 M 620512 80521 B161 7580 M 610911 80525 B161 8415 M 640709 80526 B157 9090 F 791125 80525 B154 4330 M 700906 80526 B160 9090 M 371224 80525 B401 3065 M 360522 80549 B156 7970 M 470822 80639 B159 7940 M 401025 80526 B160 1355 M 470810 80620 B160 7910 M 530831 80521 B158 8106 M 521015 80524 B157 7990 F 540328 80524 B150 4240 F 570903 80524 B161 7420 F 611010 80550 B154 9030 F 700811 80538 B158 9090 F 730513 80521 B158 9030 F 430122 80526 B158 4470 M 450830 80521 B158 9090 F 470105 80522 B158 4330 M 491121 80535 B160 5130 M 511223 80535 B152 5130 M 591123 80526 B155 5550 M 690729 80525 B161 7450 M 430810 80524 IB154 g2gp HEALTH INSURANCE CODES PLAN CODE COVERAGE Full-time CITY PLAN Option 1 $750 Deductible B150 Employee Only B151 Employee + Child(ren) B152 Em to ee + Spouse 13153 Employee + Family Option 2 $200 Deductible B154 Employee Only 13155 Employee + Child(ren) B156 Employee + Spouse B157 Employee + Family PACIFICARE HMO Plan B158 Employee Only B159 Employee + Child(ren) B160 Employee + Spouse B161 Employee + Family POINT OF SERVICE PLAN B162 Employee Only B163 Employee + Child(ren) B164 Employee + Spouse B165 Employee + Family Part-time CITY PLAN Option 1 $750 Deductible B201 Employee Only B202 Employee + Child(ren) B203 Employee + Spouse B204 Employee + Family Option 2 $200 Deductible B301 Employee Only B302 Employee + Child(ren) B303 Em to ee + Spouse B304 Employee + Family PACIFICARE HMO Plan B401 Employee Only B402 Employee + Child(ren) B403 Employee + Spouse B404 Employee + Famil POINT OF SERVICE PLAN B601 Employee Only B602 Employee + Child(ren) B603 Employee + Spouse B604 Employee + Family Hourly PACIFICARE HMO Plan B501 Employee Only B502 Employee + Child(ren) B503 Employee + Spouse B504 Employee + Family Waiver of Medical Ins. B100 M a ova<+ -'-' B161 9370 M 630429 80526 5565 670914 80525 B156 M 420507 80526 B160 7270 M 531020 80525 B160 9610 M 530330 80524 8157 9030 M 560527 80525 8161 8114 M 571107 8052b B157 9560 M 611218 80525 B161 7458 M 460116 80526 B157 7058 M 510302 80525 B152 4540 F 571212 80525 B404 6855 F 570611 80524 B157 5074 F 601219 80521 8504 2370 M 38081526 4 80 B1b6 7200 M 470227 60525 B159 6330 M M 521021 80526 B154 9380 3096 F 591019 80549 B159 2290 M 790416 80525 B501 7810 F 411130 80525 B160 4400 F 320916 80521 6154 4360 F 370612 80525 B154 9130 M 420906 80524 B156 5440 M 430801 80526 B155 9090 M 460831 80524 B155 8345 M 450320 80535 B161 F 420609 80524 B401 4710 M 440229 80525 B160 4830 M 450113 80526 B152 1015 M 490508 80526 B157 7910 M 491014 80549 B162 9150 F 501006 80524 B151 4160 M 530707 80522 B154 5710 F 530302 80549 8158 4830 F 550920 80524 B156 7560 F 551226 80524 B157 6350 F 520414 80521 B158 4315 M 670603 80535 B162 5185 M 561120 80525 B155 9090 F 550702 80524 B150 5507 M 580529 80526 B150 9510 M 680723 80526 B160 7120 M 620820 80526 B157 7580 M 670627 80526 B161 9090 F 590429 80635 B153 4480 F 600704 80525 B158 6350 F 580724 80525 B156 4145 M 590207 80525 B161 9370 M 631219 80526 B150 9370 M 640209 80525 B161 9090 M 610814 80526 B161 9510 M 580414 80538 B161 6180 F 570121 80525 B157 1760 F 730106 80550 B150 4030 F 580512 80525 B156 9070 M 580302 80525 B161 9580 M 580813 80538 B155 9370 M 610805 80525 B158 4190 F 550329 80521 B160 4250 M 621004 80524 B157 9090 F 691103 80525 B158 4140 M 711022 80521 B161 7120 M 641112 80550 B157 9370 M 700106 80524 B150 5540 M 620519 80525 B157 9090 F 600905 80526 B158 9015 F 640410 80526 B158 4226 M 680908 80524 B150 4830 M 601031 80525 B161 7250 M 620328 80524 B161 7920 M 630214 80525 B157 7810 F 651110 80521 B153 9010 M 630529 80521 B150 5090 M 611003 80525 B161 9370 M 670820 80537 B158 7530 M 620611 80524 B157 7940 F 650521 80524 B159 9090 M 650510 80550 B154 9350 M 661110 80525 B165 9110 M 701007 80526 B160 4830 M 660504 80549 B158 9090 F 670629 80524 B158 9090 F 671228 80526 B602 4120 M 720225 80521 B161 9350 F 671130 80521 B160 6560 M 690820 80 226 B158 5940 M 700625 80521 8158 9090 F ft u .. OUQZQ 490403 80526 B156 F 490516 80522 B157 9510 M 471223 80524 8165 4860 M 480729 80521 B162 7350 M 510814 80525 8157 9510 M 500731 80526 B164 7710 M 500519 80524 8161 9390 M 490130 80521 Its157 9510 M 490215 80524 8157 7185 M 620304 80527 IB159 9090 M 580429 80526 IB157 9600 M 771114 80526 B158 7412 M 481109 80526 B161 5552 M 500814 80525 B151 4160 F 500602 80526 B160 4120 F 471007 80524 B154 9090 M 510104 80526 B159 9110 M 511022 80525 B160 7200 M 710108 80525 B158 7120 M 490509 80535 B153 7550 M 650428 80526 B161 7485 M 4811048 B154 9370 M 520929 80526 B150 5940 M 500326 80524 B161 9120 M 480720 80538 8160 4055 F 500326 80524 6154 1875 M 500319 80525 B152 M 531224 80525 4170 B158 4170 F 510821 80525 B153 9130 M 10 4g7714 a0525 IB156 I5180 M 560908 80526 B161 7340 F 530916 80521 B156 4770 m 510908 80525 B152 9360 M 531216 80535 B157 7970 M 520721 80524 B155 9370 M 540209 80521 B154 9510 M 530325 80521 B161 7450 M 560224 80526 B161 4860 M 530B18 80631 B162 5140 M 590214 80524 B161 7260 M 530705 80538 B165 7380 F 520924 80525 B161 4450 M 531015 80525 B157 1065 M 550104 80526 B159 7350 M 531005 80538 B157 5225 M 581127 80526 B161 8280 M 540930 80526 B161 5130 F 540321 80526 B159 4400 M 640728 80526 B161 4830 M 541218 81416 B157 1710 F 531105 80521 B154 6375 F 550109 80524 B404 4735 M 541117 80526 B160 6861 M 541019 80526 B161 9130 M 710113 80522 B158 8060 M 550813 80525 B157 9510 M 550322 80526 B161 7370 M 541215 80535 B154 5320 M 561102 80631 B157 7940 M 551126 80521 B501 2375 M 570607 80526 B161 1755 M 550807 80525 B158 7370 M 570929 80535 B151 7980 M 631031 80521 B159 9040 F 570227 80526 B154 1258 F 630429 80525 B161 4102 F 610420 80537 B158 4360 M 640303 80526 B157 9090 M 570829 80535 8161 7081 F 631210 80526 B161 6110 M 551113 80524 B156 3024 M 580816 80524 B156 7200 M 600215 80525 B157 7100 F 570622 80525 B158 6440 F 671010 80524 B158 6315 M 721123 80526 8158 6315 M 600412 80521 B157 3056 F 590226 80026 B158 6735 M 550911 80521 B161 9090 F 591029 80526 B401 4360 M 590612 80526 B165 7970 F 640315 80524 B154 6440 F 580609 80526 B150 9090 M 571230 80525 B157 7580 F 590112 80526 B150 5240 M 610917 80526 B161 9090 F 620112 80526 B158 9050 M 651206 80525 B157 9090 M 641013 80537 B159 7350 M 590717 80526 B159 9310 11 �� F T_,.-- 510215 ---- 80524 B156 9370 M 540216 80525 B154 5527 M 490624 80525 8154 9510 12 M 500227 80525 B159 6000 M 530125 80525 8157 9370 M 530714 80513 B157 7450 M 490618 80525 B159 5995 M 510622 80512 B159 6330 F 471212 80538 B159 4370 F 490219 80521 B158 4360 F 490905 80521 B204 5812 F 511009 80524 B404 4740 M 610215 80524 B201 4740 F 491127 80525 B156 4100 M 500308 80538 B503 2370 M 501015 80521 B160 3064 M 501107 80526 B153 8280 F 510603 80526 B157 4210 M 520604 80526 B161 9090 F 510615 80521 B158 4740 F 501129 80501 B156 6840 M 470816 80526 B158 7412 F 511215 80526 B158 4360 1 500216 80521 B165 7220 F 510601 80537 B160 4120 M 650302 80501 B154 4215 M 530505 80524 B501 2011 M 530211 80538 B157 7650 F 490315 80525 B155 4400 M 500822 80521 B161 8060 F 661128 80524 B154 9020 M 511228 80525 B152 7450 F 520113 80524 B161 4860 F 521025 80524 B161 6715 M 510815 80526 B156 7200 M 570603 80524 B161 8070 M 640430 80521 B158 7830 M 560524 80521 B161 7460 F 540805 80521 B160 5519 F 540208 80524 B154 4860 M 540215 80524 B160 7910 M 520420 80521 B159 7120 M 530508 80521 B301 7320 M 530412 80525 B157 1275 M 511127 80525 B161 8400 M 520217 80526 8154 7980 F 601208 80521 B161 1060 M 530926 80537 B158 7810 F 530427 80610 B165 5505 F 620516 80524 B154 9030 M 540208 80521 B161 7910 M 530129 80526 B157 1720 M 550422 80526 B161 7910 M 540427 80521 B157 8060 F 530828 80521 B154 1360 M 540613 80521 B162 7350 M 540126 80526 B161 9370 M 540629 80524 B157 7082 M 550712 80526 B155 7940 M 550613 80521 B157 5540 F 590821 80521 B160 3040 F 541008 80526 B165 4215 M 560129 80526 B158 8020 1`/1 560430 80538 IB156 8335 13 14 nn RFnR1i IROFWq IB161 9350 F 720807 80525 B158 9090 F 670625 80521 B160 4785 F 660109 80524 B159 4330 M 700901 80234 B160 9350 M 710331 80526 8158 8060 M 731211 80526 8158 7080 M 670610 80525 B163 7450 M 670222 80525 B157 9130 M 660408 80521 B160 5532 F 710806 80524 B158 3206 M 340724 80521 B160 7810 M 360910 80631 B154 7350 M 390109 80521 B160 7910 M 360905 80521 B156 6190 F 361007 80525 B156 4780 M 371214 80521 B156 3300 M 400224 80550 B156 7710 M 360713 80524 B160 7940 F 691009 80535 B161 4315 M 700217 80528 B160 7910 F 420924 80525 B160 4315 F 720816 80525 B158 8060 M 450502 80536 B156 7450 M 430109 80512 6156 7760 M 440717 80526 B157 9150 M 450206 80526 B163 5485 M 410707 80526 B154 5116 M 470708 80525 B501 2370 M 460924 80526 B161 7480 M 470407 80525 B153 5548 M 460916 80521 8155 5405 M 470721 80517 B156 9580 M 480302 80535 B156 9510 M 461101 80526 B162 7810 F 440520 80524 B156 1655 M 470627 80526 B154 8360 F 490213 80524 B156 4450 M 540408 80524 B157 8060 m 520225 80524 B161 9600 M 490624 80522 B150 9090 F 481011 80526 B155 1070 F 500825 80525 B158 9090 M 540419 80521 B158 8060 M 570301 80526 B157 9150 M 511218 80525 B165 7260 F 510615 80524 B159 4245 F 470417 80521 B156 4240 M 581028 80528 B161 9310 F 500918 80524 B150 6480 M 570111 80550 B151 7520 M 500405 80526 B155 3056 F 590921 80526 8158 4360 M 530310 80538 B161 5130 M 491211 80526 B150 8080 F 560802 80526 B156 5556 M 540422 80524 B159 7260 M 550704 80526 B157 9560 M 520130 80524 B157 1730 M 511014 B0524 B156 7260 M 510707 80524 B157 9510 15 M 5741015 80526 B157 8100 M 550305 80521 B155 8106 M 550902 80525 B161 8106 M 530721 80512 B157 9150 M 530920 80521 B161 7200 M 541003 80521 B165 7260 M 530604 80549 B157 9090 M 550418 80526 B159 9090 M 550128 80526 B167 9510 M 541105 80537 B156 9510 M 540404 80524 B161 7910 F 560824 80524 B157 4876 M 550715 80524 B159 7470 M 540129 80525 B154 8050 F 561011 80526 B162 7612 M 570301 80521 6156 9370 M 551125 80526 B153 5400 M 560817 80524 B157 9090 M 561125 80521 B157 9370 M 570306 80525 B159 9150 M 550227 80537 B161 6170 M 580820 80550 B157 3026 F 630613 80525 B154 9090 M 630610 80615 B156 9370 M 680528 80525 B158 9090 M 640627 80525 B161 9370 F 570905 80521 B159 8106 F 571031 80550 B160 4120 M 610109 80526 6158 7040 M 570822 80526 B161 7040 M 580223 80535 B161 9130 M 581110 80526 B161 9090 M 661206 80524 B165 9090 M 740514 80526 B152 7335 M 610616 80538 B159 7910 M 740223 80538 B158 7420 M 600506 80521 8161 5195 F 601219 80549 B163 4735 M 590419 80525 IBI57 9090 F 600224 80521 IB157 6750 M 600107 80526 IB161 4830 F 700711 80526 B158 9090 M 631221 80525 IB159 7530 M 610718 80526 B157 7962 F 25 B150 4072 M 24 B162 8080 M M630711 26 B157 9090 M 26 B159 5544 M 38 B1613014F 26 B159 5885 M 701204 80549 8159 7580 M 710322 80537 B159 9370 M 670313 80526 B161 5320 M 650725 80525 8159 9370 M 700316 80215 8158 9310 M 640608 80538 B161 8050 F 660422 80537 B159 9030 M 650917 80550 B154 9370 F 700527 80525 13150 9350 F 700330 80521 8161 4740 F 670623 80521 B152 4072 16 F 731231 80524 B161 9030 F 671116 80524 B158 9090 M 700530 80526 B160 3046 F 350617 80550 B156 4420 M 710516 80521 B154 7412 F 680818 80549 B404 9030 M 680218 80549 B161 7560 F 670505 80526 B158 4360 F 670711 80549 B154 9370 F 360923 80538 B150 4170 M 391109 80535 B503 2370 M 750614 80524 B501 2290 M 700413 80526 B150 5045 M 451220 80526 B164 7450 M 420331 80521 B160 7130 M 431223 80521 B160 8410 F 420912 80525 B160 4400 M 640801 80521 B160 9090 F 431218 80526 B150 6375 M 450627 80525 B160 7745 M 420713 80525 B156 7910 M 430626 80522 B164 1010 M 440305 80538 B150 7560 F 431211 80521 B160 4360 M 401224 80525 B154 7570 M 460815 80526 B160 7280 M 460914 80526 B157 9560 F 431202 80525 B164 4740 M 711014 80535 B401 4740 M 470112 80526 B160 7200 M 470403 80521 B160 7120 M 460922 80535 B157 9370 M 470319 80526 B161 7240 F 751121 80521 B158 4330 M 700320 80525 B157 9090 M 470805 80521 B156 5020 M 490827 80526 B150 7190 M 630617 80535 B150 9370 M 491101 80521 B154 7810 M 460528 80524 B154 7180 M 481227 80525 B157 1835 M 471011 80526 8158 9610 M 480713 80536 B158 7310 M 540609 80526 B159 5320 M 480217 80525 B161 7650 M 470930 80524 B156 9620 M 461008 80525 B157 9370 M 500806 80526 B157 7740 F 561227 80525 B161 4506 M 481202 B0526 B160 7910 M 480327 80526 B157 7370 F 471117 80524 B155 6370 F 740423 80521 B154 4074 M 730724 80525 B158 9090 F 510308 80521 B158 4450 M 491124 80525 B157 7570 F 361007 80525 B156 3396 M 510211 80521 B159 6440 F 490701 80524 B155 9090 M 511031 80526 IB160 7020 F 541010 80537 IB159 6735 17 City of Fort Collins Admini ative Services Purchasing Division REQUEST FOR PROPOSAL CITY OF FORT COLLINS BENEFITS PROPOSAL NO. P-682 PROPOSAL DATE: 3:00 p.m. (our clock) JULY 299 1998 256 W. Mountain Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 e once oncIF H'I64 7520 rvi F - ----- 530630 ----- 80550 B152 4400 M 500726 80525 B157 5330 F 490617 80524 B154 4790 M 520619 80526 B161 8390 M 520306 80549 B165 7120 M 521022 80526 8161 9370 M 511014 80526 B152 7185 M 580607 B0526 B161 9110 M 551004 80615 B159 9370 M 591030 80526 B157 9090 F 531226 80525 B161 9160 M 571102 80525 8157 7940 M 540525 80526 B161 1580 F 521207 80526 B160 4334 F 530609 80521 B154 6153 F 530918 80521 8159 6850 F 531026 80512 B160 6856 M 670613 80521 B150 9090 M 531024 80526 B161 9030 M 550710 80526 B161 9090 F 640123 80521 B156 4740 M 561107 80521 B159 7745 M 540310 80537 B162 7570 F 540325 80521 5158 4170 M 550507 80525 B157 9090 F 571226 80524 B154 9090 M 551223 80525 B159 9370 F 640401 80524 B155 9090 F 561031 80549 B150 4840 M 571228 80521 B158 8060 M 551017 80521 B157 8040 M 570225 80521 B161 7100 M 541023 80525 B153 8280 F 590407 80537 B159 4865 F 621007 80525 B161 4110 M 670422 80521 B158 5190 F 610408 80538 B150 5370 F 580526 80526 B159 9130 M 610818 80549 B161 9310 M 58120B 80524 B161 9090 M 710819 80521 B160 7430 M 590819 80525 B155 7810 M 691020 80524 B161 9110 M 330626 80524 B157 7350 F 540529 80550 B15B 9070 M M M 530422 660214 54051.1 80521 82009 80525 B152 B157 B157 6454 7520 1605 M 410716 80524 B157 9370 M 481011 80524 B157 7060 F 650502 80526 B161 5750 F 610114 80535 B157 6440 M 591006 80521 B161 9510 M 490417 80526 B161 8290 F 630515 80526 B160 5550 F 620331 80538 B161 4102 M 520706 80525 B161 7740 M 540404 80636 B153 9510 F 571120 80537 B162 4070 F 720326 80525 B161 3086 18 M 490624 80526 B158 7120 F 610509 80526 B161 4430 M 540527 80525 B162 4055 M 470928 80526 B156 1565 F 560802 80521 B160 6880 M 580704 80525 B159 9510 F 430802 80521 B160 4360 M 510228 80526 B157 9620 F 661206 80526 B501 2010 F 630512 80524 B157 5145 F 460528 80525 B154 1840 F 521008 80535 B156 5505 F 661211 80521 B158 5550 M 690627 97754 B504 2290 M 560321 80537 B157 5534 M 590519 80524 8158 9110 M 571207 80521 B157 8106 M 530518 80525 B161 9090 M 590119 80517 B161 3088 F 521116 80549 B163 7810 M 511123 80521 B157 8060 M 670910 80526 B161 9090 M 481112 80524 B157 9370 M 580916 80527 B154 9380 M 530823 80526 B157 7450 F 600403 80650 B159 9030 F 551230 80521 B157 3255 M 630509 80526 B201 7810 M 630705 80526 B153 9370 F 470813 80512 B154 4780 F 541110 80526 B155 7010 M 560906 80525 B157 9610 F 560827 80524 B150 4102 M 460705 80525 B156 8440 M 600915 80512 B161 7410 F 420523 80549 B158 4050 F 500122 80537 B158 9030 M 471208 80524 B165 1817 F 640724 80526 B159 6906 F 551012 80547 B155 6440 M 500406 80525 B157 9510 M 680916 80526 B158 5210 F 510315 80526 B158 9030 F 641118 80524 B159 4830 M 520622 80525 B156 1405 M 650505 80525 8161 1832 M 460425 80538 B159 4115 F 701130 80526 B158 3094 F 470131 80512 B203 4110 M 541027 80521 B161 5548 M 720306 80527 B156 9310 F 550115 80524 8158 5527 F 460803 80526 B159 4090 F 640310 80521 B161 4360 M 661205 80521 B160 6890 M 570615 80526 B157 6890 M 531120 80535 8159 9510 M 550718 80526 B157 9090 M 700202 80524 B165 7120 F 490627 80526 IB163 1305 F 541220 80521 B158 5940 19 M 650928 80538 8158 8060 M 430327 80521 B159 1270 M 500313 80526 B161 7570 F 571005 80549 B153 9370 F 630226 80521 B158 7810 F 480905 80525 B154 9090 M 581213 80521 B161 3076 M 580330 80524 B165 3090 F 541211 80521 B154 1775 F 730129 80526 B501 2011 M 471225 80549 B157 6440 M 590623 80526 B157 5532 F 550121 80521 B157 1807 M 471029 80525 B157 1585 M 690217 80521 8158 3038 F 490917 80526 B154 4540 F 510519 80524 B159 1505 M 531130 80524 B157 1835 M 510211 80524 B152 7450 M 491215 80524 B161 9370 M 551014 80524 8150 1255 F 590809 80537 B402 5820 M 580526 80550 B157 7580 M 710101 80521 B160 9090 M 480816 80521 B158 4735 M 670815 80524 B162 3004 M 690924 80535 B160 7120 M 770123 80526 B158 6110 M 740615 92262 B150 9310 M 700731 80526 B161 9090 M 431119 80525 B157 7810 M 540309 80526 B161 1172 M 610927 80650 8158 9110 M 610226 80325 18161 9130 M 420115 80512 B162 9090 F 450626 80525 B162 7325 F 590828 80537 B158 5232 F 400519 80526 B158 7810 M 561226 80550 B157 7580 F 460313 80524 B156 4400 M 450710 B0526 B161 5565 M 520501 80524 B156 7230 M 660125 80304 B154 9370 M 660927 80524 B162 7810 M 570917 80524 B157 9510 M 541115 80524 B154 9370 F 681005 80550 B161 7932 F 590711 80524 B158 9370 M 480304 80526 B157 1180 M 550610 80526 B161 9130 F 450606 80525 B165 4740 M 601223 80528 B161 7810 F 620425 80525 B158 4380 F 480201 80538 B162 4470 M 630317 80524 B157 7520 M 500816 80521 B164 3054 M 660411 80521 6159 7120 F 571231 80526 IB161 4530 20 Washington County Clinic 482 Adams Akron, CO 80720 (970)345-2262 Telephone Enrollment: 17239 Thompson James DO 120 N 2nd Ave Ault, CO 80610 (970)834-2255 Telephone Enrollment: 16614 Armour Ross MD 401 10th Street Berthoud, CO 80513 (970)532-4602 Telephone Enrollment: 17199 Goacher Cynthia Lee MD 549 Mountain Ave Berthoud, CO 80513 (970)532-4644 Telephone Enrollment: 17103 Miller Richard MD 549 Mountain Ave Berthoud, CO 80513 (970)5324644 Telephone Enrollment: 17285 Ringel Marc MD 2400 W Edison Street Brush, CO 80723 (970)842-2833 Telephone Enrollment: 17143 Lehman Charles MD 228 7th Street Eaton, CO 80615 (970)454-2296 Telephone Enrollment: 17134 Howton James DO 131 Stanley Ave Suite 202 Estes Park, CO 80517 (970)586-2343 Telephone Enrollment: 17106 1 k4lYli✓ A i Northern Colorado Physicians 600 S St Vrain Suite 2 Estes Park, CO 80517 (970)586-1904 Telephone Enrollment: 16765 Nichol Thomas MD 555 Prospect Ave Suite B Estes Park, CO 80517 (970)586-5317 Telephone Enrollment: 14050 Van der Werf Guy MD 555 Prospect Ave Suite A Estes Park, CO 80517 (970)586-2200 Telephone Enrollment: 16689 Allen Thomas MD 2160 W Drake Rd Fort Collins, CO 80526 (970)221-5595 j Telephone Enrollment: 16732 ' Bailey Jr Austin MD 1025 Pennock PI Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 15458 ' Bender Edward MD 1212 E Elizabeth Fort Collins, CO 80524 (970)482-2791 Telephone Enrollment: 13439 ' Bermingham Roger MD 1025 Pennock PI Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 15462 Broman Steven MD 1221 E Elizabeth Suite 4 Fort Collins, CO 80524 (970)484-1757 Telephone Enrollment: 13647 Carlson H G MD 1040 E Elizabeth Suite B Fort Collins, CO 80524 (970)482-0213 Telephone Enrollment: 16554 2001 S Shields Bldg J Suite 100 Fort Collins, CO 80526 (970)221-5858 Telephone Enrollment: 16932 Carson Jr Frank MD 1006 Luke St Fort Collins, CO 80524 (970)221-2290 Telephone Enrollment: 14367 Coburn Thomas MD 1 2561 S Shields Bldg 3F Fort Collins, CO 80526 (970)484-4498 I Telephone Enrollment: 17263 Cranor J David MD 1124 E Elizabeth Suite C Fort Collins, CO 80524 (970)484-0798 Telephone Enrollment: 14846 DeYoung Douglas DO 1212 E Elizabeth Fort Collins, CO 80524 (970)482-2791 Telephone Enrollment: 13441 Ferguson David MD 1025 Pennock PI Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 15460 Fields Jacqueline MD 1017 Robertson Fort Collins, CO 80524 (970)472-5000 Telephone Enrollment: 17446 I' Gray April MD 2001 S Shields Bldg L Fort Collins, CO 80526 (970)221-3855 Telephone Enrollment: 17510 Howell Dawn MD 2025 Bighorn Dr Fort Collins, CO 8052 (970)229-9800 Telephone Enrollment: 1 Jmtch Daniel MD 2561 S Shields Bldg 3F Fort Collins, CO 80526 (970)484-4498 Telephone Enrollment: 16890 Kasenberg Thomas DO 2160 W Drake Rd Fort Collins, CO 80526 (970)221-5595 Telephone Enrollment: 16731 Kauffman Jeffrey MD 1124 E Elizabeth Suite C Fort Collins, CO 80524 (970)484-0798 Telephone Enrollment: 14947 Kent Cherie MD 1025 Pennock P1 Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 17276 ' Lopez Joseph MD 1136 E Stuart Suite 4202 Fort Collins, CO 80525 (970)221-5925 1 Telephone Enrollment: 14397 Mercer Jeannette MD 1212 E Elizabeth Fort Collins, CO 80524 (970)482-2791 Telephone Enrollment: 13442 Merkel Lawrence MD 1006 Luke St Fort Collins, CO 80524 (970)221-2290 Telephone Enrollment: 14368 Murphy Lawrence MD 1113 Oakridge Dr Fort Collins, CO 80525 (970)225-0040 Telephone Enrollment: 13651 Nevrivy Thomas MD 2001 S Shields Bldg I Fort Collins, CO 80526 (970)221-5255 .R12"one Enrollment: 13650 *Closed to new members rNember Services: 1-800-877-9777 Published February,1998 6 1 • Ottolenghi David MD 2001 S Shields Bldg L Fort Collins. CO 80526 (970)221-3855 Telephone Enrollment: 17512 Paddack Michael MD 1025 Pennock PI Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 15459 Paulsen Mark MD 1221 E Elizabeth Suite 4 Fort Collins, CO 80524 (970)484-1757 Telephone Enrollment: 13652 Piccaro John MD 1025 Pennock PI Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 17052 Podhajsky Timothy MD 2025 Bighom Dr Fort Collins, CO 80525 (970)229-9800 Telephone Enrollment 16546 Rossback Christine MD 1212 E Elizabeth Fort Collins, CO 80524 (970)482-2791 Telephone Enrollment: 17290 ' Rotman Mark MD 2001 S Shields Bldg I Fort Collins, CO 80526 (970)221-5255 Telephone Enrollment: 13653 Rubright Jon MD 2001 S Shields Bldg I Fort Collins, CO 80526 (970)221-5255 Telephone Enrollment: 16778 Samuelson Scott MD 1124 E Elizabeth Suite C Fort Collins, CO 80524 (970)484-0798 Telephone Enrollment: 17016 ' Seeton James MD 2001 S Shields Bldg L Fort Collins, CO 80526 (970)221-3855 Telephone Enrollment: 17511 Sheppard -Madden Dena MD 2160 W Drake Rd Fort Collins, CO 80526 (970)221-5595 Telephone Enrollment: 17048 Smith David MD 1025 Pennock PI Fort Collins, CO 80524 (970)495-8800 Telephone Enrollment: 17275 ' Smith Jerome MD 2025 Bighom Dr Fort Collins, CO 80525 (970)229-9800 Telephone Enrollment: 13646 Sprowell James MD 1221 E Elizabeth Suite 4 i Fort Collins, CO 80524 (970)484-1757 Telephone Enrollment: 13655 Stephens Floyd MD 1113 Oakridge Dr Fort Collins, CO 80525 (970)225-0040 ! Telephone Enrollment. 13648 j Stoddard Andrew MD 1124 E Elizabeth Suite C I Fort Collins, CO 80524 (970)484-0798 Telephone Enrollment: 14845 Sullivan Donna MD 1025 Pennock P1 Fort Collins. CO 80524 (970)495-8800 Telephone Enrollment: 15461 ' Thorson Steven MD 1212 E Elizabeth Fort Collins, CO 80524 (970)482-2791 Telephone Enrollment: 13438 Tippin Steven MD 2025 Bighom Dr Fort Collins, CO 80525 (970)229-9800 Telephone Enrollment: 16475 Towbin Michael MD 1113 Oakridge Dr Fort Collins, CO 80525 j (970)225-0040 Telephone Enrollment: 13656 Unger Mark MD 114 Bristlecone Drive Fort Collins, CO 80524 (970)495-8900 Telephone Enrollment: 17163 Valley George MD 1212 E Elizabeth Fort Collins, CO 80524 (970)482-2791 Telephone Enrollment: 17127 Vanfarowe Cynthia MD 1 1014 Centre Ave Fort Collins, CO 80526 (970)482-2201 Telephone Enrollment: 17498 I Weiskittel Deborah MD 1113 Oakridge Dr Fort Collins, CO 80525 (970)225-0040 Telephone Enrollment: 13654 Sunthankar Shivalini MD 1014 Centre Ave Fort Collins, CO 80526 (970)482-8881 Telephone Enrollment: 16352 Thieman William MD 1217 E Elizabeth Fort Collins, CO 80524 (970)484-7245 Telephone Enrollment: 13976 "Thieszen Milford MD 811 E Elizabeth Fort Collins, CO 80524 (970)224-1596 Telephone Enrollment: 15041 Green Deborah MD 315 Park Ave Fort Lupton, CO 80621 (303)857-6111 Telephone Enrollment: 14194 McDermott Martin MD 327 Park Ave Fort Lupton, CO 90621 (303)659-3151 Telephone Enrollment: 14434 Spray Selwyn MD 305 B Denver Ave Fort Lupton, CO 80621 (303)857-1007 Telephone Enrollment 11491 Fort Morgan Medical Group 102 W 9th Ave Fort Morgan, CO 80701 (970)867-5817 Telephone Enrollment: 17522 Lindell Kevin MD 220 Beaver Creek Place Fort Morgan, CO 80701 (970)867-8221 Telephone Enrollment: 17199 Salud Family Health Center 909 E Railroad Ave Fort Morgan, CO 80701 (970)867-0300 Telephone Enrollment: 17363 t r� Fretwell James MD 332 5th St Frederick, CO 80530 ' Yemm Stephen MD (303)833-2475 1212 E Elizabeth i Telephone Enrollment: 17521 Fort Collins. CO 80524 Mathwich Brian MD (970)482-2791 332 5th St Telephone Enrollment: 13440 Frederick, CO 80530 �� -} ort u on,- • (303)833-2475 Telephone Enrallmetu: 17080 Brignoni Hector MD reel " e r Y, 305 N Denver Ave -t Fort Lupton, CO 80621 • Budensiek Richard DO (303)857-4096 3211 20th St Suite A Telephone Enrollment: 17449 Greeley, CO 80631 (970)353-9011 Telephone Enrollment: 15207 w members Ylember Services: 1-800-877-9777 Closed to ne 7 Published February, 1998 L ' Chesley Charles MD 2520 16th St Greeley, CO 80631 (970)356-2520 Telephone Enrollment: 13033 ' Colgan Ann MD 2520 16th St Greeley, CO 80631 (970)356-2520 Telephone Enrollment: 13031 Corliss Scott MD 3705 W 12th Street Greeley, CO 80631 (970)351-7134 Telephone Enrollment: 16787 ' Corona Joseph MD 2010 16th St Suite C Greeley, CO 80631 (970)353-7666 Telephone Enrollment: 12412 Dallow Kurt MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 16766 Fahrenholtz H Daniel MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 15623 Flower Thomas DO 2122 9th St Greeley, CO 80631 (970)356-7555 Telephone Enrollment: 12398 Garber Stacy MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 16495 Guthrie Pamela MD 2010 16th St Suite D Greeley, CO 80631 (970)353-7668 Telephone Enrollment: 17457 Haskins Robert Scott MD 2520 16th St Greeley, CO 80631 (970)356-2520 Telephone Enrollment: 13035 "Closed to new members Hicks James MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 17161 Jensen -Fox Christine MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 16936 Kennedy Christopher MD 2010 16th St Suite D Greeley, CO 80631 (970)353-7668 Telephone Enrollment: 17458 Lee Miles DO 2627 loth St Suite 3 Greeley, CO 80631 (970)352-3274 Telephone Enrollment: 12535 Martinez Matthew MD 2520 16th St Greeley, CO 80631 (970)356-2520 Telephone Enrollment: 17262 ' McCall Janis MD 2520 16th St Greeley, CO 80631 (970)356-2520 Telephone Enrollment: 13029 Olds Kenneth MD 2520 16th St Greeley, CO 80631 (970)356-2520 Telephone Enrollment: 13030 Oligmueller William MD 3705 W 12th Street Greeley, CO 80631 (970)351-7134 Telephone Enrollment: 14296 Paczosa Michelle DO 1028 5th Ave Greeley, CO 80631 (970)353-9403 Telephone Enrollment: 17128 I Powell Patricia MD 1028 5th Ave 1 Greeley, CO 80631 I (970)356-6014 Telephone Enrollment: 17265 I Schmalhorst Brian MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 14262 Shea Ellen MD 2010 16th St Suite C Greeley, CO 80631 (970)353-7666 Telephone Enrollment: 16771 Simons Louise MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 17280 ' Tucker Kelly MD 2420 16th St Greeley, CO 80631 (970)356-1775 Telephone Enrollment: 13032 Wallace Mark MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 Telephone Enrollment: 15622 Wigpall William MD 1600 23rd Ave Greeley, CO 80631 (970)356-2424 ' Telephone Enrollment: 15620 Wilson D Craig MD 2420 16th St I Greeley, CO 80631 (970)356-1775 Telephone Enrollment: 13034 "Young Mark MD 2010 16th St Suite D Greeley, CO 80631 (970)353-7668 jTelephone Enrollment: 17455 Lev James MD 233 W Strohm Haxtun, CO 80731 j (970)774-6187 Telephone Enrollment: 17122 o�nsto Volk John W MD 16 N Parish PO Box 520 Johnstown, CO 80534 1 (970)587-4974 Telephone Enrollment: 16585 Regier Donald MD 1 116 E 9th Street Julesburg, CO 80737 (970)474-3376 Telephone Enrollment: 17237 Brignoni Hector MD 190 S Main Keenesburg, CO 80643 (303)732-4268 Telephone Enrollment: 17444 Allen Thomas MD 295 E 29th St Loveland, CO 80538 (970)669-6000 Telephone Enrollment: 16905 Anderson R Scott MD 2701 Madison Sq Drive Loveland, CO 80538 (970)663-0722 Telephone Enrollment: 16631 I' Brower Annette MD 2701 Madison Sq Drive Loveland, CO 80538 (970)663-0722 Telephone Enrollment: 15617 1 Zucker Charles MD i 2420 16th St Greeley, CO 80631 (970)356-1775 Telephone Enrollment: 16703 I Member Services: 1-800-877-9777 8 Cabrera Anthony MD 914W6thSt Loveland, CO 80537 (970)667-3976 Telephone Enrollment: 17278 Clemens Orrie MD 2701 Madison Sq Drive Loveland, CO 80538 (970)663-0722 Telephone Enrollment: 15615 Published February, 1998 3 Danforth III James MD 2701 Madison Sq Drive Loveland, CO 80538 (970)663-0722 Telephone Enrollment: 15614 de la Torre Rebecca MD 914 W 6th St Loveland, CO 80537 (970)667-3976 Telephone Enrollment: 15613 Frickman Carl MD 3320 W Eisenhower Loveland, CO 80537 (970)669-2849 Telephone Enrollment: 14594 Grosboli Robert MD 232 W 4th St Loveland, CO 80537 (970)667-3565 Telephone Enrollment: 13313 Hailey Mark MD 914 W 6th St Loveland, CO 80537 (970)667-3976 Telephone Enrollment: 15612 ' Hughes Andrew MD 2701 Madison Sq Drive Loveland, CO 80538 (970)663-0722 Telephone Enrollment: 15616 Kasenberg Thomas DO 295 E 29th St Loveland, CO 80538 (970)669-6000 Telephone Enrollment: 16730 Krantz Laurence MD 3320 W Eisenhower Loveland, CO 80537 (970)669-2849 Telephone Enrollment: 14593 Nye Brett MD 3320 W Eisenhower Loveland, CO 80537 (970)669-2849 Telephone Enrollment: 14595 Reents William MD 914 W 6th St Loveland, CO 80537 (970)667-3976 Telephone Enrollment: 15610 Rule Ingrid MD 1323 Harlow Lane Suite 2 Loveland, CO 80537 (970)667-3030 Telephone Enrollment: 14625 Salazar -Tier Maryruth MD 1805 E 18th St Suite 6 Loveland, CO 80538 (970)669-9700 Telephone Enrollment: 16794 Schafer Donald MD 914 W 6th St Loveland, CO 80537 (970)667-3976 Telephone Enrollment: 15611 Schaffer Scott MD 2701 Madison Sq Drive Loveland, CO 80538 (970)663-0722 Telephone Enrollment: 16739 Sheets Ronald MD 1808 N Boise Ave Loveland, CO 80538 (970)669-6660 Telephone Enrollment: 15608 Sheppard -Madden Dena MD 1 295 E 29th St Loveland, CO 80538 (970)669-6000 1 Telephone Enrollment: 17049 Clark Curtis MD 1405 S 8th Ave Suite 103 Sterling, CO 80751 (970)522-3304 Telephone Enrollment: 17131 F+Ilion Robert DO 615 Fairhurst Sterling, CO 80751 (970)521-3223 Telephone Enrollment. 17248 Kahler Durand DO 1405 S 8th Ave Suite 102 Sterling, CO 80751 (970)522-7100 Telephone Enrollment: 17454 Mackey Jack MD 1410 S 3rd Ave Sterling, CO 80751 (970)522-2630 Telephone Enrollment: 17133 Nix Shirley MD 615 Fairhurst Sterling, CO 80751 (970)521-3223 Telephone Enrollment: 17166 Smith Lori MD 615 Fairhurst Sterling, CO 80751 (970)521-3223 Telephone Enrollment: 17158 Vanschooneveld Craig MD 108 Delmar Sterling, CO 80751 (970)522-6120 Telephone Enrollment: 17124 Bradley Robert MD 1230 W Ash St Windsor, CO 80550 (970)686-5646 Telephone Enrollment: 14678 Carey Michael MD 1230 W Ash St Windsor, CO 80550 1 (970)686-5646 Telephone Enrollment: 14677 1' Lawton Susan MD 1190 W Ash St Suite B Windsor, CO 80550 (970)686-5655 I Telephone Enrollment. 15157 Lembitz Deanne MD 1190 W Ash St Suite B Windsor, CO 80550 (970)686-5655 Telephone Enrollment: 17009 Mason R Anthony MD 1190 W Ash St Suite B Windsor, CO 80550 (970)686-5655 Telephone Enrollment: 16966 Range[ Keith MD 1230 W Ash St Windsor, CO 80550 (970)686-5646 Telephone Enrollment: 16747 Buchanan Robert MAD j 517 Adams Street Wray, CO 80758 (970)332-4897 Telephone Enrollment: 17136 Eddens Christopher MD 517 Adams Street Wray, CO 80758 (970)332-4895 Telephone Enrollment: 17146 Uyemura Monte MD 1 517 Adams Street Wray, CO 80758 (970)332-4895 Telephone Enrollment: 17139 Yuma Clinic 910 S Main Yuma, CO 80759 (970)848-3896 Telephone Enrollment: 17524 Scanlon Charlotte MD 555 Prospect Ave Suite D Estes Park, CO 80517 (970)586-2200 Telephone Enrollment: 16999 Vr*W=}b'�'1 Abbev David MD t 100 Poudre River Dr I Fort Collins, CO 80524 (970)224-9508 Telephone Enrollment: 15003 Alessi Grace MD 1025 Pennock PI Suite 107 Fort Collins, CO 80524 (970)482-3712 Telephone Enrollment: 17059 ' Allen David MD 1260 Doctors Lane Fort Collins, CO 80524 (970)484-3496 Telephone Enrollment: 13776 'Closed to new members Member Services: 1-800-877-9777 Published February, IYYB 9 4 Bush James MD n a rt:Morgan 1 Ebens John MD 1021 Luke St s -w, Musani Ali MD 1900 16th St Fort Collins, CO 80524 419 E 9th Greeley, CO 80631 (970)484-6406 Fort Morgan, CO 80701 (970)353-1551 Telephone Enrollment: 14121 - (970)867-4823 Telephone Enrollment: 14255 Homburg Robert MD 1100 Poudre River Dr Fort Collins, CO 80524 (970)224-9508 Telephone Enrollment: 15005 Johnson Richard MD 1260 Doctors Lane Fort Collins, CO 80524 (970)484-9027 Telephone Enrollment: 13382 'Lopez Jr William MD 1136 E Stuart Suite 2140 Fort Collins, CO 80525 (970)221-3782 Telephone Enrollment: 14084 Lynch Michael DO 1100 Poudre River Dr Fort Collins, CO 80524 (970)224-9508 Telephone Enrollment: 15004 Meyer Fred MD 1217 E Elizabeth Suite 9 Fort Collins, CO 80524 (970)482-1685 Telephone Enrollment: 16493 ' OW Cathy MD 1025 Pennock PI Suite 107 Fort Collins, CO 80524 (970)482-3712 Telephone Enrollment: 16350 Sands Arthur MD 1021 Robertson Fort Collins, CO 80524 (970)482-0666 Telephone Enrollment: 17468 Stuart Jr Robert MD 1050 E Elizabeth Street Fort Collins, CO 80524 (970)221-4433 Telephone Enrollment: 17442 Wingate Dana DO 1040 E Elizabeth Suite 101 Fort Collins, CO 80524 (970)484-9796 Telephone Enrollment: 16627 *Closed to new members Telephone Enrollment: 17459 Rice Robert N MD 419 E 9th Fort Morgan, CO 80701 (970)867-4823 Telephone Enrollment: 17197 �;4 Greeley` ` ` j Baker Christopher MD 900 14th St Greeley, CO 80631 (970)353-4322 Telephone Enrollment: 16604 Berntsen Mark MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 17196 Branum Russell MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 14252 Bruce Julia MD 900 14th Street Greeley, CO 80631 (970)3534322 Telephone Enrollment: 17236 Cary Ethan MD 1900 16th St Greeley, CO 80631 (970)350-2437 Telephone Enrollment: 14265 Cash Robert MD 1900 16th St Greeley, CO 80631 i (970)350-2438 Telephone Enrollment: 14253 Christensen Dana MD 900 14th St Greeley, CO 80634 (970)353-4322 Telephone Enrollment: 17259 Fellers Neal MD 1900 16th St Greeley, CO 80631 (970)350-2438 Telephone Enrollment: 14257 Pace R Scott MD 2000 16th Street Suite 5 Greeley, CO 80631 (970)353-0155 Telephone Enrollment: 17141 Quintana Elaine MD 900 14th Street Greeley, CO 80631 (970)353-4322 Telephone Enrollment: 17130 ` Rademacher Donald MD 1900 16th St Greeley, CO 80631 (970)350-2438 Telephone Enrollment: 14261 Thompson Keith MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 14263 I Tryggestad David MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 14264 Yockey Raymond MD 900 14th St Greeley, CO 80631 (970)353-4322 Telephone Enrollment: 17261 i Zenk Daniel MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 14284 r �an Member Services: 1-800-877-9777 10 Hagan John MD 1808 N Boise Ave Loveland, CO 80538 (970)669-6660 Telephone Enrollment: 16971 Parliment Joel MD 1808 N Boise Ave Loveland, CO 80538 (970)669-6660 Telephone Enrollment: 17523 Tello Robert MD 232 W 4th St Loveland, CO 80537 (970)667-3565 Telephone Enrollment: 13314 Webster Douglas MD 1808 N Boise Ave Loveland, CO 80538 (970)669-6660 Telephone Enrollment: 17224 Lamb Richard MD 620 Iris Drive Sterling, CO 80751 (970)522-7266 jTelephone Enrollment: 17064 Soper Thomas DO 615 Fairhurst Sterling, CO 80751 (970)521-3223 Telephone Enrollment: 17387 Cooper John D MD 555 Prospect Ave Suite C Estes Park, CO 80517 (970)586-2200 Telephone Enrollment: 13390 lmm!:or Q Beard Donald MD 1200 E Elizabeth Fort Collins, CO 80524 (970)482-2515 Telephone Enrollment: 16476 Booth Richard MD 2001 S Shields Bldg G Fort Collins, CO 80526 (970)484-4871 Telephone Enrollment: 14093 Published February,1998 5 Dierauf Susan MD Kaplan Kenneth MD 1200 E Elizabeth 1620 25th Ave Fort Collins, CO 80524 Greeley,CO 80631 (970)482-2515 (97 ) Telephone Enrollment: 16671 Telephone Enrollment: 14729 Elliott Max MD 1200 E Elizabeth Fort Collins, CO 80524 (97o)482-251.5 Telephone Enrollment: 13267 Guenther John MD 1200 E Elizabeth Fort Collins, CO 80524 (970)482-2515 Telephone Enrollment: 13264 Hanson Vaughn MD 1200 E Elizabeth Fort Collins, CO 80524 (970)482-2515 Telephone Enrollment: 13269 McGinnis James MD 1200 E Elizabeth Fort Collins, CO 80524 (970)482-2515 Telephone Enrollment: 13265 Paisley Jan MD 1200 E Elizabeth Fort Collins, CO 80524 (970)482-2515 Telephone Enrollment: 13266 Sullivan William MD 1200 E Elizabeth Fort Collins, CO 80524 (970)482-2515 Telephone Enrollment. 13268 l� Dabynsky Orest MD 1620 25th Ave Greeley, CO 80631 (970)356-2600 Telephone Enrollment: 15670 Fink Anthony MD 1900 16th St Greeley, CO 80631 (970)350-2445 Telephone Enrollment: 14256 Kolanz Meshelle MD 1900 16th St Greeley, CO 80631 (970)353-1551 Telephone Enrollment: 17195 Ryan Joseph MD 1900 16th St Greeley, CO 80631 (970)350-2448 Telephone Enrollment: 14282 I Middlebrook M Tammy MD 2802 Madison Sq Dr Suite 3 Loveland, CO 80538 (970)663-5437 Telephone Enrollment: 17225 Quintana Michael MD 1931 N Boise Ave Loveland, CO 80538 (970)669-3298 Telephone Enrollment: 13551 Tomlinson Alan MD 2802 Madison Sq Dr Suite 3 Loveland, CO 80538 (970)663-5437 Telephone Enrollment. 17227 !' Wiesner Mark DO 2802 Madison Sq Dr Suite 3 Loveland, CO 80538 (970)663-5437 Telephone Enrollment: 17226 *Closed to new members .Vfember Services: 1-800-877-9777 11 Publisher! February, 1998 Fall 1997 EVERGREEN - FORT COLLINS MURTHY, KRISHNA C MD 970•' 170 z r 1124 E ELIZABETH ST FORT COLONS, 24 y 1 . IOHN F MO Nemork: FOP, MMA, NC. SUAC 303670.0426 ASHMORE, ROGER MO 970-221.100E ' AISTON, 303425468E 27904 MEADOW OR SEELEY, IANET K MO 970498.9226 1100 E EUZABETH ST FORT COLLINS, CO 50524 Nerlwk. FOP. NC MCLFAN, ANNE B MD SURE 110 EVERGREEN, CO 80439 2001 S SHIELDS 30940 STAGE COACH BL CO 80439 Newark: PRO SUITE 83 FORT COLONS, CO 80524 SUITE 270 EVERGREEN, NMrork: fC1P. NC. NGNP. SLMC f., Ndwk: SLMC WIGGINS, ROGER G MO 303674.1652 ' I 3580 EVERGREEN PKWY VEDANTHAN, PUDUPAKKAM K MD SURE 205 EVERGREEN, CO 80439 970-221.2370 Newak: PRO 1124 E ELIZABETH ST FORT COLLINS, CO 80524 BLOSSER, LEON E CRNA 970484-072Y NewaFCIP, M44A NO SLMC k: 1241 RIVERSIDE AVE ' FORMELL DONNA M CMT, 307674487E SUITE 200 FORT COLLINS, CO 80524 ME LOW OR 6 Neft rk: FCIP S27904 URE 205 EVERGREEN, CO W439 •GROG Newak; SLMC LUND, KATHRYN PHD 303-760.2270 BURKHART, DONALD W CRNA 970.48"722 PO BOX 4165 EVERGREEN. CO 80439 ALESSI, RICHARD D MO 97046"722 1241 RIVERSIDE AVE Ner a*; PRO Newak: FCIP SUITE 200 FORT COLONS, CO 80524 Ner a*. FCIP )FNSEN OLE T DDS Newak: FOP 3036743452 .8080, RUSSFIL W MD @Fl ' 1 970-4840721 GERAETS, RONALD H CRNA 970.4849722 2800E MEADOW OR EVERGREEN. CO 80439 7247 RIVERSIDE AVE Newark: MMA. SLMC CORSOVER, HARRY 0 PHD 303674.8448 BOYLAN, THOMAS 00 97048W722 SUITE 200 FORT COLLINS. CO 80524 25427 CLOVER IN EVERGREEN, CO 50439 NM.crk- FQP Nenwrk: FOP ' fril Eon Newak: PRO CARLINE MARYLIDA MD 97048W722 USKEN, GARY D CRNA 970484-0722 HAURWITZ. FRANK PSYD 3036o 49-8733 Net *. FCIP 1241 RIVERSIDE AVE FRENCH, CINDY B OTR 30347E-3268 3721 EVERGREEN PKWY SUITE 200 FORTCOIONS. CO 80524 PKWY MD SUITE 8 EVERGREEN. CO 80203 CAR 97044-0 8722 Newwk: FCIP SUITE �RGREEN EVERGREEN, CO W439 Nom *.-PRO N,THOMAS NOm *. SLMC WHRESEU. RANDY PSYD 303470.3023 DEANGEA MICHAEL A MO 97048W722 29029 UPPER BEAR CREEK N~k: FCIP EVERGREEN. CO 80139 CRAW FORD, DREG L DC SUITE 303 Newark' PRO DUNK, K MD COLLINS,CO 80535 97048W723 1337 E RD FORT WS, CO 80535 PECHEM DOUGLAS R MD 3M-674.7477 -ACID Newartr fCiP k: SLMC NkMwk: SLMC 2800E MEADOW DR 28SUITE 1 EVERGREEN, CO 80439 NJ GILLESPIE E I MD 9704954300 ESKIN, AVRAM A DC 970.129-0083 N4mwk: MMA SLMC N4m - FOP 123 E CRAKE RD FORT COLLINS. GO W525 ROBERTS. ALFRED D MO FAUX, CASS MS 303697-MO 303-674.4163 3540 EVERGREEN PKWY EVERGREEN. CO 80439 GIRARDI, GEORGE E MD Nero*. SLMC 970495-0300 3062 EVERGREEN PKWY EVERGREEN. CO a0439 NeeT.ark: SLMC NerAwk: FOP HAAS, LAMES M DC 97"3-0360 1337 E PROSPECT RD FORT COLLINS. CO 50525 SUITE A Newak: SLMC HODGB, KATHLEEN A MO 970-495-0300 Nenwrk: SLMC R Nemaek: FOP HULTGREN, GIENNM OC 970-227.1941 �cm' POLEVOY. IRA S MO 303426.0187 HORNS STEPHEN G MO 970484.0722 3200 S LEMAY AVE FORT COLLINS. CO 80525 3036743370 903 WAGON TRAIL EVERGREEN. CO W439 Newak-FOP N%r v.*:SLMC KEMP, IOHN E MD UPPER BEAR CR EVERGREEN. CO 80433 N' w : SLMC MAIITINEZ MA0.Y A MD 970495-0300 KOE14 MRON A DC 97U23]•3225 NWw *. MMA, SLMC wIWAM5,15 MD 3OY67W694 Nemerrk: FOP 27215 COLLEGE AVE - SURE 8 FORT COLLINS, CO 80525 29WO MEADOW OR EVERGREEN, CO 90439 NEiF, WILLIAM MO 97046"722 Newak: SLMC SUITE 106 Newak: MMA. SLMC Newak: FQP TIAHRT, MELANIE I DC 9704934)617 CARTER, DONALD R MO 303670-00" I,! NORRIF. THOMAS MO 970484.0722 920 5 TAFT HILL-RD FORT COLLINS. CO 80522 2800E MEADOW OR �P sSLJ '�p� Nenwk: FOP Nr^v*.-SLMC SUITE 106 Newak: MM4. SIMC EVERGREEN, CO 60439 AHL. KA1HtID4 1 SA 303.89E-7994 RECHNTTZ, GARY MO 970484-0722 WENBORG. CRAIG G DC 970.226.5797 28525 EVERGREEN MANO EVERGREEN, CO 80439 N4rwwk: FOP 373 W DRAKE RD FORT COLLINS. CO 80526 REID, CAROL M MO 303.670.3270 N4h. *; SLMC $ALIAIBETJI, IUUO MD Nemwh. SLMC 770484-07'22 1260 BERGEN PKY SUITE 040 EVERGREEN, CO 50439 Nemork: FOP N0E *: CUR SLMC - p D MD 97048iaaE1 .- NNNINTVGHAM PETER MS AVEl 1355RIVERSIOE AV 55 RIVERSIDE 970481.570E SURER FORT COLLINS. CO 80524 BIGELOW, LISA I PT 303-674.1394 WASHINGTON, KELVIN M DC 719-0364151 1032 LUKE ST FORT COLLINS, CO W524 Nenw k; NC 29029 UPPER BEAR CR 524 CASTELLO EVERGREEN, CO W439 Nelwwk: SLMC FAMPIAY, CO 80440 N4mwk: FOP HULTSCH, ANNE-USA MO 970.211.5795 SUITE 200 Newark. SEMC LENTZ WILLWNE PHD 970-221.5249 1136E STUART GARBUS. EDWARD PT ��,+��% 303674.1594 - • IE 2001 S SHIELDS SURE 3240 FORT COLLINS, CO SM25 BLDG I FORT COLONS. CO 80526 N~&. FOP 29029 UPPER BEAR CR EVERGREEN, CO 80439 KUPETS IIL IOSEPH E DO Network: FCTP 7194364151 KORNFELD, BRUCE W MO 970482-9001 SUITE 200 Newak: SLMC 624 CASTELLO ST FAIRPLAC CO 80440 1355 RIVERSIDE AVE Nelwdk: SLMC SUITE A FORT COLLINS, CO $0524 GILMORE ELIZABETH 8 FT 303674.1594 DOWNFS. THOMAS R MO Newak: FCIP, NC 970.1214141 29029 UPPER BEAR CR EVERGREEN. CO W439 FEDERAL HEIGHTS 1100E ELIZABETH ST FORT COLLINS. CO 80524 SAYERS, PAUL MO 970-49"303 SUITE 200 Newark: SLMC ,w,� 1 Newak: FOP 1120 E ELIZABETH ST . T. BLDG G SUM I FORT COLLINS. CO 80524 GLUTH, VALERIE I PT 30767M77189 3SieP DOWNES. THOMAS R MO 970484-0722 Newark: FOP , 1260 ERGEN PRY SUITE C210 CASH, UNDA M FT 303.42648" 1241 RIVERSIDE AVE EVERGREEN, CO 80439 Rp W 54TH AVE FEDERAL HEIGHTS, CO 80221 SUITE 20D FORT COLLINS, CO 80524 VVW, B LYNN MD 970-221.5795 Nd%c,k; SLMC Nerw *. SLMC Newwk: FOP 1136 E STUART BLDG 3 SUITE 240 FORT COLONS, CO 80525 - HALEY, VIRGINIA C PT 303674.7594 WENDT, DEBORAH N FT 303.426-W" �ARSON, DENNIS G MO 970.221.1000 Newak: FCIP 29029 UPPER BEAR C0. 720 W 84TH AVE FEDERAL HEIGHTS. CO 80227 I100 E ELIZABETH ST FORT COLLINS. CO 80524 SUITE 200 EVERGREEN. CO 80479 Newwk. SLMC NeA.wk: FOP, NC F Nev"*: SLMC LUCIASEN, GARY) MD 970-2274241 KAISER, KIMBERLY FT 3036704802 FLORENCE 1100 E ELIZABETH ST )OHNSTON, PHILIP 5 MO 9704956000 2942 EVERGEEN PKWY SUITE FORT COLLINS. CO 50524 1024 LEMAY AVE FORT COLLINS. CO BOS24 SUITE 300 EVERGREEN, CO 80439 Ne .*.- FOP NeMdk: SLMC Newark: SLMC LUCKASEN. GARY 1 MD 97048W722 UPOEGRAFF, JEFFREY G MD 970495.800E KUPFDL VICTOR PT 303674.1594 BUGLEWICL IOHN V MO 719-7844816 1241 RIVERSIDE AVE FLORENCE, CO 81226 1024 LEMAY AVE FORT COLLINS, CO 80524 29029 UPPER BEAR CK 501 W STH ST Newwk: PCP SUITE 200 FORT COLLINS. CO 80524 Na4.avk: SLMC SUITE 200 EVERGREEN. CO 80439 Newak: FOP Ne1o`k' SLMC MCCARRY, IOSEPH T MD 719-7844816 MILLER WILLIAM E MO 970-1114241 MCCORD, PATRICIA FT 303674.1594 SOt W 5TH ST FLORENCE. CO 81226 1100 E ELIZABETH 57 RiZ 29029 UPPER BEM CR Neft rk: PCP SURE 1 FORT COLLINS. CO 80524 ALIEN, THOMAS 1 MD 970-221.SS95 SURE 200 EVERGREEN. CO 80439 Ne6wrk: FOP 2160 W CRAKE RD FORT COLLINS. CO 8W26 Newak: SLMC E , E ® MILLER. WIWAME MD Newak: NO4P 97048W722 VOGE3036741594 UNEBEA PT ' yynn}4�F** SUIT RIVERSIDE AVE BMLEY, MD 6620 '9029 UPPER BEAR CR -� .. ALLERGY/fLNMU SURE 200 FORT NOCKUSTIN COLLINS. CO 80534 1035 PENNOCK PL FORT NS. CO 80524 COLLINS.CO ,9029 SURE 200 EVERGREEN, CO 80439 t19�""� Newak: fcIP Ner wk: FOP Newak: SLMC CONLON, ROBERT M MO 9704846373 T032 LUKE ST FORT COLLINS, CO 80524 WHRSffT, TODD8 MO 970.221-10W BENDER. EDWARD MD 97040.2791 r Newwk: FCIP HOD E ELIZABETH Sr FORT COLLINS. CO 80524 1212 E ELIZABETH ST FORT COLLINS. CO W524 iI RG M Newak: FOP, NC N4ewark: FOP CULVER. WILLIAM G MO 970498.9226 PAYEA. NORMAN P MD 303-232-0310 200T S SHIELDS FORT COLLINS, CO 80526 WHTTISn7. TODD MD 970-221.1000 BERMINGHAM, ROGER MO 9704954M 29029 UPPER BEAR CK EVERGREEN. CO 80439 Ner m *: FQP. NC- NCMP SLMC 1148 E ELIZABETH ST FORT COWNS, CO 80524 1025 PENNOCK PL FORT COLONS. CO 80524 NelNwk: MMA. SLMC FCIP Ne Work: FOP DANINetwork: IASZLO, I MD NS. CO 8GS26 5 FORT COLLINS. CO 80526 2001 5 IfLOS NNwwx: FCIP. NC. NCMP : FOR 5 Z SLOANS LAKE MANAGED CARE SECTION I GENERAL INFORMATION AND PROPOSAL FORM -• 1997 1w ^ fall FORT COLLINS -FORT COLLINS '� G NEVRIVY, THOMAS E MD 970484-1757 T59VG, JENNIFER MD 970-225.1600 HOMBURG, ROBERT MO 1221 EELIZABETH SUITE4 FORT COLLINS, CO 80524 1330 OAKRIDGE OR Netwod: FCIP FORT COLLINS. CC 60525 970424A508 1100 POUDRE RIVER OR FORTCOWNS.CO80524 MKWOrk: SLMC Network: FOP BROMAN, STEVEN D MD 970484.1757 VALLEY. GEORGE MD 970-221.2290 HOMBURG. ROBERT C MD 1221 E ELIZABETH ST NEVRIW, THOMAS E MO 970-221.5233 1006 LUKE 5T704840722 FORT COLLINS,COLLWSC080524 7241 RIVERSIOEAVE SUITE FORT COLLINS, CO 80524 7001 SSHIELDS Network: FCIP SUITE 200 NetworkSLM BLOC I FORT COLLINS, CO 80526 FORT COLLINS, CO 80524C Network: FOP Nework SLMC VANFAROWE CYNTHIA K MD 970-221.59SR BURNHAM. UNDA MD 970482-3500 1014CENTREAVE FORT COLLINS, CO 80525 JOHNSON, RICHARD MO 1217 E ELIZABETH ST OTTEMAN, MERLIN MD 970.482.6456 Network: NC FCIP 970484.34% 1260 DOCTORS LN FORT BLDG 3 FORT COLLINS, CO 80524 1015 ROBERTSON FORT COLLINS. CO 80524 COLLINS, CO 80534 Network. FOP Newod-. NC Network FOR NC WEISKITTLE, DEBORAH A MO 970.2254" CARLSON, H G MD 970482.0213 OTTOLENGHI, DAVID R MD 970484-0722 1113 OAK RIDGE OR Network: 5LMC FORT COLLINS. CO W525 LOPEL WILLIAM MO 970.321.3782 7040 E ELIZABETH 5T 1241 RIVERSIDE 7136 E STUARTBLDG 2 SURE 140 SURE 8 FORT COLLINS. CO W524 SUITE 200 FORT COLLINS. CO 80524 WELLS. DONALD 8 MD 970484.1737 FORT COLLINS, CO WS25 network: FOP Network: FOP Network: FOP, NC 1221 E ELIZABETH ST URROLL GORY D MO 970-221-SBSB OTTOLENGHI, DAVID R MD 970.221.3855 Network. SLMC SUITE 4 �� COLLINS. CO 80534 LYNCH, MICHAEL I DO 970724.9508 1014 CENTRE AVENUE FORT COLONS, C08052fi 20015SHIELDS 1100 POUORE RIVER OR FORT COLLINS, CO 80524 Network: FCIP, NC BUILDING L FORT COLLINS, CO 80525 YEA/M, STEPHEN MO 970483.2791 Network. FOP CARSON, FRANK MO 970-221.2290 Network: FOP, NC 1212 E ELIZABETH ST Network: FCIP FORT COLLINS, CO 80524 OW, CATHY L MO 970484.3712 1006 LUKE 5T FORT COLLINS. CO W524PADOACK, M104AEL MD 970495.8800 I120 ELIZABETH ST BLDG F Network: FOP 1025 PENNOCK PL FORT COLLINS, CO 80524 FORT COLLINS, CO 80524 Network FOP, NC Network: FOP CORD, LI HARDABETH MO COLLINS,CO W524 1217E ELIZABETH ST FORT 5, CO 80514 pAULSEN, MARK MD 9704847757 HOLLAND, ROD MD 9704846773 OW, UTHSI L MO 970484-0712 1I41 RIVERSIDE AVE Nen dk+FOP 1221 E ELIZABETH 5T 1212 E ELIZABETH ST FORT COLLINS. CO 80524 SURE 20D FORT COLLINS. CO 809I4 COLLINS. THOMAS MD 970493.2776 SUITE 4 FORT COLLINS. CO W524 Narwotk:SLA�' Network: FCIP N4twak: FOP, NC 1120 E ELIZABETH ST BLDG G SUITE I FORT COLLINS, CO 80524 PICURO. JOHN C MD 970495-SM JEPBONS, JOSEPH MO 7212 E ELIZABETH ST 9704849773 FORT COLUNS, CO 60524 SANDS, ARTHUR MD 970404" I021 ROBERRTSON Network. SLMC 1025 PENNOCK PLACE FORT COLLINS. CO 80524 Network: FCIP FORT COLLINS. CO 80524 Network: FOP C'RANOR, 10 MO 9704840798 MCELWEE H P MD 970484.9773 WINDATE. DANA A DO 97048"7% 7217 E ELIZABETH ST PIKE ROBERT H MO 970.2214433 1212 E ELIZABETH ST FORT COLLINS, CO WS24 1040 E ELIZABETH ST - SUITE Ik�R FORT COLLINS. CO 8OS26 NC i :� FORT COLLINS. CO 60524 NC Network: FOP SURE 101 FORT COLLINS, C000524 SIMMONS, ROBERT MD 970484.9773 Network: FOP, NC DEYOUNG, DOUGLAS 8 DO 970482.2791 PODHAISKY, TIMOTHY P MO 970484.1757 12TZ E EUZASETH ST FORT COLLINS. CO 80524 1212 E ELIZABETH ST FORT COLLINS, CO $0524 1221 E ELIZABETH ST Network: FCIP Nam', FCIP SUITE 4 PORT COWNS• CO BOS24 CLIPNetwork' HARON MD SO< r BABCOCK, MARK E LCSW 9704936667 1021 RO. COLLINS,CO0 24 SON FORT NS. CO 80524 MARK F MD 970221.5155 R001 111101ERI50N FORT COLLINS. CO 80526 Network. PRO Network: FOP Net rk: FCIP 2001 S SNEILOS S SH BACHUS, NELSON MD 9704936353 FERGUSON, DAVID MO 970495.85W SLOG I FORT COLLINS. CO S0526 New ork: SLMC 1090 E ELIZABETH Network: FCIP FORT COLLINS. CO W524 BARNES. USA LCSW 9704984934 1025 PENNOCK PL FORT COLLINS. CO BOS24 2363 E PROSPECT RD FORT COLLINS. CO 80525 ,PRO Network-FCIP RUBRIGHL ION MD 04 9784.1757 KESLER, KELVIN F MO 970493.7442 FIELDS, )ACQUELINE C MD g70{6}2849SUITE 1221 E ELIZABETH 4 FORT COLLINS,COLONSCO 80574 1106 E PROSPECT RD NOW01*1 FOP, NC FORT COLLINS,CO 50525 COUGHLAN, ROGER LCSW 97MN•5955 503 REMINGTON 70D MOUNTAIN FORT COLLINS. CO 80524 Network. SLMC FORT COLLINS, CO W524 PRO - NMwdk: NOWNttwark: GEPPERT, MARGO I MO 970-225.1600 RUBRIGHT, ION MD 970-221•SUS 2001 SSHIELDS DEVILBISS, JAMES L LCSW 970.4969045 1330 OAKRIOGE DR FORT COLLINS, CO W523 SLOG I FORT COLLINS, CO 8052G GORDON, At MD 9M22t•2827 1024 CENTER AVE BLOC E SUITE 20 FORT COWNS, CO 80526 Netwok: FOP, NC GRAY, APRILK MO 970221.3833 Network: 5LMC SCOTT MD 970484-0798 1136 E STUART SUITE 4.104 FORTCOLONS. CO 80525 Network: PRO SAMUELSON. Netwok FOP DUNN, STEPHEN LCSW 97049S4692 20015 SHIELDS BUILDING L FORT COLLINS, CO 80525 1217 E ELIZABETH ST SUITE 10 FORT COLUNS, CO 80524 2362 E PROSPECT RD FORT COLLINS, C080525 Network PRO Network: FOR NC Netwokk: FOP, NC HUMPHREY, ROBERT MO 970-2214410 SEETON, IAMES F MD 970-221•11 3855 FANGMAN,MKHAEL MD 9704936337 FRALEY, BARBARA A LCSW 970-221.28M 1325 WHEOBEE FORT COLLINS. CO 50324 1301 RIVERSIDE AVE FORT COLLINS.G080520 2001 SSHIELDS 1240 DOCIORSW Network, PRO Network.. FOP BUILDING L FORT COLLINS. CO 80525 SUITE 200 FORT COLLINS, CO W5I4 JINICH, DANIEL MO 970484.1757 Network: FOR NC Network: FOP KIOCK, JIM LCSW 9704954853 1221 E EOZABETH ST S"�ARD-MADDEN, DENA 5 MO 970221-5595 MERRILL CLINTON F MO 970-4936337 SIC REMINGTON FORT COLUM, CO 8OS24 Network PRO SUITE 4 FORT COLLINS, CO 80514 2160 W DRAKE RD FORT COLLINS, CO 8OS26 1240 DOCTORS LN FORT COLLINS. CO 80524 Network. SLMC Network. NCAtP Network: FOP RED, JOHN H LCSW 9704954699 JINICH, DANIELS MO 9704844498 SMITH, JEROME I MD 970.229.980 1 2361 E PROSPECT RD FORT COLLINS, CO 80525 PRO • 2561 S SHIELDS AVE 2025 BIGHORN DR FORT COLLINS, CO W325 SUITE 3F FORT COLLINS. CC 00526 or Netwk: SLMC 4931 JESCT H LCSFORT S362 SIMC T S240 9704936337 E PONE RD 236U E PROSPECT RD FORT NS. CO 80525 COLLINS.CC A MO 970484.1757 SPROWELL JAMEELIZABETH N DOCTORS IN AYn ark: PRO KASENBERG. THOMAS P MO 970-221.3595 SUITE EILUBETH ST 20CTORS SORE 200 SUITE FORTCOLONS, CO BO.SI4 2160 W DRAKE RD FORT COLLINS, CO SM26 Network: SUITE FORT COLLINS, CO BOS24 Network FOP LCSW 970431.7582 NG3eP Network: SlA4C ItK76 ROBERISON 1W6 ROERTSON KAUffMAN, IEFFREY MD 970.1840798 STEPIIENS, FLOYD V MD 970484.1757 SURE 205 A FORT COLLINS. CO 80524 Network: PRO ��FF���ww__��ietFI����rr33I1 "mBINf1E0'fOIT.�:pl$ 1217 E ELIZABETH ST 1127 E ELIZABETH ST FORT COLLINS. CO 80524 SUITE t0 FORT COLLINS. CO $0524 NeMaMr. AMC COBB, DAVID K MO 970•i24-0439 TOLAND, JULIA 5 LCSW 970.2234078 Network. FOR NC 1247 RIVERSIDE AVE 760 WHALERS WAY XUROIWA, CHRISTiNA MD 970.495.9900 STODDARD, ANDREW MD 4-0 97046798 2I7 E ELIZABETH 5T SUITE I Network. FCIP FORT COLLINS. CO SOS24 A•100 FORT COLLINS. CO 00525 NeMpk: PRO 114 BRISTLECONE OR FORT COLLINS, CO 80524 SUITE SUITE 10 FORT COLLINS, CO 80524 NeMdk: FOP Na0•ork: FOP. 14C LOPEZ JOSEPH MO 970-221.5929 SULLIVAN, DONNA MO 9704956800 1136 E STUART SUITE 4202 FORT COLLINS. CO 80525 1025 PENNOCK PI- FORT COLLINS. CO 80324 Network; FOP ABBEY, DAVID MD 970482.2572 ANDERSON-KEPIER,ROBIN 5 LMFT970482.8837 Network: FOP I100 POUDRE RIVER OR FORT COLLINS. CO 50524 109 W OLIVE Sr FORT COWNS. CO SOS21 SUNTNANKAR, SHNALINI MD 9704826801 Nen•arle FOPnetworlt- PRO MACDONALD, NOLA A 00 970-229.9800 COLLINS.025 BIGHORN OR FORT CONS. CO 80525 1014 CENTRE AVE FORT COLLINS. CO 80525 Network: FCIP ALES51, GRACE .MO 970482.3711 BECK, JOSEPHINE S LMFT 970490-2886 Nen 0*.-SLMC 1120 E ELIZABETH 2137 DOVER OR FORT COLLINS. CO 80526 THIEMAN, WILLIAM I MD 970484.7243 SLOG PSUITE 101 Network. FCIP FORT COLLINS, CO 80524 '� F MALY, TIMOTHY I MO 970-225.1600 1217 E ELIZABETH ST FORT COLLINS. CO 60524 A -0583 COHBV, BARCOLLEGE 13300AKRIDGF OR FORT COLLINS, CO 80525 Network: FCIP ALLEN, DAVID MD 97048/-31% 1415COLLEGFVFORT COWN5.0080524 AVELA1FF' COLLINS.CO Network. FOP. NC 1260 DOCTORS LN FORT COLLINS. CO 80524 Network: PRO -2791 MERCER, JEANNETTE MO 970483.2791 R. JEA NE TE THIESZEN, MILFORD MO 970.124.1596 511 E ELIZABETH FORT COLLINS. CO S0526 Netwok: FOP GIGUO, MICHAEL LMFT 970i31-0582 1 U72 E FORT COLLINS.97CO Newark.- FC/P, NC BUSH, JAMES MO 970484." 1415 COLLEGE AVE Network. FOP THORSON. STEVEN MD 970492.2791 1021 LUKE Sr Network. FCIP. NC FORT COLLINS. CO 80324 SURE 2 FORT COLLINS, CO 80774 1Vtlwvk. PRO MERKEL, LAWRENCE MD 970221.2290 1212 E ELIZABETH ST FORT COLLINS, CO 80524 1006 LUKE ST FORT COLLINS, CO BOS14 Nevwdk FOP EWS. ROBERT MD 970274.9508 PAUL LMFi 6608 Network: FOP TiPPIN, STEVEN B MD 970229.9800 1100 POUDRE RIVER OR FORT COLLINS. CO 80524 1520 S COLLEGE I520 S COLLEGE AVE FORT NS. CO 80424 COLLINS.CO MURPHY, LAWRENCE E MO 97022E-OOM 2025 81CHORN ORIVE FORT COLLINS. CO 80525 Nk ork. FCIP Network: PRO 1113 OAK RIDGE DR FORT COLLINS. CO 80525 Network: SUMIC LA GRAF, PAUTA MD 970484-0080 MOORE. KANOY LMR 970-03-8006 Network. SLMC I7770.IVER AVE 13025SHIELDS MURPHC LAWRENCE MD 970484.1757 T113 BIN.OAK MICHRIDGE OR FORT COLLINS.CO W525 11130AKRIDGE DR FORT N5. C080525i SUITE I Network: FCIP FORT COLLINS. CC 80524 SUITE A24 FOKf COWNS. CO 80521 Network: PRO 1221E ELIZABETH 5T Network: SLMC SUITE 4 FORT COLLINS. CO 80524 Netwdlo SLMC FORT COLLINS - FORT 1 ROBERTSON,MARY IMFT 970416-1918 19 OLD TOWN SO FORT COLLINS, CO B7524 Netwwk: PRO WATSON, M CATHERINE MS 970484.8608 1520 5 COLLEGE AVE SUITE 3 FORT COLONS. CO 80524 Nemok. PRO WETZEL, BARBARA MS, LMFr 970.495.1068 527 S WHITCOMB ST FORT COLLINS, CO 80521 Ner.w k PRO LEELANDA CMT 970-4988502 1190 NIAGARA DR SUITE 15 FORT COLLINS. CO W525 Net,Q*. SLMC ORCUR, EDWARD MT 970-493-0931 50I PETERSON ST FORT COLLINS. CO W524 Nen.ak: SLMC JENSEN, OLE T DOS 970498-0196 20015 SHIELDS BLDG I FORT COLLINS. CO W526 Nff w *.* MM& SLMC SOLDUC PHILIP 1 MS, LPC 970-224-0462 141 S COLLEGE AVE FORT COLLINS. CO 80524 Nen.ak: PRO FARIS. GARY I LPC MA 97049S6565 172 5 COLLEGE SUITE 200 FO9TCOLUNS,CO80524 Nefx k: PRO FREEMOLE CAROLE 5 LPC 970493-8006 1302 S SHIELDS STE A24 FORT COLLINS. CO 80521 Nen.ark-PRO KENT, TERRI MS 970.221-0923 109 W OLIVE ST FORT COLLINS, CD W524 Nm*"k. PRO KIMBLE PATRICIA L MA LPC 970-4936667 1049 ROBERTSON FORT COLLINS, GO 80524 Ner. a k: PRO MOUNNEY, MAUREEN M MA LPG 970-223.5125 343 W DRAKE RD SUITE 140 FORT COLLINS, CO 87526 NN .- PRO HAYGOOD,THOMAS MD 970493-7733 1120 E ELIZABETH ST FORT COLLINS, CO 87524 Nen wk. FOP SIMMONS, RICHARD E MD 970493-7733 1120 E ELIZABETH ST FORT COLLINS, CO 80524 Neff rk. FLIP smcU4�� COESTER MD, HANS C MO 970493-1292 1]73 RIVERSIDE AVE FORT COLLINS. GO 80524 Ne . FOP TURNER DONN MO 970493.1292 1313 RIVERSIDE AVE FORT COLLINS, CO 80524 Nenwwk: FCIP WARSON, TAMES MO 970493.1292 7313 RIVERSIDE AVE FORT COLLINS. C080524. NeMVrk: FCIP WIRT. TIMOTHY MO 970493-1292 1313 RIVERSIDE AVE FORT COLLINS, CC 80524 Nerl.ork: FCIP Eli 04 + CURIEL MICHAEL P MD 970-221.1993 1247 RIVERSIDE AVE SUITES 2 8 4 FORT COLLINS, CO 80524 Nets *: FOP MCINTOSH, GERALD C MO 9704624373 1247 RIVERSIDE AVE SUITES 2 AND 4 FORT COLLINS. CO 80524 Net,dk: KIP MILLER. TAMARA A MO 9704824373 1247 RIVERSIDE AVE SUITES 2 AND 4 FORT COLLINS. CO 80524 ,Venwrk. FOP b 'NU E/MID. IF, BOTTONE-POST, CAROLYN CNM 970-223.3S25 3000 S COLLEGE AVE SUITE 210 FORT COLLINS, CO 80525 ,,vetwwK: FCIP CONWA.. .AGAREr CNM 970493.744 MsswmLwj-qyamBACHUS. KEVIN MD 9704936353 1080 E ELIZABETH FORT COLLINS. Co 80524 54 SLOANS LAKE MANAGED CARE 2 1106 E PROSPECT RO FORT COLONS. CO $0525 NeMwk: FCIP FREDERICKS, PATRICIA CNM 970493.744 1106 E PROSPECT RD FORT COLUNS, CO 805 25 Network: POP GUSEY, CATHERINE A CNM 970493.7µ 1106 E PROSPECT RD FORT COLLINS, CO 8052 5 Nenwwk: FCIP KRAKAUER, KAROL CNM 970.493-7µ 1106 E PROSPECT RD FORT COLLINS, CO 805 Nero,*: FCIP LORENTZEN. SHEILA CNM 970493-196 5 1006 ROBERTSON SUITE A FORT COLLINS, CO 8053 NeMwk: FOP SPARLING. DIAN CNM 97049}7 1006 ROBERTSON SUITE A FORT COLLINS. CO 8052 4 Nenwwk: FOP WILSON-FNRIQUq TERRIE CNM 970.493.66 1224 E ELIZABETH ST FORT COLLINS. CO 8052 Navw *.-FOP MsswmLwj-qyamBACHUS. KEVIN MD 9704936353 1080 E ELIZABETH FORT COLLINS. Co 80524 Now"k.- FCIP BERDAHL, LAURIE D MO 970.223.3S25 3000 S COLLEGE SUITE 210 FORT COLONS, CO $0525 Nerwk: SIA1C CLOYD, DAVID MO 970493.5g04 1136 E STUART BLDG 2 SUITE 100 FORT COLLINS, CO 80525 Nerve *-FCIP DONNELLEY, BEVERLY MD 970-493.7442 1106 E PROSPECT RD FORT COLLINS. CO 80525wor Network: FCIP, NC FRANCO, JONATHAN E MD 970493.7442 1106 E PROSPECT RD FORT COLUNS, CO 80525 wwk NerFCIP, NC HOFFMAN, MARK L MO 970493.5904 1136 E STUART BLDG 2 SUITE 100 FORT COLLINS. CO 80525 Nawwk: FCIP AMES, WARREN MD 97049}7µ2 1106 E PROSPECT RD FORT COLLINS, CO 80525 Nfft rk.'FCIP, NC JEFFREY, RANSY L MD 970493.7µ7 1106 E PROSPECT RO FORT COLLINS, Co 80525 o Ndt t: FOP. NC KIEFT, LARRY MD 970493.5904 1136 E STUART BLDG 2 SUITE 100 FORT COLLINS. CO 805ZS Nowak: FCIP KOZAK. SUSAN MO 970493.7442 1106 E PROSPECT RD FORT COLLINS. Co 80525 N'etwrk: KIP, NC LUDWIN, GARY MD 970493.7µ2 1106 E PROSPECT RO FORT COLLINS, CO M525 wor Netk: fop,, NC ONOLL IOHN (JACK) MD 9704936677 1224 E ELIZABETH Sr FORT COLLINS, CO 80524 k: NeMwFCIP SERNIAR ELIZABETH MO 970.223.3525 3000 S COLLEGE AVE SUITE 210 FORT COLLINS, CO W525 Nefwwk; SLMC STIGLICH, NORMA I MD 970-225.1600 13J0 OAKRIOGE OR FORT COLLINS. CO 80525 NeMak NC STIGOCH, NORMA I MD 970.223.3525 3000 5 COLLEGE SUITE 210 FORT COLLINS. CO 80525fwa Nek: FOP CUMMINGS, BRENDA K OTR 970.22E-1990 1330 OAKRIOCE OR SUITE 100 FORT COLLINS. CO 80525 Netork: FCIP, SLMC CUMMINGS, BRENDA K OTR 970493-0112 2500 E PROSPECT RD FORT COLLINS, CO 80525 Net .-FOP. SLMC CUMMINGS, BRENDA K OTR 970-282-0004 901 OAKRIDGE OR SUITE 100 FORT COLLINS, CO 60525 Network: FCIP. SLMC DUESTER.ROSANNA OTR 970-493.1110 1736 E STUART i UITE 4.106 FORT COLLINS, CO 8052S Netrwk: FCIP 54 SLOANS LAKE MANAGED CARE Fall 1997 EWERS-DENNISON, MARY E OT r,0.22S-1990 1330 OAKRIDGE OR RZHOPEDICySIJRGERY`3 SURE 100 FORT COLLINS, CO 30525 w Netk. FCIP BEARD, DOUGLAS W MD 970493-0112 2 2500 E PROSPECT RD FORT COLLINS, CO 80525 EWERSDENNISON, MARY E OT 97(493-0161 Netwrk: FOP, SLMC 2500 E PROSPECT RO SUITE 100 FORT COLLINS, CO 80525 COUPENS, STEVEN D MD 970-493.0112 2 NeMwk: FOP 2500 E PROSPECT RE) FORT COLLINS. CO 80525 Nalwwk: SLMC EWERS•DENNISON, MARY E OT 970.282.OW4 901 OAKRIDGE OR DOERSCHUK, SARAN H MD 970-"3-0112 2 SUITE I W FORT COLLINS, CO 8052S 2500 E PROSPECT RO FORT COLLINS. CO 80252 ZS Network: FOP Nehu : SLMC RAURACH, SUSAN C OTR 970493-6667 DONNER. E I MD 970-221-7919 1049 ROBERTSON FORT COLLINS. CO 80524 2001 S SHIELDS FORT COLLINS, CO 80526 Neno*. FCIP NeFAWk. FOP 4 SMITH, IANET M OTR 970.493.6667 DUNCAN, KENNETH H MD 970493-0112 7049 ROBERTSON FORT COLLINS, CO 80524 2500 E PROSPECT RD FORT COLLINS, CO 80524 865 Nen . FOP Nwe *. SLAIC YOWELL, ROBYN M OTR 970.225.7990 GRANT. LEE MD 97049MIll 1330 OAKRIDGE OR ZSW E PROSPECT RD FORT COLLINS. CO 50525 SUITE Too FORT COLLINS. CO 80525 'N�k' SLMC Nenwk; FOP, SLMC 77 HORSTMAN, TAMES K MD 970493-0112 4 YOYVELL ROBYN M OTR 970493-0161 2500 E PROSPECT RD FORT COLLINS, CO 8GS25 2500 E PROSPECT RD Nwe k: SLMC SUITE 100 FORT COLLINS, CO 80525 O - NeMwk: FOP, SLMC JOHNSON, ROBERT V MD 970493-0112 2500 E PROSPECT RD FORT COLLINS, CO BOS25 YOWELL. ROBYN M OTR 970.282-0004 Network- SLAIC 901 OAKRIOGE OR KAISERSUITE 100 , DALE C MD FORT COLLINS, CO 80515 970493-0112 a Ner k: fCIP, SLMC t� 2500 E PROSPECT RD FORT COLLINS. CO 60525 /�EDCATR� KINDSFATER, KIRK MD 970493.0112 2500 E PROSPECT RD FORT COLLINS, C080525 CRANDALL WENDY G OTR 970482-0521 N&Ki *. SLMC 1200 E ELIZABETH ST SUITE A FORT COLLINS, CO 80524 KNAUER, SALLY MD 970-224-9890 Neftm*-SLMC 1136 E STUART SLOG 3 SUITE 1 W FORT COLLINS. CO 80525 NeMak fdP MAGSAMEN, BENEDICT F MD 970493-0112 MARSCHXE IR ROBERT F MO 9704936337 2500 E PROSPECT RO FORT COLLINS. CO 80523 1240 DOCTORS UN Nawak: AMC SUITE 200 FORT COLLINS.CO 80524 MARTIN, DALE M Network: FOP 93 2S E PROSPECT RO FORT COLLINS,CONS,, CC)8052S Nehmkt FOP, NCMP l ` 1 MO'ERRAN, MARK MD 970493-0112 DESANTL% DIANA MO 970485.0000 2500 E PROSPECT RD FORT COLLINS, CO 80525 2001 5 SHIELDS NeMak: FOP, SLMC BLDG A SUITE B FORT SLMC COLLINS. CO 80526 MURRAY, DOUGLAS MD 970497-0112 Nowak: AM44, Z500 E PROSPECT RD FORT COLLINS. CO 80524 NeMwk: FC7P NELSON, GARTH C MD 970493.21In 80EHLKE. RUSSELL MD 970484.5322 1020 LUKE ST FORT COLLINS, GO 80524 1017 ROBERTSON FORT COLLI97 CO -5322 NerMwk FOP Nefwark• FQP PETTINE KENNETH A MD 970-221.1919 ENZENAUER, ROBERT W MD 970488-0000 2001 5 SHIELDS 2001 5 SHIELDS BLDG L FORT COLUNS, CO BO526 BLDGA SUITES FORT COLLINS, CO 8OS26 NNwak-FOP NeMak-MMA SOBEL ROGER MO 970493-0112 FOSTER GARY I MD 970484.5322 2300 E PROSPECT RD FORT COLLINS, CO 80S25 1017 ROBERTSON FORTCOLUNS, CO 60524 Nen a+k. f{fP SLMC Nenork- FLIP TRUMPER, BOCCI Y MD 970493-0112 HAMMOND, RICHARD MO 970494.5322 25W E PROSPECT RD FORT COLLINS. C080525 1017 ROBERTSON FORT COLLINS.CO 8OS24 Net-*: NGeP SLMC mw Ne*. FOP YOUNG, ERIC E MD 970.22T•1919 KING, ROBERT A MD 201 5 SHIELDS 970-18&OppO BLDG L FORT COLLINS, CO $0526 BLDG 5 SHIELDS l0(, A SURE B FORT COLLINS. CO 80526 Ner a* FCIP Naww,k: M1M, SLMC 00 NORRIS. ANDREW M MD 970.224.2020 1025 GARFIELD FORT NC COLLINS.O 80524 OUBSEN CHILLSTOPHE NeR M MD 970.221•/177 Mark: FOP. 1120 E ELIZABETH ST OLSEN, GERALD MD 97D484,5322 BLDG F SUITE 101 FORT COLUNS, CO 80524 1017 ROBERTSON FORT COLLIN5. N�k' FCIR NC. NGMP vt Nwak: FCIP CO 80524 P LOURY, MARK MD 1136 E STUART 970493.5336 ROB1017 NSON,ROBERTSON MATTHEW I MD COLLINS,CO 80524 SLOG 3 SUITE 3200 FORT COLLINS. CC 40525 1017 *:FCJ SON FORT NS, CO 80524 Nowak: FOP NC NeMo/k: FCIP SHACHTMAN, WILLIAM A MD 9704845322 RUNYAN, BRAD MD 970-221.IM 7017 ROBERTSON FORT COLLINS.CO 80524 1120 E ELIZABETH ST NFe : FOP BLDO F SUITE 101 FORT COLLINS, CO 80524 Nefwak: FCIP, NC AGW SMITH, RANDALLW MD 970-221-2272 SMITH, BRUCEM MD 1124 E ELIZABETH ST 9704846373 BLDGC FORT COLLINS. CO 80524 1020 LUKE ST FORT COLLINS. CO 80524 Netwrk. FCIP Ner4v*. FOR, NC STEVENS, WILLIAM MO 970-221-2222 iAiR1QS:a::. 11 Z4 E ELIZABETH 5T _ BLDG C FORT COLLINS. CO 80524 BEARD. DONALD Y MO Nefwwk: FCIP 970442.2515 1200 E ELIZABETH Sr FORT COO.INS, CO M524 THORNTON, WILLIAM R MO 970484-0722 NE6"XkrSlMC 1241 RIVERSIDE AVE H, SUITE 2W BOOTRICHARD MD FORT COLLINS. CO 90524 BOO H.9704844871 wr Net k: FCIP SHIELDS BLOC G FORT COLLINS, CO 80526 THORNTON. WILLIAM R MO 970484.0722 Nkowrk FCIP 200I SSHIELDS OIERAURSUSAN MD BLOC ASUITE B FORT COLLINS. CO 8052fi 970482.257E Nelwwk: FOP f 2W E FLRABETH ST FORT COLLINS, C080524 No"oNrSLAIC D C G D C G -f- .. FORT COLLINS - FORT COLLINS Fall1997 FELLER, BARBARA PT 970.221.2942 SIMMONS, WANDA PT 970-221.2942 SCHULTE, ROBERT C OPM 970.493.4660 FDIATRIES;4 1236 E ELIZWH ST T236 E ELIZABETH ST . 2001 5 SHIELDS >OFITINUE SUITE 1 FORT COLLINS. CO $0524 SUITE 1 FORT COLLINS. CO 80524 BLDG F FORT COLLINS, CO 80526 ,r,�„�-,,,,.,� ,Vem .- FOP, SLMC Nemdk: FCIP Network: FOP ELLIOTT, MAX A MO 970482.2515 1200 E EUTABETH 5T FORT COLLINS, CO 80524 FONDY, BETH PT 970484.2219 SOKOLOSKI, LEONARD IT 970.223.3713 THOMAS, MICHAEL I DPM 970.4844620 Nenw,k: SLMC 1148 E ELIZABETH 5T FORT COLLINS, CO 60524 1148 E ELIZABETH ST FORT COLLINS, CO 80524 1355 RIVERSIDE AVE NolWk: FCIP Nenwk: FOP SUITE F0RT C0LUNS. CO 80524 F ELLIOTT, MAX A MD 97043"722 FONOY, BETH PT 9704842219 S0K0lO5KI, LEONARD M PT 970.223.3713 Nenwk: FCIP I' 1241 RIVERSIDE AVE SUITE FORT COLLINS.CO 80524 415 EM0NR0E F0RT COLLINS. CO 80525 1449 RIVERSIDE DR F0RT COLLINS. CO 80525 TREWARTHA, WILLIAM OPM 970493166 k: Network: SLMC Network: FCIP Nenwk: FCIP 20015SHIELDS FORT C0LONS.00 8O516 NeNark: FCIP GOLUB,'DANIEL MD 970.484-9175 HAND, TRAVIS O PT 970.493-0161 SOKOLOSKI, LEONARD PT 970-223.3713 1260 DOCTORS LN FORT COLLINS. CO 80524 2500 E PROSPECT RD 415 E MONROE FORT COLLINS. CO 80525 Newk: FOR NC SUITE 100 FORT COLLINS. CO 80525 Nenwk: FCIP Ner p*: FOP GUENTHER, IOHN P MO 970482.2515 TROUT, ROBERT D PT 970484.1694 BERNS. BARRY MO 970P226-0= 1200 E ELIZABETH ST FOKT COLONS, CO 8024 HAND, TRAVIS D PT 970-282.00M 2555 AS SHIELDS FORT COLLINS, CO 80526 1625 TICONOEROCA OR FORT COLLINS. CO BOS25 New*: SLMC 901 OAKRIOCE OR Nenw k: FC1P Netw/: PRO SUITE 100 FORT COLLINS. CO 80525 HANSON, VAUGHN W MO 970482-2515 Nety k: FOP TURNER, MICHAEL D PT 970-225.1990 BROWNING, TAMES MD 97O n3.1600 1200 E ELIZABETH ST FORT COLLINS. CO 00524 1330 CAKRIOGE OR 375 E HORSETOOTH RD NeMwk: SLMC FORT COLLINS, CO 80525 DACE R PT 970-221.2328 SUITE 100FORT BLDG 2, SUITE 203 FORT COLLINS, CO 90525 6KENY��CAN SLMC Nevck: PRO JOHNSON, LEE A MO 970484.4871 SUITE 9 FORT C0LUN5, CO 80524 2001 5 SHIELDS Nor w*: FcfP TURNER, MICHAEL D PT 970493-0112 IONES, WILUAM MD 970493.3040 BLDG O F0FIT COLLINS. CO 80526 3500 E PROSPECT RD 1302 5 5HIEL05 Network:FCIP KIEFER,SHARON FT 970-224-9145 SUITE 100 F0RT COLLINS. CO 80525 St.In A24 F0RT COLLINS, GO 80521 2001 5 SHIELDS Naewk: FOR SLMC Netwk. PRO MCGINN1S, TAMES G MO 970482.251E BLDG X 1200 E ELIZABETH ST FORT COLLINS. CO 80524 Newk: FOP FORT COLLINS, CO W526 TURNER. MICHAEL D PT 970.28241004 KAGAN, LAMES MD 970.223.5125 NeMdk: SLMC 901 OAKRIDGE DR 343 W ORAKE RD LOCKWOOD, DEBORAH U PT 970484.2219 SUITE 100 F0RT COLLINS. CO 80525 SUITE 240 F0RTC0WNS, CO W526 MCGINNIS, WMES G MD 9704840722 1148 E ELIZABETH ST FORT COLLINS, CO 80524 Network: FCIP, SLMC Newk: PRO 1241 RIVERSIDE AVE Ner wk+FOP FORT COLLINS. CO W524 WEBSTER, SUSAN PT 970-221-2942 KAMMERER. WILLIAM R MO 9M=-1293 - SUITE 200 Nenwk: SLMC LUTTRELL TAMMY RPT 970.49&9310 1236 E ELIZABETH ST 375 E HORSETOOTH RD 1215 E CR 59 FORT COLLINS. CO SD524 SUITE 1 FORT COLLINS. CO 8O524 BLDG 2.201 F0RTC0WN5, CO 80525 PAISLEY, TAN E MO 9704U-2575 Nerwk: POP Netwrk. FOP Network: PRO I= E EL17ASETH ST Network: SLMC FORT COLLINS. CO 50524 MONNET,MAUD PT 97&225.1990 WILSON, CATHRYN A PT 970-221.2942 MALER, RICHARD MD 970-221-0077 1330 OAKRIOGE OR 1236 E ELIZABETH ST 1217 E ELIZABETH ST SULUVAN, WILLIAM I MO 970484.2515 SUITE 100 FORT COLLINS. CO MS SUITE I FORT COLLINS. CO 805I4 BLDG 6 FORT COLLINS, CO 80524 1200 E ELIZABETH ST FORT COLLINS, CO 80524 Nenwk: FOP. SLMC N&wk: SLMC NeMok: PRO Nemok: SLMC MONNET, MAUD PT 970.493-0112 mamsvmvm�760 MOIL IOHN MD 970490.1404 WUERSLIN. EOZABETH A MD 9704844871 2500 E PROSPECT RD WHALERS WAY 2001 5 SHIELDS SUITE t00 FOKT COLLINS, CO 80525 BLDG 8 SURE 201 FORT COLLINS. CO 80525 BLDG G FORT COLLINS, CO 80526 Network: FCIP, SLMC MORRIS. KATHLEEN PT 9704U-OS21 Nelwk: PRO - Nerw*: FOP 1200 E ELIZABETH ST FORT COLLINS. CO 80524 MONNEr, MAUD FT 97U-28241004 Netwok: SLA1C 901 OAKRIDGE OR CIMAI EDL61 ABILITPi� SUS FORT COLLINS. CO 80525 BPS LMCT IRISH,MARGAREr A DO 970498-0330 YANCEY, ASA I. MO VO-n3.1294 2001 SHIELDS ST NICKEL PAULAM FT 970-221.2942 DELTZ, MICHAEL C PA 970493-0112 4601 C0RBETT F0RT COLLINS, CO 805Z.9 SUITE I100 FORT COLLINS. CO 8052fi 1236 E ELIZABETH ST 2500 E PROSPECT RD FORT COLLINS, CO 80323 Newk, PRO Network. FOP SUITE 1 FORT COLLINS. CO 80524 Netwok: FOP Network: FOP r VAN DEN HOVEN, RAYMOND P MD 0. PA -0112 D NALDPROSPECT KELL2500 970.493-0112 OTT. CHRISTIANA PT COLLINS,CO 2S 97&225.1990 2500 E PROSPECT RD FORT N5, CO 80525 E 2500 E PROSPECT RD FORT COLLINS. CO 80525 1330 OAKRIOGE OR Nerwk: FCIP ASH, KENNON H MD 970495." Nenwk: FCIP, SLMC SUITE 100 FORT C0LUN5, CO B0525 2362 E PROSPECT RD FORT COLLINS. CO 812525 Network: FOP, SLMC VALOEL ROBERT 5 PA 970493-0112 Net pk. PRO 2500 E PROSPECT RD FORT COLLINS. CO 80525 mmm.ysl •` OTT.CHRISTIANA Fr 970-493-M12 Neft"xk SLMC 2500 E PROSPECT RD BARCLAY. CAROL F FT 970-=-1990 SUITE 100 FORT COLLINS, CO W525 1330 OAKRIOGE OR Newak: FOP, SLMC MESINGER, BRIAN W PHD 970482.2313 SUITE 100 F0RT COLLINS, CO W525 Orr, CHRISIIANA FT 970-M4004 BESHUAN, KEVIN MO 970493-8800 1200 E ELIZABETH ST F0RT C0WNS, CO 80514 Neewk. PRO Netwk: FOR STMC 901 OAKRIOGE DR 1217 E ELIZABETH ST BARCLAY, CAROL F PT 970493-0161 SUITE 100 FORT COLLINS. CO 80525 SUITE 7 FORT COLLINS, CO W524 2500 E PROSPECT RO FORT COLLINS. CO 80525 Nenwk: FOP, SLMC Network: FOP Netwrk: FOP. SLMC pO0LO5, ROBERT I PT 970.22S-1990 DUNCAN, DIANE MD 970493-7445 PHD 970.227.7765 BARCA CAROL F PT 970-282-0004 1130 OAKRIDGE OR 1701 E PROSPECT FORT COLLINS. CO 50524 5 COLLEGE AVE 30M 5 CO EGE R 901 OAKRIOGE DR SUITE 100 F0RT COLLINS, CO 50525 Network:FOP SUIT SUITE 210 F0RT COLLINS, CO 80519 SUITE 100 FORT COLLINS. CO 80525 Ne -*: FOP. SLMC FORD, EDWARD G MO 970-221.5678 Newark: PRO NeNak: FOP. SLMC POOH, ROBERT 1 Pr 970493-0112 1148 E ELIZABETH ST FORT COLLINS. CO 80524 BAKER• PSYD 970493.8006 BEST MMIREEN PT 970-221.2942 25M E PROSPECT Network: FCIP SHIELDS , SUIT E ELIZABETH ST SUITE 100 FORT COLLINS. CO 80524 Nowak: FOP. SLMC FORT COLLINS. CO 80515 HILL, AMY E MD 74 SUITE1302 AHIELOS SUITE A2-0 FORT COLLINS. CO 8O517 Netwk: PRO SUITE 1 Netw*: FOP NS. 14 1701E PROSPECT FORT GOWNS, CO CO 80524 '.. POOLOS. ROBERT I IT 970-2824004 Nenvk: fC7P BENNET7 THOAtAS L PHD 9704934667 BEST, PATRICIAM PT 970-221.2942 901 OAKRIDGE OR SUITE 100 FORT COLLINS, CO 80525 TSOI, CHRISTOPHER MD 970493-MM 1049 R0BERTS0N F0RT C0WNS, CO 80524 New*: PRO 1236 E ELIZABETH ST SUITE 1 FOBT COLLWS, CO 80524 Nenwk: FOR. SLMC 1217 E ELIZABETH ST Nemok' FOP SUITE 7 FORT COLLINS. CO $0524 BEYER HAROLD N FHD 970493-920S POTTS, IANET PT 970-229.1617 NeMak: FCIP MS RIVERSIDE AVE DEHART, STACY PT 970-225.19" 421 B IOLEOALE OR FORT COLLINS. CO 60526 SIRE E FORT COLLINS. CO 60524 1330 OAKRIDGE OR Netwk: FOP Network:PRO SUITE 100 Netwok: FOP FORT COLLINS, CO $0525 RAY, JEFFREY Fr 970-221.2942 BIORK DEBRAF PHD 970493.9205 1136 E ELIZABETH ST ANDERSON, TAMES C DPM 9704844620 1355 RIVERSIDE AVE DEHART, STACY IT 970.282-0004 SUITE i FORT COLLINS. C08OS24 1355 RIVERSIDE AVE SURE E FOKr COLLINS. CO 80524 901 OAKRIDGE OR N~*: FOR SLMC SUITE C FORT COLLINS. CO 80524 NeNp*: PRO SUITE 100 FORT C0LLIN5. CO 80525 Network: FOP NeNak: FOP RIVOIRE. STEPHEN D FT 970484.7219 BRANDON, ALLEN D PHD 970-223.1293 1148 f ELIZABETH ST FORT COLLINS, CO 80524 BOYCE, KRISTEN DPM 9M221-0425 375 E HORSETOOTH RD DUKART, SUE M PT 970'225.1990 Newvk: FCIP Two POVDRE RIVER DR FORT COLLINS, CO 80524 OLD 2. STE 201 FORT COLONS, CO 80525 1330 OAKRIOGE OR FORT COLLINS, CO 80525 SEAVER, COZETTE B Nenwk: FOP T 9702251990 FT Network: PRO SUITE 100 NeNok: FOR SLMC 1330 OAKRIDCE OR BURNS. MICHAEL DPM 970-221-0423 CALHOUN, ROBERT W FHO 970-493.8006 SURE 100 FORT COLLINS. CO 80525 1100 POUDRE RIVER DR FORT COLLINS, CO 80524 1302 5 SHIELDS DUKART, SUE IT 97(1.493-0161 Nemok: PCIP Nemwk: FOP SUITE A24 F0R7rC0tUN5. CO80521 2500 E PROSPECT RD FORT COLLINS. CO 60525 SEAVER, COZETTE B FT 9704A161 93KNUTSEN, CHAO DPM 970493-4660 Network: PRO SUITE 100 Nenw *: FOR SLMC 2500 E PROSPECT RD 2001 5 SHIELDS CASSIDY, STEPHEN E PHD 970.498A045 SUITE 100 FORT COLLINS. CO 80525 BUILDING F•1 FORT COLLINS. CD 50526 1024 CENTRE AVE OUKARL SUE M PT OAKRIOCE DR 970282-0004 Ner u *: FOP Network: FCIP BLDG E SUITE 200 FORT COLLINS, CO 80526 Newok-PRO 901 FORT COLLINS, CO 8052E SEAVER. COZERE 8 PT 970.182-0004 NYGA. THOAUS DPM 970-M193.4660 SUITE 100 SUITE 10 fC1P. SLMC 901 OAKRIOGE OR 2001 5 SHIELDS CORCORAN, TAMES R PHO 970-416-0626 SUITE 100 FORT COLLINS. CO 80525 BLDG F FORT COLLINS. CO TIMM 2001 S SHIELDS ST EDWARDS. SYLVIA S IT 970221-0173 Nemak: FCIP Network: FCIP BLDG L FORT COLLINS. CO 60526 1325 E PROSPECT RD FORT COLLINS. CO 80525 WILLIAM DPM 970482.366E O01 Nerwk: PRO ,Vemak: FOP L101 RIVERSIDE AVE FORT COLLINS. CO M7524 *. FCIP Network: FCIP S7� _Sm �ac mna 3 rm_ a: m o ,s o2Nygc� 'm8g➢y W m�oof2, min 2mc� 33'mDnp� rn33mo m \V ?$ mmm- k'+�`. n53�aao�z as=m 3 um Ivn3 ac Saplanag sad. �3 3� 0 [d V, CD tCD ElN a� a, oaa d co 3o S Ch m N N c� N 1 m N C) O n Z.n aq iM - n'1 N p'» 0 A� za r ° m" *1 i my Z 0 rw 1° Cn C 3 nn o3 W O W V _p C) O O p ul C3 O co N O 1+ ru NT W ❑ - If a u n , u O 7) , 23 ❑ _ N- saa033a anoti a03 ti3oa SIMI 14,v138 E- ws n m aci i w C 0 m...Q m a E'm o n_ N m d N N Y N 7 C N 7dTw cY O)>y mN O6 V�d' Ac yn9j as LNVNia 'ny mom:`... ac:.Nd dim darn iE �� am Yw c o> m v K c m e o cy] m N U w U N 0-6_ N a M. ,cOQm o a n mE i� cp n �i A n'a n' E mEad �doc Om N�ya6 OO'a ��'n Yw"'m �� c� LL� mNw rn 0'�i �CC.. 'sue O'9c Oa�9 mn a`f tf, A« %o ' m a m E Q Q d F L w C m G o W Y m rn'- Eu •' n t E E 'm-'d N c. x m CO m m o Yam. o N N E C O C. N v N C 0 �O c t Z E y rnw W 0 go «Y m m y �. � c mf� '= Y E o W� -- 3: o O E E E o u W v W a w o« w m $ ';? c m c9 x�n E v Z .5 C_N C m03 C -U wd�NOWN.G-' JO Tp'V •r otl1'Z=m o un3'3 Yd. dm .N. mtn n dmnm«m« SE l AO u � ._ 3oawiw � m' o aciEo wOrmd> a c�= E u3c? U G C m m Y m 9> -� E O W O> E'.N. c .a 3 u u_ p Q'« c x >.—•- m d 9 O N'C1 O_' ? W O O:IVCm ONN �Y'p mY CdO G 'LL Oa 60 oa'Er m�>«w c ao 2dmE �._ _mN EON ""O Cttt moL `m_ mja pp'Eom � m n >E - mOv. t6 o'a't m3L O ommEa mn jE 'Wm OL W C vi [ri Y 7 d Y« ` d_ O Nocw E rn -o'`o 'a'C m� coo a ov nw w A o cmi mac c E" w..�E Vao 01 N mo c E°'oL`9 oy W`oa aQo vo—> v $ 7 > m A o c d N N O A 9 C n N L X A J d m 0 N O H m d= d U W d ry] w « d O L E Y E C 7 Y y N C i N E i' 9 (A d N 0 H - V Y Ol L« C T T a roc yc m,w.. ato^ - ma co o m o d a m d t d a o 0 r d> C c w W E o O m To"p `U U'�UN u dY oy�j-NI�LI myW Y«�6«N-N'O ILNV N?i jW � 'i Q 1 1 d: L : H J� • Y m O • o m C y COC ONm CY �.mm9 « o p90 m m'E YnE o'y 5« nocoo 003 to 9 O y U` C O E m w 9 9 d E .« «� ro 3n._�w OEms m E owso EooauWic �K90 =Eo «Lm.. O'mY=mo >m�y E o '� 3 ' y a d m u o = E d >_ o 1B O nOc w �x mm_m R� � � N nod o 9� oo = N W E O d� 9ddm6 UTU9N �QLE 9p�'6 m w - O N n U C U Np Y w� >N�oH Qd OYWa>i= �'9 09C dC mdmO Ym No A c m aOri wane m C .Q can C m ou N Y_ [ S i E--EEO c n« 9.oc owj°Oa m3>o dN rndo mm moacivc g .`w aid�'o+u cc.E� V, Y d n a t >= J Q E a j m o H d d ✓, g y c o E m� R 3 m y -wo c a c d't oi� m EO 'L O A U�En me EE'Zc OcvcL _�ai3o 02 uoaAO '3 mYon oc of ay oEi E F' S o O n' = rn L' .? LL C N� C W 'a m a a aoi Yo m V O a c 'Y ._ O m d o E O° o ', c o c ry �tO o aNiY« a>+°.' mo°r'v g?.N.o y�� oc'm o_cwin aci :c0mE sd oomm O« 0 3 a A a o m C o> m m E A 9 �"� 0• 3oaE9 a m Oa _ d Cnm Cmc>G ofw>ommio CC a2io WJ m� ��a� @o Usc of wS O o m m m O n aO m a n� .0 � c � A$ ,C �« Oo'�to da N'y_ o'wma YaN' aN Av o EC oA EwOc V. ..y �j'm Tc cS m•owom Gnw>JQ � O �o>como KQ rnn /1 90 ❑a sR m_ ar W 0 O o %el_ p - O -` g slaqT m o ❑s of rm 'T "JOl p2a P wn= mmPP 6= O 0 C) C7 (p o3v g` me g! � (D hvomz 30 �mnm3 ozR z. u 33F to o: A! m.6 O y _ y 3o m O O m - m y w rl CII 3 a a � m v 32?I a u ru 0 3,o e- q �m 3 �O ❑a0oo - nm N co C O oyez c a rn am V gs Z r ❑ f� T 3 S m (N m m r"- C') O a Z Z. m a n ©3 n n 2 m o ao IZ CD d (A N L ma ^' (D r— r a ma fc O N 9 __ r' 3 h coa y wry Z C O zZZ a —I (D ti IN � Iw I � O O CO iru C3 N �. Er 0 O Ln gm ❑o ❑ m = J g.e o - -- llsilf; ^ ' O = s ❑ of O z 3 2» ❑� nI b ¢46A. g� oN ;.kfl Am L a lft �a3 -El ` CO L�. n a o ❑ ° a 3� _�❑ CD U) 'O a ❑ �� n 3 •.3 ag m3 V = "NO33H UnOA H0j AdOD SIM NIV13N d y U c �FRm1� �.Em o @mac E- cd tutu oam gm m.L. >'E—... y m a 'd d 5 U" m c 9 - d o nm E c w Z y o LEya of rn�o"o.N._Zti r N U d0_lC0 T_ N�.6`O.W=� �Cy G� d@NN aA OIN 'y m EE�� d>iyy -� �Z W`S •'po` F-a tw u�Sw 0o n .K EN—m �m ~dV-Wjw� Trn t`ny ac TUCp. �@ 6�T UN CLO r C� C �N m Nm�y -o Gz �aEi o_OTm ymm E. NOo Wm rnN mm'o n .pm m Oy nmm o 3—_ Op1 NY d �c •' �' �_ wpn a•a._ ..y E zYn 'LL y v m E y mood Cab'i GLono 0-60. g mudE p9 OCG a`d' t aY _ Q d O a Y O f U O C m C E m L L y di @ L d a C 9 .�o m N d dm'�••@YdOImd OQmf3 Cd�a �d'.�LLaum. .LL«a rn m E y t n i E E.a« E� o y Oho O�ym wA C1rw as E� GTE a a X d CO V UO r «901N .•^'�� «ym � mN �a � w mao aE3" ¢ � 'E N mtp E'- 't" «d'sx�«�E� �r d cC do>$ m15 15 « « L" >« d L ..9 E .N .- .aC- C TY= m d O N r O. d@ LL m~ @ m G N d O+ tUil > « r m mn Y u O a O C a O 6� n@ O :..�UyU�@daOdO Qy why N_O. C `m«T«.m �c a•p ;2'`°mE ao.Em m m E. � omw N m m'dat mat o mEm Enm o. jE 'm �• a o>-o o u c « �15.8m o. m y E c c o to E oos��_E>� 9 E c t E m 10 a c w_ L x m E a`i mod «Ew: oa' .-E�7 dE� "a�mwoa °' ai Q.Z'fn doW cm p E N w o y o 9 m E � o _ _ L m E o �o—mq R.c oom L IL@coi 3rn3 �mmu n«Em ma c °1 I I I O rn m « y E _..i aT 9LL@�E C TE a d a c°' o « 5 my LNWa «gym a @ m LLo 0 2� a !P m m c y as rnm@«L- O'E«n of tun =s�dw aym o —E i w 'or od�'o. am�c�ym �,` O� o,aa CmoS �E oo Eom ao3 and > oo p1�Lmdd d � E_1O L W d mda m� @o aa� c do dd - OIUE�G9L „�� _n �m ap m,Nd9a�_ do` d N"-m �Td mJpyCDm �d�C1L,t>—y2JQ O .nEc Nc@a'dd 6crn«m3 aom330 aom@3m mN.y H'^ Eo Aso U d HwaEi EEy=Zo Owc my :. OT3 p 02 win ao.�y @mo a oc oL- r�p 3 L. o V $-« tutu mNo LLmc'm mu'cmo O� aom��a tummy m «orn �l ccN-~din««Z >m�3 tutu r,N.;�Od duE..o 3D��d�m jQ`-w� oo `m OY m. c p Hom .•m v' 'm V m aoE �'.E d m E om FE`o i... 6 N m O C T [i d 9 � C N U �« W� a G � • G O a C C o y o n�_� •C m C d p � m m � c a% @ � '_° Y c y o E@_ M yY«�ca 3rn OLL�yE�w aE�n �9 "c'mm$o covtn3 Gdv EEL..-vQ m�o� and>a=EC om Eu3c Y-� pm Tc'35 y..�y@��Gnmi JQ OWeQTNNUU'OKQ0160 ^. RM o� d¢LONF�Q A n ¢ o aa�"a a 2m�nP�a. m3oy-� ❑a y Wm$ 2d� cc.g 3xcP m- tn33mo m c3�3go - m3Tp�m x 3A8�vm H m m m 3 v > -Q l cmm oil m c s I �Sm}g� oamm I m' a m e 'M x�ama 'm<' r 3g r ,y �m as TTN• m�g to Cfi CR _ m _ m 3� 2Sol 4 N 1 m o _® A� ❑ nmm anx n� _ m W n 3 2v n 3 N < W d N � I i P O O n' V O C3 N I Q' V � Ctl O El 21 N O n a ru m' a 3� mm x 3. y 23 El z [T4 Ai _ pn �N _ mn ❑ma ?� O y 3n 3 ay =C ❑ CD Ul yy Pi P 3 ON snaoaaa anOA HOJ edoa SIM NIV138 9 d E C d C T N Ni ry .XEm �d ddoo o-g�' AST Ed E= - om'�o o Eo m OdTA CO O�Tddd 06 U. CYN 'rd �0 �.., AA t Emn EE �Y nEN Z� dT d3�.i m� HOv�aa H U C i 0 A O1P 0'c of �a'mHp Uy ,Q dj OI«/lo y ��]n jd mE, Ad OU TO Ji7OOVJd �N anmd �� dW � �'y' o9LL5 d Zi E.vim��� f-£ Cooco y �Yn dim s,c TE a`.o= m pmEvm o-OTo 7o �`E NrnLLn cN yyv o f m and Cm 2Loo.O mJo mma ppxoE ry Oc c uxi ao L S m an d m X m y m U r' Y IL N W d O m) c W L W y E m f lL d E > ? n 01 a ma 's o n n cv E5- CC T CC 9 9 �•� d X d C� d Q U V N rEE p 9 9 c cE S m 3 0 � E o E m o S - d �'d_' mywN x>> 20 wa good oa L 3d `° o o Az - .°.3 d 33 mYc tO Amin is>S �E9 �_� �y ^`mom d don- v m d 30a`"i d= 3 cE ada Oi£AS g.E om `°`mN� W m«Q-E Y x c o A d o A A .« - 9 u C 0 9 0 d d C J p L> L m d'U W r 6TWLL O dNV 90. �_ �O)NJd O Y._ 09 �9 `CTa d f C N C w d W 6 E U d 9 d l] ~ L d Ls d> W E o'w 7 -' w « a�m35 � y'y :;c U Y � Lyd >NO C'rY ON �Oy 9'U `�'q TTjU d qo �.9�Z j y� m am aOgg A m> a`o ioE mm o09 >mm m �v o. me uc`o m `m� oo Co dnt_9iOc '`° 8 '� m Y�'O `°cLmE W 9C•N �L gym` y-auio No.,�y Vo._ cod m'-TE . E w 9-A �m .p amiE ��S � Ew 9vu'idd oa v�o�Q;�'in u� m LYm oy o o ofJi=nc o"L-L.,.c:._d Eo s""�ECc `'d.`c 3NoaA >Q .. �o.:Ud. W'E oo �1QS Eva odo"m a-(oaJ`c IL A.. 3N'3 umL f A'� dN0 d0 d'09T dd� O O'H dLd 00>i .✓ d> > L U_ Oi C 7 a N W n' N✓ C j m a C ✓ ~' X C_ pi N V o _ �9od E ass sd Cry dm .n Uaoc Nm w'° �a udm da' d amcL ,� o O AAO� TNL U✓� QO YY Wa �C Od TU d= Od7E 'v 9 mo cam' dmm� Cm.n eau Cmo.�.r E ooEooZ �o3ot °' Emm Ol `o¢�om m3To O wo:=c= m Eo cnS O - T viddm W.y� Wjm mocmv+o.-BNo 'E._ U n E n m 0 m a n c t o m- 7 0 - o m @ j m c a N o N s r� a E EEoSuo in�t Y: p>:3o OZ oin rno.A"'3HmYo ai d c m 00 u E d> 3 m 9 9 a m y N C o m d o pmm Co c._9 d«�m 0J2 ..2 d >cv3E .c Evm 0 o b E C n w m Y c m E M Y n m w r m r. e W_ - 9 .E .: 9 3 d '- y c- d n 9 Ems« E O Ez -,a - � mcO-o m N UbC m of m md9 yam M.o� Ec Omm E$c �vvca3 r Gw �' Qi-mmcoi two �Q rnn'om 0 3 �6 ppJ� El= m na�o2 N. O p oa AFi rn ine r-° aq=��o3 ❑yy 0 �CD nl n iF '+�, N m3gnP'g moZ n � ayno `P rang _� 3 m az _goy o� am Ac$x = m cwo �a3a3�y rtca 3m3 W3 I�ci O =sagnmay I w O =9� oo O �83 nG _gym ❑ W mm ru LY m � ❑ M 097 n 3 n 3 Rono ` H 11 *1 N n C, f7 < N W� d� w5 d� Z C p 'o o s Uj z O 7 w a� D n �. s M 0 m m' z r C m a a z i0o Iol i W 0 r 0 N C3 lu Q f . IR7 Q r 1 g V o N DO 3 Q ru O <T b $.^ w ❑ i w• � El2 ym m a�^ m m Pp ❑ea cn _ ❑ ��_q cD e s C ] - 3: _H ❑ CD to -� z sy CO) sa ti csr s N N •3 qQ �3 N S9a03311 VnOA 1101 hdOD SINI NIV1311 THIS FORM MUST BE COMPLETED BY ALL PkOPOSERS CITY OF FORT COLLINS, COLORADO PROPOSAL FORM 1. Our proposal is valid for 90 days 2. Fee/Rate Guarantee: PPO Network months POS Network months EPO Network months TPA months UR months Stop -Loss months Carve -Out PPO Prescription Drugs 3. Standard & Poor's Rating (if applicable): 4. Commissions: Yes No 5 months it yes: i o wnom $ /year Contact Name (in case of questions regarding proposal): Telephone Number: Fax Number: 6. Carrier Name: 7. Complete the following: COMPANY NAME ADDRESS DATE CITY. STATE, ZIP CODE SIGNATURE COUNTY PRINTED SIGNATURE TELEPHONE NUMBER TITLE FAX NUMBER ANSWERS MUST BE PROVIDED FOR ALL ABOVE QUESTIONS ON THIS FORM. DO NOT REFERENCE ANOTHER SECTION OF THE PROPOSAL FOR YOUR RESPONSE. M r N O1] Cd NNO JLL XNN ?�N U O L >v C- n U OI m✓ d C O m Q m 9 O � c E U L N N m J .Ni+ O C Y O y O O OIN C z. Q d Q O'n O N d d 9 N L T= C d 1 EEmda o..w v_+m da Ey.-ZQ m� m3'^ mE anDa�s Wd E y N o (n d an d d; Z c m y U C 6 m d:C T UN ct O V C A C d p � W � E rn�Of Z t; OI N VI L d �°�uc {�7o •'un'ca o, ��a mD C'C93m� �'ud`. wca e+s oty C.m �so vnio mJo ydjmn LOxmE yD oc � E Kam W- `+EaxoOcd�E �" ms¢ mAD„ Ol co ac m r d c E �aaEE 6>ce yDsv+m Cirw Q« D p �C X d C O (J U O N 'N -p OI ymj m N O W 01 D m m ~ Eu E v+m X$ � Ew� m Z o o� o .a c o EmE ,.o E mn3- i•m d ax�o mo'm monAY o -o Noma f', �.✓ X O j E J O t D W D O d d u C C m m m D' J E O O L dL N a E y L 9 C _ L O V O Q'Y C T N T N O V_ LL d m N d d O x W O% Ip O L V m Y d m U m 6 U W O« GOO O •.m'NU Dn� O+N dDH OOO aCr >'d OOfOJ > C 'O n V D m N 9 = •. E V V D d T H d L G 9 O z N m O m c'�,•°_.'Oa o �om E�«' nn.E and E`o 'sv+ ?'Lwg c�`>°� d d UEyNO � L � �m � mlO d9:_y"C 3 Od LLL a �« mN p m �'oi't A3s o oo'mEamn �E mw•� >EE 2y' y C VI Y d > m O N d_ U N d m O _U C Y a 0 •• •E > N d y Y 9 J« n O C d ON a0 J C T m N ✓ 7 'O ccco m +`o� '-'o�A m d E� W Eo E>•-Ec iE.�c-c 0$ 7 0 `-^ E> E d DEo9 mEm Wa.N-9m'P x'OEacimooE���+ �E H C D C Y 7 N d N d >i d - N E C 3 _ E N C T� �O.26m mm s`° LL��� oim >i�nL.mmmo ILdm N3 0 mo N O�oa ma ycc �m9c xc o�y m�' o'-sd�E CiE mD9 ocmo S. sNWD m�� D o3n'-'in .m. 7�i c,c��m c6�_y :Ei msc 3d�m .E�c E DdN E2 N Omw�mrn cn. a •� >_ a m c •I�l o c � E «o m� C -mo �� o. n✓ i o c Y m Y> E o o H o 3 n d c o �' �. TYdd dQY`r c _E �._m �� .�E �a dm ���E9s ama E��o amdam N d �omTo �E Ys?aE�T-N��m j Qt0 ac�a -ZEE 0 - - - Q m o � 9 1- N N'U yY U ayH6co oL m3 0 >d o 00 �mE ° -aNmo h cy d NYm EEi� p1 o O m".c .o+«- p 'v3i OZ NF» o-> 'Y-N and mdz LLm'�d�E LLomE co oo UtTp> �� ..m ?�' ` E o m C c o 0 0' i °1 E a o o m m C Y .. im2+ E m a i n m «n d N c Z's ''r, W '� v .� T' D 3 m e m o o 0` o_' W e OCI m OnN-N p 9Nd« C d� m NN.Om 00 :UUYC 3 OE �a9� 3 m p,� d m a yw O E> n J 3 u 1Oo9 d ays 6 d 9 o c= a e m A Y= 9 Q m? g m Y E 9 E E c o m E n= Odm �E>co�� p. oaEm 2nmTJQ Q W O O w N P L' a qq2 ❑f A. a�N 1 zo Ul x� m ?.X n0 mN N oSm�� acOM ry ^I O Ur DTI r mAaa': e3,en m ID 'm =AV N3 ❑s (z7 m o a. n oa„�dcg y C7 m3ozopc rno• CO w sq 8g N3' "eoo qm sm 5` „�S O �;yoya o ma Zootil m ffu uql �oaN3 iry�o ❑a �I mn_co) l O==gAdma m�ae �8�3g6 tni m' O Q ul f if =F ❑ sn00338 UNA 1101 AaO3 SIH.i reivl3a 9 9 >OIT@ C7 A'O Oj90'iW dy3. ->j'EC z UA d:'i NC U E'E C a m V P L O•�Y/1 C% r d Q O N O L N w d 9 �@ O J A E 0000�1II/ _o n m> d 2� N A C m n y O L m L EV=1 C O E L Y G 'L N-LJ Ol C m 01 J -E C y N N Y A r vs a��o m.To�.N cdi kmy Cif `CIE a E. c'm O "- O .' o o ti9LL a d zi Ev�m m om ~ mw E.> .o c m'ri NVCn �A nC TE UN CYO Ym� Wo NL Wd" �E 71 �+`•@ qiy y-9 :E" cW L i' C7 3 m C L 9 rn Yn `f m N C G Q1 9 1Y p W. �� U @1 W V = N r L a u •r Q O J C {i m 9� m 6 m y A L d C N C 9 O O IA a W d.L O« O •� J O O. O lO O_ U E m o o d C. m cc m y o W p W-'� Co x r_ X m X c YET. O •_ to N C C > O� W Y W C 'O m o9 moo~ Qdmm�OQd gs FY-3n C ii> damn Wmn ��9 $mmE °1 Ln c E->Oxx Yy`« rLu d[=9: LLo p C Y L Z L E N on pl N m _ Eo ui -Asw =- E E mdAo rn 9_ in ao m_ rc p. 1 A m m 9 A w c o 9 ;m o E 3 0 mac@ LL ':.w c' 'c t� LEodo Zim Eo Eo+ E m � m O y N =«U 9 9 9 p 10 cc m > m U d c C E c E c@i n3L m xo N min n m>�'d'md `�•' >>c E moA o cE.. Q mn>>i m« E N O O@ 9 U� m 9 J> O o 'Y 9 d m E � c Q"«� x U r 8 O W w0 A O y U 9nH Old Q �d NPA-J n 1']OaU VCd JNN YU9d OC d"- in ._ OA6E O t0t//aa �9 G� 9 m'�p9 Uj U @ Ted C 90 �mdE C «.Nd�7 3 RCN E yl d6.EUN@O� Nr �� m>Am 'm �._ d q 9- m n TEo@'@Ea d N �E@°^ w O L..@C _m V_ NL aLm+ 5 2L CdV�Nd3! p>�d Ui00 dC'p9 C N �O OO •E •OO NnN CO@ m>Q>PAdA p9 >d Ey79 mEEmc n m; .mom (cm'coo W uy oa_ o�0 900> c v 4 e -F x`N° daio 'N'�� 3m O oZ Umw m� �E vi rd 09C.mEC� «d NC3 d�H 9�dmO NN6 �O�LY OO p� o f w y o d o m s n m o o@ o o m c@i v >>'- @ Ol m>. om o oA3sn o'y ro N._m E.- o.- Yt»LIS i _>Qood@d@Usm LLo'°'n dvoi«rILAd T « y C L E ^ct' yO� c in mdLmzE C TE A9'O 9W, Eo oa d 09 o3a!2 rn� O�@a>EWW �nmo:: Emo�c -moE EEc aides O C m d O V O O @ > N E d> U N O Q Y U N • (J N 9 � j a+ O A 9 d � d � Q U W 1] N O• > m T O C A N C d C L OI m C Y �. •1.� oc9 m nm C mL rn n Cm o w =E o>�o mZ mo3 @E o.Y JT°'oOf mil,JE 9L V�-¢ NCO aW �d-VOO �dNmOd9C U-�'001 V =� aNi` - � U O) C - W m E L l0 W L L � ✓i N y 3 0 T m O N d d N W n O d 7 d a 0@@ Y 9 O U n2 c_ .-? c LLc m m3 0 3 O0 mmT w@mo m E W o� mo Y o.csL: p?3o OZ E E CrnO =o'«^' N R`o N >o�>Om �doE �'o 3m=ad d n�cc .M Li Oo` Oyo-co _�@ao @P �2od C� 1O coon d'O J-E oomm `� c ~i.m°,_�'� odic d Lod �j y a m ODm�T.v3 m� moo o To"vc W n w C o >F u E m Y 9@ aNi " W c o m m E O m= Oy« Emmca'3 �' O- v+d'- 6mmE" 9 E c oo c99LL !� o Wv+A'yU dQ E CC adoYam gE,90 EC pm@rwc -o�°om Qnmi JQ ^ SECTION II ATTACHMENT C THIRD PARTY ADMINISTRATION (TPA) SERVICES THIRD PARTY ADMINISTRATION (TPA) SERVICES SPECIFIC INFORMATION (continued) Large Claims History - EPO Plan January l.through December 31, 1997 (claims exceeding $67,500) January I through March 31, 1998 (claims exceeding $25,000) Total . . .... Dm' gnosw,Pro asps None 28 18. Provide COBRA and Retiree administration to include compliance, mailing notices, collection and posting of premiums, recordkeeping of payments, changes in coverage, eligibility, answering questions from participants, reporting and mailing payments and appropriate reports to City, and follow-up as needed. 19. Coordinate special situations with the Utilization Management company to insure appropriate payment of claims. 20. Provide support in compliance with issuing HIPAA certifications. 33 SECTION H ATTACHMENT D UTILIZATION REVIEW (UR) SERVICES UR SERVICES GENERAL INFORMATION 1. Utilization review is currently performed by Rocky Mountain Health Management Corporation for the PPO plans. 2. Utilization review is currently performed by PacifiCare for the POS plan and EPO plan. 3. Please refer to Section If, Attachment B (TPA Services) for experience information. 38 c. Briefly describe a Utilization Management program/process/tool developed by your firm which you believe is innovative in controlling or measuring health care costs. d. Does your organization offer disease management programs? If so, describe including chronic conditions evaluated, length of program, savings and associated costs. Are the costs included in your quotation or are they additional? e. Complete the grid regarding your firm's Utilization Management services. of Client Check (X) the Type of Service Number of Firms 7NumberType General Medical Worker's Compensation Taft -Hartley Trusts Single employer corporate Government (State/Fed) Municipalities (city/county) Schools Associations Other TOTAL 61 STOP -LOSS INSURANCE GENERAL INFORMATION 1. Stop -loss coverage is currently provided by PacifiCare for all medical plans. 2. Individual stop -loss rates are currently as follows: PPO POS EPO Employee Only $3.88 $3.36 $3.23 Employee + Spouse 8.52 7.41 7.10 Employee + Child(ren) 9.50 8.27 7.90 Employee + Family 13.17 11.46 10.97 The City intends to retain the four -tier rate structure. 3. Organ transplant benefits for all plans were carved out through BCS Insurance Company effective June 1, 1997 and therefore, should be excluded for rate quotation purposes. 4. Stop -loss coverage currently does not include prescription drugs. However, your proposal should include prescription drugs under stop -loss. 5. Please refer to Section II, Attachment B (TPA Services) for experience information. 6. Your proposal should assume an effective date of January 1, 1999. 7. Medicare retirees are currently excluded from stop -loss coverage. Your proposal should assume they will continue to be excluded. 62 REVIEW AND ASSESSMENT - Section VI Professional firms will be evaluated on the following criteria. These criteria will be the basis for review of the written proposals and interview session. The rating scale shall be from 1 to 5, with 1 being a poor rating, 3 being an average rating, and 5 being an outstanding rating. WEIGHTING FACTOR QUALIFICATION STANDARD 2.0 Scope of Proposal Does the proposal show an understanding of the services to be provided, philosophy of the City's medical plan and goals that are projected based on these services? Number of providers? Specialists? Locations? Facilities? Adequate providers for # of employees covered and accepting new patients? 2.0 Assigned Personnel Do the persons who will be working on the project have the necessary knowledge and skills? Are sufficient people of the requisite skills assigned to provide these services? 1.0 Availability Are the hours of availability reasonable and convenient for adequate customer service needs, if applicable? Are other qualified personnel available to assist in meeting the service needs if required? Is the service team or representative available to attend meetings as required? Could the transition of services be completed by January 1, 1999. 1.0 Motivation Is the firm interested and are they willing and capable of providing the necessary services? 2.0 Cost Impact Do the proposed cost and work hours compare favorably with the intended estimate? 2.0 Firm Capability & Experience Does the firm have the support capabilities the assigned personnel require? Has the firm done previous projects of this type and scope for similar customers? 0 SECTION H ATTACHMENT F PRESCRIPTION DRUG PLAN PRESCRIPTION DRUG PLAN GENERAL INFORMATION 1. The current prescription drug program for the PPO is a carve -out card plan through PCS Health Systems. POS and EPO prescription drugs are currently covered under each of these respective medical plans. Current plans of benefits are described in Section III. 2. Your proposal should assume an effective date of January 1, 1999. 3. There are approximately 605 employees and their dependents with prescription drug coverage under the PPO plans, 80 under the POS plan, and 585 under the EPO plan. 4. Please refer to the experience information in this section for purposes of your quote. M. PRESCRIPTION DRUG PLAN FEE OUOTATIONS (continued) POS/EPO PLANS ONLY Mail Order Only POS EPO Generic Dispensing Fee $ /Rx $ /Rx Brand Dispensing Fee $ /Rx $ /Rx Generic Discount Below AWP* (AWP based on quantities of 90) % Brand Discount Below AWP** (AWP based on quantities of 90) % Administration Fees (per prescription) $ /Rx $ /Rx Other Fees Identification Cards $ /ee $ /ee DUR Program $ /ee $ /ee MAC Pricing $ /ee $ /ee Other Fees (List in detail) $ /ee 1 $ /ee * If AMC, please indicate the average discount %. ** Indicate Source of AWP. For purposes of your quote, please assume 80 eligibles in the POS plan and 585 in the EPO plan. How do the above charges differ assuming you are selected to provide prescription drugs for all plans? 72 SCHEDULE OF BENEFITS (enclosed) SECTION IV CENSUS (enclosed) SECTION V Attachment 1 - POS/EPO complete list of physicians (Northern Colorado) Attachment 2 - POS/EPO top 20 physician list Attachment 3 - PPO top 100 physician list FORT COLLINS - FOR IVIVKL.AN • I , DENMARK, LARRY EDO 970225.9191 4601 CORBETT OR FORT COLLINS. CO 80525 Nmwk:PRO DENMARK. RAINA M PSYD 970-493.1358 112 5 COLLEGE SUITE 200 FORT COLLINS, CO 80524 Nmwrk: PRO DERANEY-REILLY. SANDRA PHD 970493-0560 2001 S SHIELDS ST BLO S. STE 4 FORT COLLINS, CO 80526 Nmwrk: PRO DWORKIN, DANIEL 5 PHD 970493.9205 1355 RIVERSIDE AVE SUITE E FORT COLLINS. CO 80524 Nedo/k: PRO FARIS, MICHELE A PSYD 970493-1358 112 5 COLLEGE SUITE 200 FORT COLLINS. CO 80524 Neewrk: PRO FISH, DONALD E PHD 970464-9086 6 BLDG E ELIZABETH ST BIDC. FORT COLLINS, CO 80524 I' Ne6wxk: PRO FISHER, BARBARA PHD 970493.8006 1302 5 SHIELDS SUITE A24 FORT COLLINS. CO W521 Netwk: PRO GA®LEK, FRANCIS PSYD 970.4954567 112 5 COLLEGE SUITE 200 FORT COLLINS. CO 80524 Nm1 k: PRO GLASSEL JEFFREY PHD 970493-00% 1302 S SHIELDS SUREA24 FORT COLLINS. CO SOS21 Network: PRO ]ONES. BARBARA PHD 970493.3040 1302 5 SHEKDS SURE A21 FORT COLLINS. CO W521 Newk. PRO KIROHNER. KENNETH R PHD 9704934550 1837 WALLENBERG OR FORT COLUNS, CO 80526 Nowak: PRO KIRCHNER. KENNETH R PHD 9704934550 1302 S SHIELDS Al-3 FORTCOLLINS. CO 80526 Nework PRO KIRCHNER. KENNETH R PHD 9704934550 1900 8015E AVE - SURE 130 FORT COLLINS. CO 80538 Network: PRO KUNSTAL FRANK EDO "G-223.9776 375 E HORSETOOTH RD SLOG 2 SUITE 203 FORT COLLINS, CO 80525 t, w PRO KUTCHUKIAN-BOXLEY, CAROL PHD 0-223-5125 343 W DRAKE RD FORT COLLINS, CO 80526 Nowak: PRO LAWUSL FERN PHO 970-224.1500 218 PETERSON FORT COLLINS. CO 80524 Nowak: PRO LINNELL A. TOM EDO 970493.1358 112 5 COLLEGE SUITE 200 FORT COLLINS. CO 80524 Nowak: PRO 10225 P�ENNOCKK Pl. MARVIN K PHO 970-495-8800 FORT COLLINS. CO 80524 Nowak: PRO MCCOMB, MARYA PHD 970224-1567 1045 ROBERTSON FORT COLLINS. CO 80524 Nowak: PRO MEDOFF, LEONARD PHD 970484-0663 1217 E ELIZABETH ST BLDG 6 FORT COLLINS. CO $0524 N&N ak: PRO MOORE MARVIN PHD 9704934227 1025 PENNOCK SUITE 115 FORT COLLINS, CO W525 Nowak: PRO MOORS MARVIN PHD 9704840121 2362 E PROSPECT FORT COLLINS. CO 80525 Netwak: PRO MORIARTY, RACHEL EDD 970484.5955 503 REMINTON FORT COLLINS. CO 80526 NeMo*; PRO MOOSE JOHNS LMFT 97D493.8M 1302 5 SHIELDS SUITE A24 FORT COLLINS, CO $0524 Newk: PRO OREILLY. BRENDA PHD 970495.9045 1024 CENTRE AVE BLDG E SUITE 200 FORT COLLINS. CO 80526 Network. PRO 1AINTON, :A PHD 970492.5878 I120 E ELIL.. .1 3LDG F FORT COLLINS, CO 80524 VeMwk: PRO POSES. PETER L PHD 970.4823429 1006 ROBERTSON SUITE 202A FORT COLLINS. CO 80524 Net o*: PRO SCOTL TALLY M PHD 970498-0365 1217 E ELIZABETH SF BLDG 6 FORT COLLINS, CO 80524 Nmvu,k: PRO SIITERI. ERIC PHD 97041646I6 2001 5 SHIELDS ST BLDG L FORT COLONS, CO 80526 N&t * PRO TAHAN, PATRICIA PHO 970493-9205 1355 RIVERSIDE AVE SUITE E FORT COLLINS. CO 80524 Ne9wak: PRO TAYLOR, SUSAN PHD 97O221d266 1006 ROBERTSON SITE 204 A FORT COLLINS. CO 80524 Nethak: PRO WELSH, LOAN R PHD 970-129.9121 316 DEL CLAIR ROAD FORT COLLINS. CO B0525 Netwrk: PRO GUNSTRFAAL STANLEY MO 970-224.9102 1247 RIVERSIDE AVE SUITE 1 FORT COLLINS, CO 80524 Network: FOP HOYT, TAMES D MD 97(1.224A102 1247 RIVERSIDE AVE SUITE 1 FORT COLONS, CO 50524 Net ak: FCIP PERUN, MARK MD 970-224.9102 1247 RIVERSIDE AVE SUITE 1 FORT COLLINS. CO 805Z4 Nowak FOP UK MENG L MO 970AM-3328 1240 DOCTORS LN SUITE 100 FONTCOWNS.CO80524 Nowak: FOP. NC USHLA, GWEN MO 970482.3378 1240 DOCTORS LN FORT COLLINS. CO 80524 Network FLIP SIMPSON, KELLEY MO 970482-3326 1240 DOCTORS LN SUITE 100 FORT COLLINS. CO 80524 j New o*: FOR NC NEWNIEWL MEYER-FREDH MD 970492.1695 1217 E ELIZABETH ST SUITE 9 FORT COLLINS. CO 80524 Natwak FOR.. NC HOWELL, LYNNEM MS 970493-6667 1049 ROBERTSON FORT COLLINS, CO 80524 Nowk FOP MIZUSHIMA. MARGARET MS 970.226.2926 3030 S COLLEGE AVE SUITE 101 FORT COLLINS, CO BOS25 Nowak: FLIP PENDLEY. ANN L PHD 970493-6667 1049 ROBERTSON FORT COLLINS, CO 8OS24 Nowak: FOP PENDLEY, ANN L PHD 970493-1150 2001 5 SHIELDS BLOC 8 SUITE 2 FORT COLLINS. CO 80526 NeMpk FOP SLOSSON. CYNTHIA MA 970.226.2926 3030 S COLLEGE SUITE 101 FORT COLLINS, CO 80525 Nowak: FOP SORACL LYNNE L MA 9704412.2515 1200 E ELIZABETH 5T FORT COLLINS. CO $0524 Network: SLMC HARVEY. ]OHN NICK S MD 970493-0112 25DO E PROSPECT RD FORT COLLINS. CO $0525 Nowak: FOR SLMC CHIAVETTA, THOMAS MO -9704824456 1015 ROBERTSON FORT COLLINS. CO 80524 Ne : FOP. NC CRIBARI, CHRIS MO 1.5878 1148 E ELIZABET}I ST FORE COLL. ) 80524 Net a *: FLIP, NC HENSON, STANLEY MD 9704824456 1015 ROBERTSON FORT COLLINS, CO 50524 NeMo*. FOP HOHM. RICHARD MO 970490.2662 1217 RIVERSIDE AVE FORT COLLINS. CO 80524 Netwk: FOP QUAID, ROBERT R MO 9704824456 1015 ROBERTSON FORT COLLINS. CO 80524 Network: POP, NC RIVERON, FERNANDO A MD 970-2244434 1224 E ELIZABETH ST FORT COLONS. CO 80524 Nmwrk: POP. NC TAGGE. GORDON K MD 9704M-6456 1015 ROBEWWN FORT COLLINS. CO 50524 NeMpk: FOP, NC TUTT, GEORGE MD 970-221-SB78 1148 E ELIZABETH ST FORT COLLINS. CO 60524 Nmw k: FOP. NC WISE DAMES MO 970482-W6 1015 ROBERFSON FORT COLLINS, CO W524 Neiv pk: FOP, NC LESSER, SCOTT D CST 970493-0112 2500 E PROSPECT RD FORT COLLINS. CO W525 NOVANk: FOP NELSON, FRANKLIN D SA 970493-M12 2500 E PROSPECT RD FORT COW N5. CO 80525 Nowak: SLMC POKTEL MARKS SA 970493-0112 2500 E PROSPECT RD FORT COLLINS. CO W525 NeMak:FOP SHERMAN, CYNTHIA M SA 9704934112 2500 E PROSPECT RD FORT COLLINS, CO 50525 Network: SLMC Fall 1997 DENEGRI.ALBERTO MD 303-892-0004 1115 2NO ST FORT LUPTON, CO 80621 Netwwfr: NC SLMC GREEN, DEBORAH MD 303-659.2094 315 PARK AVE FORT LUPTON, CO 80621 Netwk: NC SLMC JOHNSON, WARREN T MO 303-957-6111 375 PARK AVE FORT LUFTON, CO 8W621 Neaw *., NC SLMC LICONA, VIRGIUO MO 303492-0004 I I75 2NO ST FORT LUPTON. CO 80621 Network: NC MCDERMOTT MARTIN MO 303-659.3151 327 PARK AVE FORT LUPTON, CO$M1 Nen.wk: NC SLMC SPRAY, SELWYN M MD 303.857.1007 305 RB DENVER AVE PO BOX 650 FORT LUPTON. CO 00621 Newalr SLMC MAY,ANDREI R MD 303492-M 1115 2NO ST FORT LUPTON. CO 50621 Network: NC QUINTANA, ELANE MD 30MS740% 305 N DENVER AVE FORT LUPTON, CO 8%21 Na-wk. NC CUSS KEITH MO ET 97086741221 220E BEAVER AVE FORT MORGAN, CO $0701 Nenwdr: NC GARONER, IED MO 970467.4334 830 MAIN FORT MORGAN. CO 80701 Nehvwk. NC KRI i , DONALD MD 9711HIII 6B1 10N 2 W 9TH AVEFORT MORGAN. CO 80701 SLMC -® LINDELL XVAN V MO 970467.8221 GUAOAGNOLL MARK D 4434 220 E BEAVER AVE FORT MORGAN, CO 80701 Nenwrk: NC SLMC /234 E ELIZABETH ST FORT COLLINS. S. CO 80524 GO Netwk: FOP MEWNGER, WILLIAM MO 970467.5681 VOILES, DAVID MD 970.4907662 102 W 9TH AVE FORT MORGAN. CO 80701 NeMak NC SLMC 1217 RIVERSIDE AVE FORT COLLINS, CO 80524 Nowak: FOP OVERTURF. BRUCE R MO 9704674911 231 PROSPECT SUITE A FORT MORGAN, CO 50701 NeMak NC SLMC DU073NSI0. PAUL MO 9704846700 PALU, MARGARET E MO 976467-5681 ISMS LEMAY Sr FORT COLLINS. CO SM24 102 W 9TH AVE FORT MORGAN, CO WMI Ndwk: FOP NdM *-NC SLMC EVERETT, RANDY W MD 9704844700 PENTECOST. JENNIFER MD 9704K7.OM 1500 S LEMAY ST FORT COLLINS, CO 80524 909 E RAILROAD ST FORT MORGAN. CO 50701 Nm"k: FOP Nowak: Nc E7IF" WIWAM MD 970221.9545 THIEL ROBERT MD 970467-5681 1337 RIVERSIDE AVE 102 W 9TH AVE FORTMORGAN, CO 80701 SUITE 3 FORT COLLINS. CO 813524 Nemwk: NC SLMC Nowak: FOP THOMPSON. PATRICK L MD 9708674221 MALONEY, IDHN MD 9704846J00 220 E BEAVER AVE FORT MORGAN, CO 80701 1500 S LEMAY ST FORTCOLUNS, CO 80524 Nvnwk: NC. SLMC Navro k: FOP STANDARD. PETER I MD 9704846700 1500 5 LEMAY ST FORT COLONS. CO 80524 NeMark: FOP RICE. ROBERT MD 9794674823 419 E 9TH AVE FLIRT MORGAN, CO M701 Nmlvrk:NC FORT LUPTO ®- VILLAR, ADOLFO MD 970467-0300 909 E RAILROAD ST FORTMORGAN. CO MMI Network. NC GROSS. MICHELLE CCC- 3034 5746B6 25B 3RO ST FORT LUPTON, CO Ml NeMak: NC BE IL. JOSEPHINE S LMFT 970467.4924 910 E RAILROAD FORT MORGAN. CO 80701 Nowak: PRO WILLIAMS. TERRY DC 3032574633 331 PARK AVE FORT LUPTON. CO 80621 Nowak: SLMC BLOEDELWIWAM MO 303492-0W4 I715 SECOND ST FORT LUPTON. CO 50621 Nowak: SLMC SLOEDON, WILLIAM DO 303-M-OM 1115 2NO ST FORT LUPTON. CO 80621 Nowak: NC BRIGNONI, HECTOR I MD 303457.40% 305 N DENVER AVE FORT LUPTON. GO 80621 Network: NC. SLMC CANNON, DANIEL MO 303419241004 1115 2NO ST FORT LUPTON. CO 50621 Net k: NC. SLMC SPAULDING. LYMAN MD 97OS42.OU2 231 PROSPECT SURE S FORT MORGAN, CO 80701 NmwwkNC SLMC EVANS, RICHARD P MD 970467.3391 1000 LINCOLN FORT MORGAN. CO WMI Nlewak: CUP 57ULL PHILIPA MO 3M4954060 102 W 9TH AVE FORT MORGAN CO 80701 Net .MA4A. SLMC LN 56 SLOANS LAKE MANAGED CARE j City of Ft. Collins Top 20 PCP's Reported as of 5/98 PROVIDER NAME STEPHEN YEMM MD GEORGE VALLEY MD SHIVALINI SUNTHANKAR MD MILFORD THIESZEN MD RICHARD BOOTH MD DOUGLAS DEYOUNG DO JOSEPH LOPEZ MD CORY CARROLL MD DAVID ABBEY MD EDWARD BENDER MD APRIL GRAY MD H G CARLSON MD STEVEN THORSON MD DAVID OTTOLENGHI MD ROBERT HOMBURG MD JEANNETTE MERCER MD WILLIAM THIEMAN MD AUSTIN BAILEY JR MD DANA WINGATE DO DAVID ALLEN MD Page 1 awprM m E k)-T 3 FMPA00 FM1A01 95153 15:21 199E JUNE 02 PACE EXPENSE D 1 5 T A 1 5 U T 1 0 N BY PROVIDER P A 1 0 GROUP 17 CITY OF FORT COLLINS OATS SPAN 9T101 TO 97/12 PROVIDER N DAYS RB CHGS BENEFIT AMC CHGS BENEFIT OUT PAT CHGS BENEFIT NAME CLAIMS EMS CHGS BENEFIT TOTAL CHGS TOTAL BENEFIT X TOT ADDRESS CITY ST ZIP PHONE �wcccssssossm=--_a_aeuuacs-so. «=vvnvve 84-1122837 PRO BEHAVIORAL HEALTH 553 DE►T 0514 DENVER CO 80263 (303)512-1240 64-1352405 CLINICAL LABS OF COLORADO 515 PO BOX 46504 DENVER CO 80201 (303)922-2210 64-1178797 ADVANTAGE CLINICAL LABORATORY 420 13952 DENVER WEST PKWY STE 400 GOLDEN CO 80401 (303)271-%S4 84-0747567 2 MURTHY KRISHNA C MD 274 1124 E ELIZABETH BLDG E FORT COLLINS CO 80524 (303)221-2370 84-0985071 SCHRAM BRIAN L DC 2" 1424 E HORSETOOTH RD STE 3 FORT COLLINS CO BU525 (303)462-4047 W0791312 36 JINICH DANIEL MD 228 1221 EAST ELIZABETH SUITE 4 FORT COLLINS CO 80524 C ) 84-0890573 BOOTH RICHARD R NO 176 20M S SHIELDS BLDG G FORT COLLINS CO 80526 (303)484-4871 84-0747567 3 VEDANTHAN P K MD 16V 1124 E ELIZABETH SLOG E FORT COLLINS tO W524 (303)221-2370 84-0732417 1 TENN STEPHEN J NO 151 1212 EAST ELIZABETH ST FORT COLLINS CO 80524 (9T0)482-2791 84-0592063 3 PINCH HOWARD NO 143 4200 WEST CONEJOS PL 9234 DENVER CO 80204 (303)592-7264 84-0732417 2 BENDER EDWARD L MO 136 1212 EAST ELIZABETH STREET FORT COLLINS CO W524 (3US)482-2791 84-09T1410 1 HMS JAMES M DC 126 1337 E PROSPECT ROAD FORT COLLINS CO Son (3U3)493-8360 - 84-06T9626 1 BEARD DONALD Y MD 124 12W E ELIZABETH FORT COLLINS CO 80524 (970)482-2515 1 MPA00 FM1A01 93153 15:21 1998 JUNE 02 PAGE 2 EXPENSE 0 1 S T R 1 8 U T 1 0 N BY PROVIDER P A 1 0 GROUP IT CITY OF FORT COLLINS DATE SPAN 97/01 TO 9T/12 PROVIDtR 0 DAYS RS CHGS BENEFIT ANC CNGS BENEFIT OUT PAT CHO$ BENEFIT MAHE CLAIMS ERG CHGS BENEFIT TOTAL CNGS TOTAL BENEFIT X TOT ADDRESS - CITY ST ZIP PHONE ssssssssssssssssxsssss<s..aaaaasasaaaac--..ssssssaaaaaaasasaamaaazazr_asr_raasaaasezr_enzssaazzaaaszzxssszzzzsasazzaaaar_aaaaaasaa 184-0719841 SAYERS CLINTON F MD 120 1120 EAST ELIZABETH 62 FORT COLLINS CO 80524 (970)484-6303 1 84-1012032 2 MERKEL LAWRENCE A MD 118 1006 LUKE ST FT. COLLINS CO $0524 (303)221-2290 164-0706789 2 LUTTENEGGER THOMAS NO 115 1221 EAST ELIZABETH 03 FORT COLLINS CO W24 (303)4908-4193 164-0610541 CONLON ROBERT M NB 115 1032 LUKE STREET FORT COLLINS CO W524 (303)484-8686 1 84-0732417 4 THORSON STEVEN J N0 114 1Z1Z EAST ELIZABETH STREET FORT COLLINS CO W524 (303)482-2791 84-1209445 1 KRAUS"ILLER LOR1 L OC 110 13M S SHIELDS STE Al-3 FORT COLLINS CO 80521 (303)224-5006 1 84-0732417 3 DEYOUMG DOUGLAS B 00 108 1212 EAST ELIZABETH ST FORT COLLINS CO W524 (303)482-2791 84-067M6 18 SORACI LYNNE MA irk*R 106 12W E ELIZABETH FORT COLLINS CO 80524 (303)462-2515 84-06T9626 17 SULLIVAN WILLIAM NO tttA 105 1200 E ELIIABETH FORT COLLINS CO 80524 (303)4W2515 84-iZ8F6(TL Y SEELEY JANET NO 101 18M BOISE AVENUE LOVELAND CO 90538 (303)669-6660 84-1209390 MILLER VERN K DC kRitR 100 3120 REMINGTON ST FT COLLINS CO 80525 (303)223-9993 84-1328898 3 ALLEN THOMAS J MD 96 2160 WEST DRAKE RD FORT COLLINS CO 80526 (970)221-5595 64-1183633 1 TMIESZEN MILFORD NO 94 811 E ELIZABETH FORT COLLINS CO W524 (303)224-1596 Fa SECTION II ATTACHMENT A QUESTIONS TO BE ANSWERED BY ALL PROPOSERS FM►AOO FNIA01 96153 15:21 1996 JUNE 02 PAGE 3 E X P E N S E 0 1 5 T R I 8 U T I O N 8 Y P R O V I D E R P A I D GROUP 17 CITY OF FORT COLLINS DATE WN 97/01 TO 97112 PROVIDER N DAYS RB CHGS BENEFIT AMC CHGS BENEFIT OUT PAT CHGS BENEFIT NAME CLAIMS ERG CHGS BENEFIT TOTAL CHGS TOTAL BENEFIT X TOT ADDRESS CITY ST ZIP PHONE M 54-1102662 RUSSELL HAL U OC xxkx 94 200 SOUTH MASON FORT COLLINS CO 60524 (3U3)482-2053 M 84-0679G26 4 MCGINNIS JAMES G NO xxxx 93 1200 E ELIZABETH FORT COLLINS CO OM24 (303)45Z-2515 M 84-1203645 VEST B LYNN NO PC 89 1136 E STUART N3-240 FORT COLLINS CO W525 (503)221-S795 N 64-1174590 1 LYNCH MICHAEL J PRO DO B3 1100 ►OUDRE RIVER DRIVE FORT COLLINS CO 80524 (303)224-9506 M 64-0679626 19 PAISLEY JAN E MD ##kx ST 1200 E ELIZABETH FORT COLLINS CO W524 (305)462-2515 M 84-0706789 11 LOSASSO CARL MD 61 1221 E ELIZABETH 03 FORT COLLINS CO 80524 C ) M 84-0732417 5 MERCER JEANETTE MD 61 1212 E ELIZABETH STREET FORT COLLINS CO 60524 (305)482-2791 N 84-067%26 22 HANSOM VAUGHN V NO xxkx 79 1200 E ELIZABETH FORT COLLINS CO 80524 (970)482-2515 M 84-0679626 3 ELLIOTT MAX A NO xAtk 79 12W E ELIZABETH FORT COLLINS CO W524 (303)482-2515 M 84-0596245 2 JEFFREY RANSY L MD 79 1106 E PROSPECT FORT COLLIMS CO W525 (303)493-7442 M WIL*U5645 2 HULTSCH ANNE-LISE A RD 76 1136 E STUART STE 3-249 FORT COLLINS CO W523 (970)221-5795 M 84-0688325 1 ONEILL JOHN J NO 75 1224 E ELIZABETH FORT COLLINS CO W524 (303)493-4677 M 84-0T06789 12 FLORANT TRACY ND 75 1221 E ELIZABETH NO 3 FT COLLINS CO W524 (970)464-4757 3 MPA00 FM1A01 98153 15:21 1998 JUNE 02 PAGE 4 EXPENSE D I S T R 1 8 U T 1 0 N BY PROVIDER PAID GROUP 17 CITY OF FORT COLLINS DALE $PAN 97/01 TO 97/12 PROVIDER 9 DAYS RB CHGS BENEFIT AMC CH03 BENEFIT OUT PAT CH03 BENEFIT MARE CLAIMS ENO CHGS BENEFIT TOTAL CHO$ TOTAL BENEFIT X ToT ADDRESS CITY ST ZIP PHONE _saasa-��_-�-_-�-���GrCfCvw������wtMwwwwwwess_--� �----sa___x-__-a___sa-zaa_ax_a_xa__a_sx_--asaassS__S_zaaL_i xas-asa-- i 84-0791312 11 NEVRIVY THOMAS E MO 75 1221 EAST ELIZABETH STREET SUITE 4 FORT COLLINS CO 80524 (303)484-1757 i 84-O8S96O7 1 BURNHM L100A NO 74 1217 E ELIZABETH 03 FT COLLINS CO 8024 (303)482-350o 84-0892988 1 KIEFT LARRY 0 NO 71 1136 E STUART 92-100 FORT COLLINS CO 80525 (970)493-5904 84-1012032 4 CARSON FRANK MO 71 1006 LUKE FT COLLINS CO 80524 (303)221-2290 84-0596245 5 LUDVIN GARY A NO 71 1106 E PROSPECT FORT COLLINS CO =25 (303)493-7442 74-2161737 UNIVERSITY PHYSICIANS NON-PPO kkkk 69 PO BOX 22029 DENVER CO W222 (303)372-2232 84-0949212 COLLINS THONAS J NO k"k 68 1120 E ELIZABETH SLOG 6 01 FORT COLLINS CO 80S24 (303)493-2776 84-0911601 STALLINGS THERON N OC akkk 65 2200 $O COLLEGE AVE FORT COLLINS CO 80525 (970)484-0686 84-0596245 1 KESLER KELVIN F NO 67 1106 E PROSPECT FORT COLLINS CO 80525 (303)493-7442 84-0706789 10 PACINI RICHARD J NO 66 1221 EAST ELIIASETH FORT COLLINS C0 =24 (303)490,4193 84-0791312 39 SMITH JEROME NO 1221 E ELIZABETH 94 FORT COLLINS CO 80524 (970)484-1757 84-1174590 3 ABBEY DAVID R NO 66 1100 POUDRE RIVER DRIVE FORT COLLINS CO W524 (303)224-950B 84-0706789 B CRAVEN VINFIELD H NO 6S 1221 E ELIZABETH 93 FORT COLLINS CO W524 (303)484-4757 4 N►A00 FMW1 98153 15:21 1995 JUNE 02 PAGE 5 E X P E M 3 E DISTRIBUTION BY PROVIDER PAID GROUP : 17 CITY OF FORT COLLINS DATE SPAN 97/01 TO 97/12 PROVIDER M DAYS RB CHGS BENEFIT AMC CHGS BENEFIT OUT PAT CHGS BENEFIT NAME CLAIMS ENG CHOS BENEFIT TOTAL CNGS TOTAL BENEFIT X TOT ADDRESS CITY ST ZIP PHONE ------ xesxa•eaaaeaaaaaeesccea»»cossets--s.ava�aesa»--�-rurrooruuraurrauuruorauaruuaaaaraoourpr - 84-0679626 10 GUENTHER JOHN NO 65 1200 E ELIZABETH FORT COLL114S CO 80524 (303)482-251S 84-1267602 27 VIDOM BARBARA NO 64 1808 BOISE AVE LOVELAND CO 80538 ( ) 84-0979S5S GOLUB DANIEL E NO 61 12M DOCTORS LANE FORT COLLINS CO SM24 (303)484-9175 W1174590 2 HOMBURG ROBERT C NO 59 1100 POUORE RIVER DRIVE FORT COLLINS CO 80524 (303)224-9508 84-0791312 5 BROMAN STEVEN 0 HD 58 1221 EAST ELIZABETH STREET SUITE 4 FORT COLLINS CO BO524 (303)484-1757 84-0706769 3 SINGER CHARLES J NO S7 1221 EAST ELIZABETH FORT COLLINS CO W324 (303)490-4193 W1311028 2 PETERS ROBERT L NO 57 2918 V IOTH ST GREELEY CO 80631 ( ) 84-1210523 SCHLEE BRUCE 0 DC RRAR 57 429 S MOVES FORT COLLINS CO 80521 (303)493-4012 84-1110280 MEYER FRED H ND 55 1217 E ELIZABETH 69 FORT COLLINS CO W524 ( ) 84-12876M 25 LASZLO DANIEL NO 54 180E BOISE AVENUE LOVELAND CO 80538 ( ) 8rr-1U1309V NICHZE KEVIN J DC tNhFY 54 3120 REMINGTON ST fORT COLLINS W 80525 (303)484-S99S 64-1012032 1 VALLEY GEORGE E MO 53 l(M LUKE ST t1. COLLINS CO 80524 (303)221-2290 84-0706769 9 GEIS J RAYMOND MD 53 1221 E ELIZABETH STE 3 FORT COLLINS CO M24 (303)484-4757 5 MPA00 FRIA01 V8153 15:21 1998 JUNE 02 PAGE 6 EXPENSE D I S T R 1 8 U 7 1 0 N a PROVIDER P A 1 0 GROUP 17 CITY OF FORT COLLINS DATE SPAN 97/01 TO 97/12 PROVIDER D DAYS RB CHGS BENEFIT ANC CHGS BENEFIT OUT PAT CMDS BENEf1T NAME CLAIMS ENO CHGS BENEFIT TOTAL CHGS TOTAL BENEFIT X 70T AOORkSS CITY 3T ZIP PHONE 84-0596245 15 KOZAK SUSAN NO 53 1106 E PROSPECT FT COLLINS CO W525 ( ) W1129120 3 CARROR JOHN RD 52 1124 E ELIZABETH RC FORT COLLINS CO W521 (303)484-0798 1 84-1129120 1 STODDARD ANDREW NO A to 50 1124 E ELIZABETH SC FT COLLINS CO W524 (303)484-0798 i B4-0957576 2 TREWARTHA WILLIAM OPM 50 2001 S SHIELDS BLDG F1 FORT COLLINS CO 80526 (303)493-4660 i B4-1129120 8 SAMUELSON SCOTT MD 48 1124 E ELIZABETH RC roes COLLINS Co 80524 (970)484-OT98 84-MY5016 7 SNACHTMAN WILLIAM A NO 47 1725 E PROSPECT FORT COLLINS CO W525 (970)481-5322 84-0791312 37 RUBRIGHT JON S MD 46 IZ21 E ELIZABETH FORT COLLINS CO B05I4 (970)221-5255 84-MI227 BUSH JAMES F MD 45 1021 LUKE STREET FORT COLLINS CO M24 (970)484-6406 54-6929390 BRATMAN STEVEN MD *A 44 700 W MOUNTAIN AVE FORT COLLINS CO 80921 ( ) i 84-0706799 1 DAVIDSON JAMES E NO 44 1221 EAST ELIZABETH FORT COLLINS CO W524 (303)490-4193 84-0745274 1 TIANRT MAURICE 0 DC *fAA 43 211 CANYON AVE FORT COLLINS CO W522 (303)493-0611 33-0057155 37 A►RIA-FORT COLLINS ARRA 43 PO BOX 2259 LOVELAND CO W539 (970)203-1299 64-1287602 24 CULVER WILLIAM MD 43 1808 8013E AVENUE LOVELAND CO W538 C ) on MPA00 fmIA01 98153 15:21 1995 JUNE 02 PAGE 7 EXPENSE 9 1 S 7 R 1 8 U T 1 0 N BY PROVIDER P A 1 0 GROUP 17 CITY Of FORT COLLINS DATE SPAN 97101 TO 97/12 PROVIDER N DAYS RB CHGS BENEFIT AMC CMGS BtHttll OU1 PAT CHGS BENEFIT NAME CLAIMS EMS CHO$ BENEFIT TOTAL CH63 TOTAL BENEFIT X TOT ADDRESS $T ZIP PHONE �z-zaaaas=cza�er�_-ss:aasstas�M�s3szSxzsaava:a.va:a:aaeaaaaa�aa�aiz--zso evzz=aazy-zzazzsaazasz=air--�- 1 84-1257598 LOURY MARK NO 43 2001 5 SHIELDS BLDG E 101 FORT COLLINS CO W526 (303)493-5334 1 84-1009475 1 FANGNAN MICHAEL P NO 42 1240 DOCTORS LANE SUITE 200 FORT COLLINS CO SOS24 (303)493-6331 84-1029556 LOPEZ JOSEPH MO 42 1136 E STUART STE 4202 FORT COLLINS CO W525 (9M)221-5925 1 84-OSv34SS 25 COUPENS STEVEN 0 NO 42 PO BOX 451 FT COLLINS CO 80522 ( ) 43-1643557 LEVY J J LSWII LCSW 41 315 CANYON fT COLLINS CO 80521 (303)493-8T80 1 841-16-8155 1 YOUNG ERIC MD 41 1900 N BOise R110 LOVELAND CO W530 ( ) 84-1129120 6 KAUFFMAN JEFFREY MD * 41 1124 E ELIZABETH NC FORT COLLINS CO SU524 (303)484-0f" 184-1160746 WILBUR" MONTY DC * 40 1015 $ LENAY FORT COLLINS CO 80524 (970)224-2282 i 8"769717 11 LARSON DENNIS MO 40 1100 E ELIZABETN STREET FORT COLLINS CO 80S24 (970)221-1000 84-1105900 CRAWFORD GREG L OC 39 133T E PROSPECT RD FORT COLLINS CO 60525 (50 1493-2105 1 33-0057155 47 APRIA HEALTHCARE INC lftt 39 PO BOX 2259 LOVELAND CO W539 (970)663-0500 1 63-1115340 8 POOLOS ROBERT RPT 39 DRAWER 0519 PO BOX 11407 BIRMINGHAM AL 35246 (800)781-6899 64-0679626 12 DIERAUF 3USAH NO 39 1200 E ELIZABETH FORT COLLINS CO W524 (970)482-2515 7 MPA00 FM1A01 98153 15:21 199a JUNE OZ PAGE 8 EXPENSE DISTRIBUTION BY PROVIDER PAID GROUP : 17 CITY OF FORT COLLINS DATE SPAN 97101 TO 97112 PROVIDER M PATS RB CHGS BENEFIT AMC CHGS BENEFIT OUT PAT CHO$ BENEFIT NAME CLAIMS EMG CHGS BENEFIT TOTAL CHGS TOTAL BENEFIT X TOT ADDRESS CITY 3T ZIP PHONE i 84-1363030 VANFAROYE CYNTHIA MD 39 1014 CENTRE FORT COLLINS CO W526 C ) 1 64-1178T11 1 ERIKSEN CHN13TOPMER NO 39 1120 E ELIZABETH SLOG F 0101 FT COLLINS CO M24 (303)221-1177 1 84-1217723 22 OLSEN ERIC B NO 38 PO BOX 7179 LOVELAND CO 00537 ( ) 1 84-0675076 9 ROBINSON MATTHEW MD 38 1723 E PROSPECT FORT COLLINS CO SO52S (970)454-5322 1 54-0738034 PIKE ROBERT H NO *kkk 37 1080 E ELIZABETH FORT COLLINS CO 80524 (303)221-4433 184-M15750 2 ALLEN DAVID K MD 37 12W DOCTORS LANE FORT COLLINS CO aJ524 (303)484-3496 184-0977084 1 ONALLORAN WILLIAM D RPM 36 13M RIVERSIDE AVE FORT COLLINS CO W524 (303)482-3668 1 31-9369144 2 CARR EDMARD E DC !RR>r 35 1700 3 COLLEGE AVE FORT COLLINS CO W525 ( ) 1 840-61-a779 4 STANDARD PETER J MD 35 15M SOUTH LEMAT FORT COLLINS CO M24 (303)484-6700 1 64-1119490 1 CRANDALL YENDY MS OTA 35 1200 E ELIZABETH SUITE A FORT COLLINS 00 80524 (303)482-0921 4 a4-1205909 KNAUER SALLY MD 35 1136 E STUART 031W FORT COLLINS CO W525 (303)224-9890 I a4-1217723 20 TEUMER JAMES K MD 3S PO BOX 7179 LOVELAND Co W537 ( ) 1 64-0593455 9 "BEL ROGER M NO 34 PO BOX 451 FORT COLLINS CO W522 (3U3)493-5615 N. MPA00 FM1A01 98153 15:21 19" JUNE 02 PACE 9 E X P E N S E 0 I S T R I D U T 1 0 H B Y P R 0 V 1 0 E R P A 1 D GROUP 17 CITY OF FORT COLLINS DATE SPAN 97/01 TO 97/12 PROVIDER M BAYS RB CHGS BENEFIT ANC CHGS BENEPIT OUT PAT CHGS BENEFIT NAME CLAIMS EMG CHGS BENEFIT TOTAL CHGS TOTAL BENEFIT % TOT ADDRESS CITY ST ZIP PIKNiE ��RtfQQYQQQiiCr3.:IIQ�i�lWQii rT—��—r IIII+—�'1000iQii�--� II —��� QQ/QiQ'ii533i2 r.c3' i Siliii5'liiJiIIiIIaiitiIIiiiLiiYiwl�L��II•p�Qy 1 84-0596245 6 DOINIELLEY BEVERLY NO 34 1106 E PROSPECT FORT COLLINS CO W525 ( ) 184-13S943S 1 STIGLICH NORHA NO 33 3000 S COLLEGE STE 210 FT COLLINS CO 8052S ( ) 1 W1117603 1 POUDRE CARE CONNECTION INC 32 1119 VEST DRAKE AD STE C30 FORT COLLINS CO W526 (970)207-4900 1 84-0596245 9 JAMES WARREN K MD 32 1106 PROSPECT ROAD FORT COLLINS CO 80525 (303)i93-7442 1 64-1095446 CARLSON H G NO 32 1040 E ELIZABETH STE B FORT COLLINS CO W524 (303)482-0213 1 64-0815744 1 6I~3 ROBERT A NO 31 1330 OAKRIDGE DRIVE SUITE 100 FORT COLLINS CO W525 (800)279-9775 1 84-0769717 6 DOWNES THOMAS R NO 31 1100 E ELIZABETH FORT COLLINS CO 00324 (303)221-4241 ( 64-0957576 5 SCHULTE ROBERT DPM 31 2001 S SHIELDS BLDG F-1 FORT COLLINS CO 80526 ( ) 1 74-2161737 1 UNIVERSITY PKY31CIANS PPO 31 PO BOX 22029 DENVER CO SM22 ( ) 1 84-WT5076 10 FOSTER GARY RD 31 1017 ROBERTSON FORT COLLINS CO 80524 (303)404-5322 1 84-1119490 2 MORRIS KATHLEEN ►T 30 12M E ELIZABETH SUITE A FORT COLLINS CO SOS24 (303)482-0521 4 64-0593455 2 HORSTRAN JAMES K NO 30 PO Box 451 FORT COLLINS CO $0522 (303)493-0112 M 84-09376W 1 BURNS MICHAEL 4 DPN 30 1100 POUORE RIVER DRIVE FORT COLLINS CO W524 (303)221-0425 9 NPA00 FN1A(11 9a153 15:21 1995 JUNE 02 PAGE 10 EXPENSE DISTRIBUTION BY PROVIDER PAID GROUP : 17 CITY OF FORT COLLINS DATE SPAN 97/91 TO 97112 PROVIDER 0 DAYS RB CHGS BENEFIT ANC CHGS BENEFIT OUT PAT CHGS BENEFIT NAME CLAIMS EKG CMGS BENEFIT TOTAL [NG3 TOTAL BENEFIT X TOT ADDRESS CITY ST ZIP PHONE aasus3i4!/fY/wN3iaaaaaai'sI-NNNiSYS-a-a �� !/Yiti�-3sE1ss223�!///NCi --� �---�-----C`JswiM/iiiiiissssiassaisssssf 84-0791312 a STEPNENS FLOYD V NO tttR 30 1221 EAST ELIZABETH STREET SUITE 4 FORT COLLINS CO 80524 (970)225-0400 13S-2427192 KLEKER MICHAEL DC 30 2601 S LEMAY SUITE 28 FORT COLLINS CO 80325 (303)223-4422 390-S8-634a FOLBAECHT CHIROPRACTIC +►tst 30 134 U HARVARD STE 5 FORT COLLINS CO 80S2S (303)226-5545 840-59-34S5 7 GRANT LEE 8 NO 29 PO 80x 451 FORT COLLINS CO BD522 (303)493-5615 t 84-0593455 62 TRUMPER ROCCI V NO 29 PO BOX 451 FORT COLLINS CO 80522 (970)493-5615 1 63-1115340 41 BARCLAY CAROL PT 29 GRAVER 0519 PO Box 11407 BIRMINGHAM AL 35246 (800)781-6899 184-0647312 11 JENSEN CHRIS MD 29 1241 RIVERSIDE 1200 FORT COLLINS CO 8US24 ( ) 1 84-0647312 1 DECKER JOHN T RD 29 1241 RIVERSIDE STE 200 FORT COLLINS CO 80524 (303)484-0722 1 84-1217723 28 UPOEGRAFF JEFFREY NO 29 PO BOX 7179 LOVELAND CO W337 (970)663-2742 1 a4-1177985 2 STEELE'S PHARMACY* 29 1001 E HARMONY NO FORT COLLINS CO 80522 C ) 1 W1287602 12 THOM/SON J STEPHEN KD 29 1806 BOISE AVE LOVELAND CO 80S38 (303)669-6660 1 W1281602 22 "DOPER PHILLIP ND 28 1aos 8023E AVENUE LOVELAND Co W533 C ) 1 44-MO726 SANDS ARTHUR C HD 26 1021 ROBERTSON FORT COLLINS CO M24 (303)482-0666 10 C. affiliated organizations; and d. include a copy of your most recent audited financial statement. 2. Provide a statement, signed by an Officer of your company, that your firm has adequate personnel and financial resources to provide the services indicated in this Request for Proposal. 3. If applicable, indicate the location of the claims office where claims would be processed and/or member services is handled. Is a toll -free phone number available for member inquiries? What are the hours? If a toll -free phone number is not available, will you establish one at no additional charge? Include a description of your member services. 4. Is your firm licensed in the state of Colorado (if applicable)? Please confirm that your proposal and/or plan design offered is in compliance with all federal and state laws and regulations that pertain to employee benefit programs, relevant state insurance regulations and other related laws. 5. Please identify the individual responsible for the account in the event of claim disputes, service problems, etc. 6. In the event the City desires employee meetings to present your proposed plan, are representatives from your company available to make presentations? If "yes", are there any additional costs associated with these services? 7. Do you agree that if this proposal results in your company being awarded a contract and if, in the preparation of that contract, there are inconsistencies between what was proposed and accepted versus the contract language that has been generated and executed, that any controversy arising over such discrepancy will be resolved in favor of the language contained in the proposal or correspondence relating to your proposal? 8. Are there any outstanding legal actions pending against your organization? If so, please explain the nature and current status of the action(s). 9. Please state the time line your company intends to follow to commence work as of January 1, 1999. 10. What is your perspective on the health care industry in five years? What changes do you foresee? 11. If you have obtained national accreditation, please state through which agency and when it was obtained. 0 SECTION II ATTACHMENT B MEDICAL MANAGED CARE PLANS (PPO, POS & EPO) TABLE OF CONTENTS Page No. Request for Proposal 1-2 Section I - General Information and Proposal Form General Information 3-4 Proposal Form 5 Review and Assessment 6 Section II - Attachment A - Questions to be Answered by all Proposers General Questions to be Answered by all Proposers 7-9 Exhibit "A" Professional Services Agreement 10-15 Section II - Attachment B - Medical Managed Care (PPO, POS & EPO) General Information Fee Quotations Questions To Be Answered 16 17 18-23 Section II - Attachment C - Third Party Administration (TPA) Services General Information 24 Specific Information Eligibility History - PPO Plans 25 Claims History - PPO Plans 26 Large Claims History - PPO Plans 27 Large Claims History - EPO Plan 28 Fee Quotations 29-30 Specific Information 31-33 Questions to be Answered 34-37 Section II - Attachment D - Utilization Review (UR) Services General Information 38 Fee Quotation Section 39-40 Instruction for Completion of UR RFP Questions 41 Utilization Management Questionnaire 42-50 Statistical Reporting 51-55 Quality Control 56 General Questions 57-59 Requested Attachments 60-61 This rule also applies to subcontracts with the City. Soliciting or accepting any gift, gratuity favor, entertainment, kickback or any items of monetary value from any person who has or is seeking to do business with the City of Fort Collins is prohibited. Collusive or sham proposals: Any proposal deemed to be collusive or a sham proposal will be rejected and reported to authorities as such. Your authorized signature of this proposal assures that such proposal is genuine and is not a collusive or sham proposal. The specifications contain five Sections which outline the items that are to be the basis for your proposal: I. GENERAL INFORMATION AND PROPOSAL FORM to be completed by all proposers II. ATTACHMENTS relative to each specific benefit ATTACHMENT A - Questions to be Answered by All Proposers ATTACHMENT B - Medical Managed Care Plans (PPO, POS, & EPO) ATTACHMENT C - Third Party Administration (TPA) Services ATTACHMENT D - Utilization Review (UR) Services ATTACHMENT E - Stop -Loss Insurance ATTACHMENT F - Prescription Drug Plan III. SCHEDULE OF BENEFITS IV. CENSUS V. POS/EPO - complete list of physicians (Northern Colorado POS/EPO - top 20 physician list PPO - top 100 physician list Each attachment contains basic information about the benefit program, questions to be answered and the necessary forms your company must complete to submit a proposal. Telephone calls or other verbal requests will not be responded to by the City or The Segal Company. Questions should be submitted in writing to James B. O'Neill II CPPO, Director of Purchasing and Risk Management, P. O. Box 580, Fort Collins CO 80522 prior to July 13, 1998. All changes to the specifications will only be made by written addendum issued by the City of Fort Collins. As the City wants to evaluate all of the bids on the same basis, it i s required that your bid conform in all respects to the specifications outlined in this letter and attached exhibits. If the policy of your company prevents you from submitting a bid on the basis of any of the specifications or assumptions, you may submit a bid on a basis that is in accordance with your policy. In such a case, however, kindly submit a statement of your reasons for such deviation. The City reserves the right to accept or reject any or all proposals and to waive any irregularities or informalities Sincerely, 7 s B. O'Neill II, CPPO ector of Purchasing & Risk Management Page No. Section II- Attachment E - Stop -Loss Insurance General Information 62 Quotation Form 63-64 Questions to be Answered 65-66 Section II - attachment F - Prescription Drug Plan General Information 67 Specific Information Claim History - PPO Presecription Drugs 68 Fee Quotations 69-72 Questions to be Answered 73-82 Exhibit "B" Year 2000 Compliance Certification and Indemnity 83-84 Section III - Schedule of Benefits Section IV - Census 1-20 Section V 3 Attachment 1 POS/EPO - complete list of physicians (Northern Colorado) Attachment 2 POS/EPO - top 20 pysician list Attachment 3 PPO - top physician list REQUEST FOR PROPOSAL CITY OF FORT COLLINS BENEFITS PROPOSAL NO. P-682 The City of Fort Collins is requesting proposals from firms reflecting fees for providing a Preferred Provider Organization (PPO) network, Point -of -Service (POS) network, Exclusive Provider Organization (EPO) network, third party administration services, utilization review services, stop-1 oss insurance and prescription drug coverage. Single service as well as multiple service providers are encouraged to respond. Proposers may bid on one or multiple services. The City currently provides all eligible employees and their dependents medical benefits on a self - funded basis. Prescription drug coverage is provided to employees and their dependents participating in the PPO options through a carve -out card program. Proposals are being solicited by the City to obtain the most competitive benefits for i is employees and their eligible dependents. Current plan designs are to be replicated. Plan documents are available upon request. Written proposals, four (4) copies will be received at the City of Fort Collins' Purchasing Division, 256 West Mountain Avenue, Fort Collins, Colorado 80521. Proposals will be received before 3:00 p.m. (our clock), July 29, 1998. Proposal No. P-682. Proposals must be valid for ninety days. Proposals received after this time will be considered non -responsive and will be ineligible for consideration. Copies of the proposal documents may be obtained at the office of the Director of Purchasing and Risk Management, 256 West Mountain Avenue, Fort Collins, Colorado, 80521 or by calling (970) 221-6775. Fax requests may be faxed to (970) 221-6707. Questions regarding the proposal submittal or process should be directed to James B. O'Neill II, CPPO, Director of Purchasing and Risk Management (970) 221-6775. Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall have a financial interest in the sale to the City of any real or personal property, equipment, material, supplies or services where such officer or employee exercises directly or indirectly any decision - making authority concerning such sale or any supervisory authority over the services to be rendered. This rule also applies to subcontracts with the City. Soliciting or accepting any gift, gratuity favor, entertainment, kickback or any items of monetary value from any person who has or is seeking to do business with the City of Fort Collins is prohibited. Collusive or sham proposals: Any proposal deemed to be collusive or a sham proposal will be rejected and reported to authorities as such. Your authorized signature of this proposal assures that such proposal is genuine and is not a collusive or sham proposal. The specifications contain five Sections which outline the items that are to be the basis for your proposal: GENERAL INFORMATION AND PROPOSAL FORM to be completed by all proposers II. ATTACHMENTS relative to each specific benefit ATTACHMENT A - Questions to be Answered by All Proposers ATTACHMENT B - Medical Managed Care Plans (PPO, POS, & EPO) ATTACHMENT C - Third Party Administration (TPA) Services ATTACHMENT D - Utilization Review (UR) Services ATTACHMENT E - Stop -Loss Insurance ATTACHMENT F - Prescription Drug Plan III. SCHEDULE OF BENEFITS IV. CENSUS V. POS/EPO - complete list of physicians (Northern Colorado POS/EPO - top 20 physician list PPO - top 100 physician list Each attachment contains basic information about the benefit program, questions to be answered and the necessary forms your company must complete to submit a proposal. Telephone calls or other verbal requests will not be responded to by the City or The Segal Company Questions should be submitted in writing to James B. O'Neill H. CPPO. Director of Purchasing and Risk Management, P. O. Box 580, Fort Collins. CO 80522. prior to July 13, 1998 Ail changes to the apeeif'ications will only be made by written addendum issued by the City of Fort Collins. As the City wants to evaluate all of the bids on the same basis, it i s required that your bid conform in all respects to the specifications outlined in this letter and attached exhibits. If the policy of your company prevents you from submitting a bid on the basis of any of the specifications or assumptions, you may submit a bid on a basis that is in accordance with your policy. In such a case, however, kindly submit a statement of your reasons for such deviation. The City reserves the right to accept or reject any or all grovosals and to waive any irregularities or informalities. Sincerely, .0 e B. O'Neill H, CPPO Director of Purchasing & Risk Management GENERAL INFORMATION Effective January 1, 1997, the City implemented a comprehensive, credit -based flexible benefits plan. Under the flex plan, employees have the option of participating in a Comprehensive PPO plan, a Basic PPO plan, a Point -of -Service plan or an EPO plan. All plans are self -funded. Employees also have the option of opting out of coverage for cash back. There are currently approximately 25 employees opting out of medical coverage. Effective January 1, 1998, the City implemented a carve -out prescription drug card plan through PCS Health Systems for the PPO plans. Prior to this time, a cash and carry prescription drug program was in place through PCS Health Systems. POS and EPO prescription drugs are currently covered under each of these respective medical plans. The City is requesting quotes for: • Network access, third party administration, utilization review, and stop- loss insurance for the Comprehensive and Basic PPO plans. PPO network access is currently provided by Sloans Lake Managed Care. Third party administration is provided by National Health Systems. Utilization review (UR) services are provided by the Rocky Mountain Health Management Corporation. Stop -loss insurance is provided by PacifiCare. It is the City's intention to continue bundling all services/coverages for both PPO plans. • Network access, third party administration, utilization review, and stop- loss insurance for the POS plan and EPO plan. Network access, administrative services, utilization review, and stop -loss insurance are currently provided by PacifiCare. The City may select separate vendors to provide services/coverage for the POS and EPO plans. It is the City's intention to continue bundling all services/coverages for both the POS and EPO plans. • A carve -out prescription drug card program for the PPO plans which replicate current benefits. POS and EPO prescription drugs shall remain covered under each of these respective medical plans. As required by the City, your managed care plan must have an existing network in northern Colorado. 2. For all plans, organ transplant coverage was carved out through BCS Insurance Company effective June 1, 1997. Proposals should assume the carve out of organ transplant coverage will continue. 3 3. Base your quotes on the current plan design as described in Section III. These benefits must be duplicated. If you are unable to duplicate the current program, your proposal should clearly define where such differences exist. 4. No commissions, finder fees, service fees or fee arrangements are to be paid to any person or organization. If this is not possible, please identify in your transmittal 1 etter and thoroughly explain the details of any such arrangement. 5. An eligible employee is defined as someone who is full-time, permanent and works at least 20 hours per week and scheduled to work at least five months per year. Eligible dependents are spouses and/or children to age 19 or 25 if full-time student or indefinite if dependent is handicapped. Dependent "child" includes a step child or foster child. Effective January 1, 1996, early and Medicare retirees became eligible on a self -pay basis. 6. The proposed effective date is January 1, 1999. The contract term is one year with the option to renew, at the discretion of the City, for additional one year periods for a maximum of up to five years. 7 3 10. The City is requesting a 12-month fee guarantee. However, longer fee guarantee periods (potentially for the maximum 5-year term) would be preferred. The projected timetable is as follows: Release RFP Questions Due Return Proposals to City Conduct Interviews Final Decision Effective Date June 19, 1998 July 13, 1998 July 29, 1998 Week of August 17, 1998 Week of August 24, 1998 January 1, 1999 Copies of the City Plan documents may be reviewed at the Purchasing Office, 256 West Mountain Ave., Fort Collins, Colorado. Proprietary information needs to be identified and placed in separate section of your response. 4 GENERAL QUESTIONS TO BE ANSWERED BY ALL PROPOSERS All proposals submitted must include answers to the following questions: Administrative Agreements and General Information 1. It is the intention of the City that the master contract reflect the elimination of the actively -at - work restriction or deferred effective date for all initially enrolled active or inactive employees and dependents. This will include only initial eligibles (those eligible on the effective date of th e contract) including COBRA continuees. Please indicate your acceptance to this requirement. 2. It is required that proposals assume that all participants (including COBRA) presently covered will be covered under a successor plan regardless of medical condition, disabled status, or whether they are actively -at -work or on a no -loss no -gain basis for both the City and the participant. Is your proposal written in accordance with this requirement? 3. If your company is awarded this business, how soon after notification of the award would you be able to have a draft of the contract? 4. If the services furnished by your company differ in any respect from those described, please indicate where such differences exist. If you do not indicate any differences, it will be assumed that the services included in your proposal do, in fact, exactly match those described. 5. Provide a sample contract similar to the one that would be used for the City. City Standard Services Agreement is enclosed as Exhibit "A", note specific exception or changes requested. 6. Commissions or fees of any type are not to be paid to any entity as part of the cost of the services requested in this specifications letter. Is your proposal written in accordance with this provision? 7. Please provide at least three Colorado (preferably municipality plans with at least 500 employees) references (not current Segal Company clients) for each service you are proposing. List the name of the organization, address, telephone number, and contact person's name and title. If your company is quoting all or a portion of the benefits included in this Request for Proposal, please provide references for each benefit you are proposing. Also, provide the name and telephone numbers of any clients you are not now serving that you were serving three years ago. Why are you not providing service to these clients? 8. Provide samples of any communication materials that would be provided by your company to the City at no additional cost. What customized materials are available? Please identify the retention costs associated with these communication materials. 9. Would you agree to contractual performance guarantees regarding telephone calls, referrals, access standards, Ld. cards, NCQA accreditation? Please provide the specific standards and examples of similar arrangements with other clients. 10. The City will require that contracts include language that any data associated with the City's plan is the property of the City and, as such, must be available to the City (e.g., when changing vendors). Please indicate your acceptance of this requirement. 7 11. Record keeping: a. Discuss how participant and dependent records are maintained. b. Indicate your data needs from the City in order to administer this program. C. How will your organization verify eligibility? 12. Confirm that you will be Year 2000 compliant, and describe your procedures to become compliant. 13. How does your organization handle the surcharge requirements of New York and Massachusetts? What impact do these surcharges have on your clients (e.g., describe charges, if applicable)? Fees and Rate Guarantees 1. These specifications require that any fees quoted in your proposal be firm and guaranteed for a minimum of 12 months and cannot be changed by recalculation based on actual enrollment. Please indicate your agreement to this requirement. Is your organization willing to provide a multiple year guarantee or a second year cap on fees? Please specify separately for each service. 2. The City is requesting that formal renewal notice for all services be received no later than four months or 120 days prior to the renewal date of the program. Please indicate your agreement to this stipulation. 3. When are fees due and what is the grace period for payment of fees under your agreement? If fees are paid subsequently, is a penalty and/or interest charge assessed? If yes, please explain in detail. 4. Are there any options available with respect to the grace period? If so, please explain the option(s) and any charge that is made for them. 5. The contracts are to provide that change in fees can only be instituted on January 1. Please indicate whether your company is willing to issue master contracts reflecting this provision. 6. Can the individual services proposed by your company be purchased separately or are they interdependent upon each other? Please be specific and elaborate on any fee consideration. Organization Issues 1. Please describe your organization addressing the following items: a. Ownership; b. length of time in business; 0 EXHIBIT "A" PROFESSIONAL SERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below, by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and , [insert either a corporation, a partnership or an individual, doing business as ], hereinafter referred to as "Professional". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Scope of Services. The Professional agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of (_) page[s], and incorporated herein by this reference. 2. The Work Schedule. [Optional] The services to be performed pursuant to this Agreement shall be performed in accordance with the Work Schedule attached hereto as Exhibit "B", consisting of () page[s], and incorporated herein by this reference. 3. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated within days following execution of this Agreement. Services shall be completed no later than . Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in writing by the parties hereto. 4. Early Termination by City. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Professional. Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. 10 All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: If Professional: If City: With Copy To: In the event of any such early termination by the City, the Professional shall be paid for services rendered prior to the date of termination, subject only to the satisfactory performance of the Professional's obligations under this Agreement. Such payment shall be the Professional's sole right and remedy for such termination. 5. Design Project. Indemnity and Insurance Responsibility. The Professional shall be responsible for the professional quality, technical accuracy, timely completion and the coordination of all services rendered by the Professional, including but not limited to designs, plans, reports, specifications, and drawings and shall, without additional compensation, promptly remedy and correct any errors, omissions, or other deficiencies. The Professional shall indemnify, save and hold harmles s the City, its officers and employees in accordance with Colorado law, from all damages whatsoever claimed by third parties against the City; and for the City's costs and reasonable attorneys fees, arising directly or indirectly out of the Professional's performance of any of the services furnished under this Agreement. The Professional shall maintain commercial general liability insurance in the amount of $500,000 combined single limits, and errors and omissions insurance in the amount of _ 6. ComVensation. [Use this paragraph or Option 1 below.] In consideration of the services to be performed pursuant to this Agreement, the City agrees to pay Professional a fixed fee in the amount of ($_) plus reimbursable direct costs. All such fees and costs shall not exceed ($_). Monthly partial payments based upon the Professional's billings and itemized 11 statements are permissible. The amounts of all such partial payments shall be based upon the Professional's City -verified progress in completing the services to be performed pursuant hereto and upon the City's approval of the Professional's actual reimbursable expenses. Final payment shall be made following acceptance of the work by the City. Upon final payment, all designs, plans, reports, specifications, drawings, and other services rendered by the Professional shall become the sole property of the City. 6. Compensation. [Option 1] In consideration of the services to be performed pursuant to this Agreement, the City agrees to pay Professional on a time and reimbursable direct cost basis according to the following schedule: Hourly billing rates: Reimbursable direct costs: with maximum compensation (for both Professional's time and reimbursable direct costs) not to exceed ($___). Monthly partial payments based upon the Professional's billings and itemized statements of reimbursable direct costs are permissible. The amounts of all such partial payments shal 1 be based upon the Professional's City -verified progress in completing the services to be performed pursuant hereto and upon the City's approval of the Professional's reimbursable direct costs. Final payment shall be made following acceptance of the work by the City. Upon final payment, all designs, plans, reports, specifications, drawings and other services rendered by the Professional shall become the sole property of the City. 7. City Representative. The City will designate, prior to commencement of work, its project representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the project. All requests for contract interpretations, change orders, and other clarification or instruction shall be directed to the City Representative. 12 FAX REQUEST FOR BENEFITS Proposal No. P-682 DATE: Send Fax Request to: CITY OF FORT COLLINS PURCHASING DIVISION FAX NUMBER: (970) 221-6707 PLEASE PRINT OR TYPE Please send a copy of the Request for Proposal Number P-682. Attention: Firm Name Street or Post Office Box City/State/Zip Telephone Number Fax Number E-Mail Address 8. Project Drawings. [Optional] Upon conclusion of the project and before final payment, the Professional shall provide the City with reproducible drawings of the project containing accurate information on the project as constructed. Drawings shall be of archival quality, prepared on stable mylar base material using a non -fading process to prove for long storage and high quality reproduction. 9. Monthly Re Commencing thirty (30) days after the date of execution of this Agreement and every thirty (30) days thereafter, Professional is required to provide the City Representative with a written report of the status of the work with respect to the Scope of Services, Work Schedule, and other material information. Failure to provide any required monthly report may, at the option of the City, suspend the processing of any partial payment request. 10. Independent Contractor. The services to be performed by Professional are those of an independent contractor and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Professional's compensation hereunder for the payment of FICA, Workers' Compensation, other taxes or benefits or for any other purpose. 11. Personal Services. It is understood that the City enters into this Agreement based on the special abilities of the Professional and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Professional shall neither assign any responsibilities nor delegate any duties arising under this Agreement without the prior written consent of the City. 12. Accetance Not Waiver. The City's approval of drawings, designs, plans, specifications, reports, and incidental work or materials furnished hereunder shall not in any way relieve the Professional of responsibility for the quality or technical accuracy of the work. The City's approval or acceptance of, or payment for, any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the City under this Agreement. 13 13. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refu se to perform according to the terms of this agreement, such party may be declared in default. 14. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non -defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non -defaulting party for the non -defaulting parry's reasonable attorney fees and costs incurred because of the default. 15. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties. 16. Law/Severability. The laws of the State of Colorado shall govern the construction, interpretation, execution and enforcement of this Agreement. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement.17. Serial Provisions. [Optional] Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit "C", consisting of () page[s], attached hereto and incorporated herein by this reference. 14 THE CITY OF FORT COLLINS, COLORADO John F. Fischbach City Manager By: James B. O'Neill II, CPPO Director of Purchasing & Risk Management 107.UY:9 ATTEST: City Clerk APPROVED AS TO FORM: Assistant City Attorney PROFESSIONAL Un Title: CORPORATE PRESIDENT OR VICE PRESIDENT Date: ATTEST: Corporate Secretary (Corporate Seal) 15 MEDICAL MANAGED CARE PLANS (PPO. POS & EPO) GENERAL INFORMATION The City is requesting quotes for a hospital/physician network for their PPO, POS, and EPO plans, with a service area including primarily the metro areas of Ft. Collins, Greeley, Loveland, and Metro Denver. 2. As required by the City, your managed care plan must have an existing network in northern Colorado. Please indicate the person(s) who would be the liaison to the City. 3. Assume an effective date of January 1, 1999. 4. The City currently provides a Comprehensive PPO plan which covers approximately 425 employees, a Basic PPO plan which covers approximately 180 employees, a POS plan which covers approximately 80 employees and an EPO plan which covers approximately 585 employees. Approximately 25 employees are currently opting out of medical coverage. The City's employees and their dependents are located predominantly in Fort Collins. Effective January 1, 1996, early and Medicare retirees became eligible on a self -pay basis. See section III for the current plan of benefits. 5. The Comprehensive PPO's deductible is $200. The Basic PPG's deductible increased from $600 to $750 effective January 1, 1997. 6. Network accessibility and provider disruption are key concerns. Zip code data is enclosed for the purposes of providing a GeoAccess report. The parameters for GeoAccess are 2 physicians within 10 miles and 1 hospital within 20 miles. Provide physician accessibility information for internists, family practitioners, general practitioners, pediatricians, and OB/GYNs. Further, your proposal must include a disruption analysis (enclosed is a listing of the most utilized physicians for each current program) and a directory match (enclosed are current directories for the Northern Colorado area). Refer to Section V. You are to indicate which of the listed physicians are in your proposed network products by placing a check mark next to the name of the physician who is contracted with your network(s). Be sure to differentiate between your PPO, POS and EPO networks, if the networks differ. 7. Please refer to Section II, Attachment B (TPA Services) for experience information. IR MEDICAL MANAGED CARE PLANS (PPO. POS & EPO) FEE QUOTATIONS Please provide your fee quotation with regard to the services described in this section. Your fee quotation should be presented in the following format. For purposes of your quote, please assume 605 eligibles in the PPO plans. M on. thly Charges .08MM'Network.0fil Ilk y Per "Sfi gI ble POS EPO Access Fee $ $ Capitation Fee $ $ Incentive $ Additional Charges: IDCards/Enrollment $ $ Start -Up Fees $ $ Other (detail) For purposes of your quote, please assume 80 eligibles in the POS plan and 585 in the EPO plan. How do the above charges differ assuming you are selected as the network provider for all plans? 17 MEDICAL MANAGED CARE PLANS (PPO. POS & EPO) QUESTIONS TO BE ANSWERED You are required to respond to all of the following questions. Each question must be answered in detail. Reference should not be made to a prior response nor should an overall response be used to answer more than one question. Each question has been written to address a specific area of concern and not general concepts of preferred provider organizations and their operation. A complete answer to each question is required even when such answers may appear repetitious. Note: Unless otherwise specifically noted in your proposal, we will assume that the responses to the following questions apply to all in -network plans. For any question that this is not accurate, your proposal should clearly state to which plan the response applies. Your proposal shall provide responses for all plans. H. Organization 1. Please provide the names and positions of officers and board members, and whether they represent any hospital, physician medical association, or other interest. 2. Please indicate the person(s) who would be the liaison to the City. 3. What is your network's service area? 4. How many enrolled groups and total number of enrolled participants participated in your managed care plan during the most recently completed quarter? During the same quarter last year? 5. What is the projected enrollment for the next fiscal year? 6. Will you provide client specific directories to the City, at no cost, for employee distribution? If no, will you agree to provide directories on diskette to the City for internal production? 7. How often will you update your directories? What is the turn -around time for getting these updated directories to the City? 8. Please provide sample utilization reports readily available for clients. How often are they produced? Is there a charge? If so, please state the charge. 18 I. 9. Describe recent network provider utilization experience for the following: a. lab procedures per office visit; b. x-rays per office visit; and C. C-sections, as a percent of total deliveries. 10. Are there any "restructuring" plans for expansion or reduction of the network over the next 18 months? Please specify. 11. Please enclose all pertinent materials regarding your network and managed care services. 12. Will you agree to allow the City to omit providers from your existing network? Contract directly with network providers? Contract directly with non -network providers? 13. Please indicate the person(s) who will be the liaison to the City. Include resume. Physician Specific Issues Please outline the physician selection criteria utilized by yo ur managed care program in contracting with primary care and specialty physicians. How are their credentials verified? How often are they reviewed? 2. How is the quality of care and physician cost efficiency monitored on an ongoing basis? How often is this review conducted? 3. How many physician members have been terminated within the last two years? For what reasons? What provisions are made for patients of terminated physicians? What has the average turnover rate been of the physician network over the past two years? 4. How many primary care physicians do you directly contract with in the Plan's service area? How many specialists? Please enclose a copy of your directory, including any mental health/substance abuse providers. 5. Are there any specific areas of care which would not be available from your organization's contracted physicians? If so, which ones? What provisions are made for patients requiring these services? 6. Do physicians pay a membership fee to the managed care provider? If so, how much is the fee and how often is it charged? 7. Does your physician contract require they utilize a network lab for all or certain lab procedures? If so, please detail this requirement and the specifics of the lab contract. 19 8. Please provide a copy of your physician contract and physician office manual. 9. What ratio of physicians to participants do you maintain? What is the ratio currently in Larimer County? 10. Please describe the professional liability insurance arrangement your organization maintains with respect to participating physicians. 11. Provide a GeoAccess and disruption analysis/network analysis as described in the General Information section. J. Hospital/FacilitySpecific Issues What criteria are used to select hospitals and other health care facilities? How are the hospitals monitored for cost efficiency and quality of care on an ongoing basis? How often is this review conducted? Have any hospitals been terminated or dropped from the managed care program? Please describe circumstances. 2. Identify all hospital/health care facilities that have contractual relationships with the managed care program. 3. Are there any forms of treatment that cannot be provided by your hospital network? If so, which ones? 4. Please submit a list of negotiated rates for all participating health care facilities in your network. Please note that the preference is DRGs or per diems. 5. Are there additional discounts available to the group for "prompt payment"? If so, please define "prompt payment" and state amount of discount. 6. How long are these hospital rates guaranteed? Are you able to deliver multiple year agreements with increases tied to economic indicators? 7. What has been the average rate of increase for participating facilities since you first became operational? 8. Are there any ancillary services not contracted? Please explain. (i.e., emergency room physicians, durable medical equipment, hospice, rehabilitation, laboratory, home health care, etc.) Please identify negotiated terms of those under contract. 9. Please describe the liability insurance requirements for your contracted hospitals. 10. Please enclose a sample hospital contract. ►FTS K. Utilization Mana ement/Quality Assurance Please respond to the following questions about your organization's internal utilization management and quality assurance programs. The City is concurrently seeking proposals for utilization management services, and your network will be required to interface with the selected organization. Please provide a detailed description of your utilization management and quality assurance programs, how they operate and the protocols and criteria used. 2. Describe in detail how your organization determines the medical necessity of medical treatment. What types of standardized quality measurement systems do you use? 3. Is there a review committee to monitor quality of care? Who is on the committee and how often do they meet? 4. Does the managed care program have a formal procedure for addressing member grievances? If so, please explain. 5. Please provide copies of your standard reports applicable to utilization management and quality assurance. L. Administration/Fees 1. Are any administrative costs for your network paid for via a physician withhold? If so, please describe in detail. 2. Would your organization consider a multiple year fee guarantee? If yes, please state monthly fee(s) per member. 3. This RFP requires that the fees you quote for the City's 1999 plan year be guaranteed for the 12-month period. Will your organization comply with this requirement? 4. Are there any additional costs or fees which are not covered by the fees outlined in your fee quotation? M. Legal 1. Will you agree to a contract provision requiring your organization to provide at least a 120-day written notice to the City prior to the renewal dates of the contract of a change in rates? 2. Are you willing to enter into a hold harmless agreement? Please explain. 3. Will you agree to the following contract provision for termination of agreement? 21 Termination of Agreement. This Agreement may be terminated at any time by mutual consent of both parties. This Agreement may be terminated by either party at any time upon sixty (60) days written notice to the other party. N. Financial The City currently uses the 1997-98 St. Anthony's RVS Schedule for Physicians for the network services. Will you agree to continue the use of these schedules? If no, please indicate the schedules you currently use. Do your factors vary by area throughout your network? Please specify. O. Conversion Factors Please furnish conversion factors applicable to the 1997-98 St. Anthony's RVS Schedule for Physicians for determining your Participating Physician's maximum allowable charge for a covered service(s), as determined by the Plan. For purposes of your response to this request, please identify whether a withhold arrangement is assumed. Medicine $ Surgery $ Obstetrical $ Radiology $ Pathology (laboratory) $ Anesthesia $ For unlisted or by -report procedures, will you approve 80 % of usual, customary and reasonable charges, as determined by the City, as the participating physician's maximum allowable charge? If not, please submit your proposal for the pricing of these claims. If lab fee reimbursements are not to be based on the 1997-98 St. Anthony's RVS Schedule for Physicians, please describe your proposed reimbursement arrangement. 22 City of Fort Collins AdminiL..ative Services Purchasing Division CITY OF FORT COLLINS ADDENDUM No. 3 July 16, 1998 Description of Proposal #P682 - Benefits OPENING DATE: 3:00 p.m. (our clock) July 29, 1998 To all prospective proposers under the specifications and contract documents described above, the following changes are hereby made. Clarification of Question No. 1 - Answer should read: Answer: RX should be bid for all medical plans. PPO, POS, EPO - could be carved out for all. In addition to the questions and answers issued in Addendum 2 the following question and answer is submitted: 14. Given that physicians use drug information for clinical management purposes, is it possible to include the drug benefits side by side with the medical to enhance members quality of care? Answer: Yes, the City would consider this option. RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE PROPOSAL STATING THAT THIS ADDENDUM HAS BEEN RECEIVED. 256 W Mountain Avenue • PO. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 P. Hospital 1. What is the average discount over allowable for Metro Denver area hospitals in aggregate at a minimum, by hospital preferred? 2. Please complete the following table for McKee Medical Center, Poudre Valley Hospital and North Colorado Medical Center facilities, as applicable. Name of Rates: In atient: ICU/CCU Normal Vi C-Section NICU Other (sne Other (specifvl Indicate type and amount of contractual agreements (per diem or DRG vreferrec 23 TPA SERVICES GENERAL INFORMATION 1. Third party administration for the current PPO plans is provided by National Health Systems, Inc. 2. Third party administration for the current POS and EPO plan is provided by PacifiCare. 3. Please refer to the experience information in this section for purposes of your quote. 4. The City also uses a Third Party Claims Administrator for liability and workers compensation claims. This service is being solicited separately under RFP P-686. Proposers are also encourage to submit a proposal under that RFP for liability and worker's compensation claim services. Contact the city at 221-6775 to receive a copy of this RFP. 24 THIRD PARTY ADMINISTRATION (TPA) SERVICES SPECIFIC INFORMATION Eligibility History - PPO Plans EligibiI4 History - POS Plan - implemented January 1, 1997 Eligibility History - EPO P1an 47411 7 Note: Comprehensive credit -based flexible benefits plan implemented effective January 1, 1997. 25 THIRD PARTY ADMINISTRATION (TPA) SERVICES SPECIFIC INFORMATION (continued) Claims_History - PPO Plans Number Total Paid CIaims (I} of Items (2) Paid January 1 through December 31, 1996 15,644' $2,888,351 January 1 through December 31, 1997 13,846 $2,499,493 January 1 through March 31, 1998 3,212 $707,314 Claims History - POS Plan - implemented January 1 1997 Number Total j Paid Claims (l)(3) of Ttems (2): Faid January 1 through December 31, 1997 Not available j $175,178I January 1 through - March 31, 1998 Not available $31,470 Claims History - EPO Plan Number Total Paid Claims (1)(3 of t w. January 1 through December 31, 1996 Not available 1 $990,36J January 1 through December 31, 1997 Not available $1,356,455 I January 1 through j March 31, 1998 Not available $305,066II i (1) All figures are net of stop -loss reimbursements and prescription drug claims. (2) Represents number of line items, not necessarily number of claims. (3) Includes capitation. 26 THIRD PARTY ADMINISTRATION ffPAI SERVICES SPECIFIC INFORMATION (continued) Large Claims History - PPO Plans janugZ 1 through December 31 1997 (claims exceeding $67,500) M O1/10/53 Employee $137,449I Malignant Melanoma Deceased M 05/24/38 Employee 72,195 Bypass Surgery Fair M 06/21/61 Employee 120,425 Cystic Fibrosis w/ Lung Transplant 1/98 Guarded M 04/23/51 Spouse 410,361 Liver Disease w/ 4th Transplant 1/98 Deceased Janus 1 through March 311998 (claims exceeding $25 0001 Large Claims History - POS Plan January I through December 31 1997 (claims exceeding $67.500) January 1 through March 31 1998 (claims exceeding $25.000) 27 TPA SERVICES FEE QUOTATIONS Please provide your fee quotation with regard to the administrative services described in this section. Your fee quotation should be presented in the following format. Monthly. Charges PPO Plans Only Per Eligible Without Run -In Medical Claims Administration $ Additional Charges: COBRA Administration $ per election/notice Retiree Administration $ HIPAA Administration $ ID Cards $ Start -Up Fees $ Other (detail) $ For purposes of your quote, please assume 605 eligibles in the PPO plans. 1V onthly Charges POS/EP0 EIans Only Pei Eligible Without Run -In POS Epp Medical Claims Administration $ $ Rx Administration $ $ Additional Charges: COBRA Administration $ per $ per election/notice election/notice Retiree Administration $ $ HIPAA Administration $ $ ID Cards $ $ Start -Up Fees $ $ Other (detail) $ 1 $ For purposes of your quote, please assume 80 eligibles in the POS plan and 585 in the EPO plan. 29 How do the above charges differ assuming you are selected to administer all plans? Note: (1) The costs of postage, telephone service, and printing of forms are assumed to be included in your fees. If not, please so note. (2) Charges for all required reports are to be included in the monthly fees. (3) Booklets and certificate preparation and distribution must be included in your fees. (4) Indicate any charges for customized identification cards. $ /card (5) Indicate if Retiree Administration (sending election notices, etc.) is a separate charge. You may request a copy of RFP P686, Claims Administrator Services, after June 26, 1998. 30 TPA SERVICES SPECIFIC INFORMATION The claims administrator is to provide claims administration and payment and reporting services for all PPO, POS, and/or EPO medical claims incurred pursuant to the City's Plan in effect on January 1, 1999, and as amended from time to time. The claims administrator must be able to adjudicate managed care claims. The eligibility will be provided by the City. Services. Provide for the City the maintenance of necessary procedures to perform the following: 1. receiving and processing claims for benefits under the benefit program, including: 2. certification of eligibility for medical claims; and 3. provision of accounting services required in the processing of claims and recordkeeping as directed by the City and/or the stop -loss carrier. 4. distribution of drafts in payment of claims after appropriate adjustment. 5. prepare letters for distribution to participants, with respect to denial of benefits, similar to plan requirements. 6. handle pending claims, including follow-up with hospitals or providers in order to obtain information applicable to claims, screening of claims to avoid duplicate payment, maintenance procedures to assure consistency to claims payment in accordance with the plan of benefits and plan provisions for coordination of benefits. 7. provide a monthly summary of medical claim payments to the City and its consultant. The summary should include the following information: a. number of claims by line of coverage, including dollar amount claimed, number of claims, total allowable charges, deductibles taken, and amount paid by line of coverage. All must be provided on a monthly and year-to-date basis by line of coverage each month,- b. coordination of benefit savings; C. other specific claims data as requested by the City or the stop -loss carrier; and d. , quarterly reports of claims exceeding 50% of individual stop -loss on a year-to-date basis. The claims summary should be broken down into categories as directed by the City and will include Active, COBRA and Retiree claims data, dependent claims data and combined totals, both on a monthly and year-to-date basis. Copies of the claims summary will be furnished to the City and other parties as directed by the City. 31 8. furnish on a monthly basis: a. an updated list of those claims which have exceeded the individual stop -loss attachment point, (including employee status, sex, age, diagnosis, amount paid, and prognosis); b. a recap showing the accumulated status of the individual stop -loss attachment point; and C. claim turnaround time. 9. furnish on a all rterly�n wear -to -date basis by participant category: a. claim payment analysis of payments to providers, separately and combined; b. claims by diagnostic (ICD-9) category, as requested; C. hospital claims data (admissions, number of days) by at least all surgical, medical, maternity and psychiatric/substance abuse admissions; and d. claims by CPT-4 procedure code, as requested. 10. incurred date lag reporting capability, and provisions for reporting premiums to claims ratios. 11. provisions for audit to see that plan policies and practices are followed as well as claim accuracy and claims processing efficiency. 12. preparation and distribution on an annual basis of any forms which may be required by law. 13. answer all telephone calls, mail or personal inquiries from the City and their employees with respect to the requirements and procedures of the plan, or detail of the benefits provided. 14. provide a contractually generated minimum average turn -around time of 95 % of all 'clean" claims per week processed of not more than ten (10) working days which includes the period from the date the claim is received in your office to the date the check is issued to either participant or provider or notification of inability to immediately process the claim. 15. maintain all files having to do with the claim payments including correspondence with the City and its participants. 16. produce census data in chronological order by date of birth and including other information as specified; totals must be provided. 17. assist in the procurement of check stock, claims forms, identification cards, and other materials necessary to administer the medical plan. 32 TPA SERVICES QUESTIONS TO BE ANSWERED Claims Administration 1. From what city will claims be administered? 2. What are your normal business hours? 3. How long have you administered managed care plans? Define dates, as applicable, for each network plan. 4. Do you provide in -state and/or national WATS telephone service? What, if any, are the additional charges for this service? 5. Describe your company's performance standards with respect to: a. employee inquiries (both written and telephonic) b. claims turnaround C. claims accuracy Please indicate your actual performance during the 1997 calendar year in attaining these standards. 6. Is your firm willing to incorporate guaranteed turnaround time, COB recovery and quality performance standards in its contract with the City? Please detail under what conditions and terms your company would be willing to negotiate. 7. Describe your company's quality assurance and/or internal audit procedures and programs. Are you willing to provide the client with quarterly audit reports on its claims? Are you willing to allow an annual audit to be performed by an external auditor? 8. Describe your organization's errors and omissions insurance. 9. Describe in detail your claims adjudication hardware and software systems, and in particular, your claims editing capabilities. Specifically, address how it checks for procedural discrepancies based on diagnosis, diagnostic "creep", duplication of claims and procedural unbundling. What percent of claims are detected by these edits? What percent of dollars claimed? How do you treat claims detected as a result of these edits? Is this software/hardware capable of producing special reports, tapes, data transfers that may be requested by the City. If so, is there an additional expense for these requests? List costs. 34 Adminis—ative Services Purchasing Division City of Fort Collins CITY OF FORT COLLINS ADDENDUM No. 2 July 14, 1998 Description of Proposal #13682 - Benefits OPENING DATE: 3:00 p.m. (our clock) July 29, 1998 To all prospective proposers under the specifications and contract documents described above, the following questions and answers are submitted. 1. As we prepare to bid on the prescription Drug Plan (page 67 of the proposal) item #3 what plans (number of eligible) are intended to be included. Answer: All plans possibly as RX PPO, POS, EPO - could be carved out for all. 2. Full-time employees are defined how under the plans? 20 hours a week? Part -times are defined how? They are not covered, correct? Answer: Employee means all classified and unclassified management and contractual Employees (who are entitled to benefits by virtue of their contract), who are working or scheduled to work at least twenty (20) hours per week. Hourly or seasonal employees are not included in the definition of Employee. Temporary (with benefits): Any temporary hourly working on a scheduled basis at least 30 hours per week for 6-9 or more months out of the year is eligible for EPO option only. 3. The stated intention is to "continue bundling all services/coverages" for both the PPO plans and the POS and EPO plans. I assume this bundling will not apply to Stop Loss, and we can be considered for all plans, right? Answer: Yes 4. If #3 is correct can we be considered also to provide Stop Loss over other carriers and providers, e.g. PacifiCare? If so, who are some of the other providers considered? Answer: Yes. See attached list. 5. Does the City currently have aggregate stop loss coverage? Answer: No 256 W Mountain Avenue • PO. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6775 • FAX (970) 221-6707 10. When a claim is submitted for payment, please check below how the following procedures are addressed: Claim inventory Eligibility of employee Eligibility of dependent Usual, customary, reasonable Benefit plan excluded charges Pre-existing conditions Adjudication Coordination of benefits Check issuance Subrogation Explanation of benefits issuance UR authorized inpatient days Medical necessity Deductible Out-of-pocket benefit maximums Coinsurance Duplicate charges Second opinion program Copays Preferred provider/ non preferred provider Unbundling of charges Workers compensation 11. How do you propose to collect claims data from the prior third party administrator to accommodate a smooth transition? 12. Present an implementation plan to begin adjudicating claims January 1, 1999 assuming a September 1, 1998 notification. 13. In the event of termination, what is your guaranteed fee to provide for payment of run -out claims? Include all data processing charges. 14. What mechanisms are in place fbr claims administration backup? Are you proposing a dedicated claims administration unit and 800 number for the City? 15. Are you able to administer on-line, electronic transfer, and tape -to -tape eligibility transfers? How does this impact your cost proposal? 16. Do you have the capability for the City to have access to your claims and eligibility system through an on-line system? What, if any, are the additional costs? 35 17. Does your system handle member files as opposed to subscriber files? Provide samples of "per member" utilization reports which reflect this capability. 18. Do you have physician and patient profiling/reporting capabilities? If so, please describe the standard reports available and ad hoc capability. Provide sample reports. 19. How would your organization determine usual, customary and reasonable charges for medical, surgical and anesthesia procedures? Answer this question in specific detail for PPO, POS and EPO claims; and by area (Colorado, national, worldwide). How often is this data updated? 20. Would you be willing to provide underwriting review for medical evidence for enrollments other than during open enrollment periods? Would there be an extra charge for this service? If so, please state your charges. 21. If claims exceed the individual attachment point, how often are updated claim reports sent to the stop -loss carrier? Explain this process of coordination with the stop loss carrier. 22. Please submit a sample of your proposed claim and Explanation of Benefits forms. Would you be willing to customize the information contained in these forms? Would there be an additional cost? 23. Please state what records (including the participant and data processing documents) would, in fact, belong to the City upon contract termination. 24. In the event of contract termination, when would records which are property of the Pan be released to the party or organization designated by the City? Describe your termination notice requirement. 25. What non-standard claim utilization and payment reports are available? What, if any, are the additional costs? 26. It is required that all reporting requirements be included in your per capita administrative fee. Would you agree with this provision? 27. Will a representative attend and assist in open enrollment meetings? Is a representative available to meet with employees other than during open enrollment? Is there a separate charge for this service? 28. Provide details of your company's claims dispute resolution procedures. 29. Will you agree to furnish monthly and year-to-date average enrollment, and total claims paid, by line of coverage, showing the information separately for active, COBRA participants, and retirees; and separately for employees and dependents? 30. Please describe in detail what claim reports would be provided at no cost to the City and consultant. Please describe the utilization data to be included in your reports. For example, number of hospital admissions, number of hospital days, etc. 31. Are you willing and able to provide the City or its consultant electronic claims data? What, if any, are the additional costs? 36 32. What stop -loss carriers have approved your company? 33. Do your fees include the cost to produce check stock, postage, telephone service, and printing of forms? If not, what are your charges for such services? 34. How often are claim reimbursement and administrative expense billings submitted? Form of transfer? Will the City collect all interest credits? 35. Describe how new members (employees) will be added to your system, terminated members inactivated and status changes made to current members. 36. Do you agree to provide COBRA and Retiree administration? 37. In addition to COBRA, describe your support services in complying with the issuance of HIPAA certifications. Is there an additional charge for these services? 38. What or how many hours per day will customer service representatives by available to assist callers with questions and problems? 39. Describe what your coordination efforts would be in dealing with the City's utilization management and/or case management firm. 37 UR SERVICES FEE QUOTATION SECTION Please provide your fee quotations to provide the cost management services requested. Your quotation should be in the following format. 1. Pre-Admission/Concurrent Utilization Review 2. Psychiatric/Substance Abuse Review (if separate from #1 above) Full Package (1 and 2 above) 3. Case Management") Other Charges 1. Start-Up/Implementation Fee 2. Basic Communication Package (brochure, stickers, and letters) Note: Excludes Medicare Retirees. (') Indicate hourly rate if this is your standard arrangement. For purposes of your quote, please assume 600 eligibles in the PPO plans. 39 UR SERVICES FEE QUOTATION SECTION (continued) Note: Excludes Medicare Retirees. (1) Indicate hourly rate if this is your standard arrangement. For purposes of your quote, please assume 80 eligibles in the POS plan and 585 in the EPO plan. How do the above charges differ assuming you are selected to provide utilization review for all plans? 40 INSTRUCTIONS FOR COMPLETION OF UR RFP QUESTIONS These UR RFP questions have been created to help the City determine which organizations can offer both the TYPE of review services desired as well as EFFECTIVE PERFORMANCE of those services. 1. Answers may be handwritten ON the RFP questionnaire form. Explanations can be attached or added onto the back of the questionnaire as desired. Questions, answers and additional information must be identified by question number. 2. Some of the UR questions prompt you to provide multiple answers; however, several questions ask for ONLY ONE response to be marked. UR vendors will not be contacted to clarify why multiple answers are marked to a "check one only" type of question. If you check one answer but wish to add an explanation/rationale then please do so by providing a written attachment to that question. 3. Please proof your answers before submitting the RFP response to ensure completeness. A UR vendor will also NOT be contacted to query as to why a question was NOT answered. 4. A UR firm will be held accountable for all answers. You may be asked to substantiate a response during the interview, onsite evaluation or through a formal UR audit process. 5. Reporting of basic utilization statistics as well as the effectiveness of the UR firm's services will be important to this client. 6. Please note that a vendor's proposal responses will become part of the contract between the client and the UR organization if and when the proposal is accepted by the client and accompanied by a separate formal written contract document. 7. Submit separate responses if your answers differ for the plans you propose to administer. 41 UTILIZATION MANAGEMENT QUESTIONNAIRE NOTE: PLEASE READ QUESTIONS CAREFULLY. While some questions may allow for multiple responses, those annotated with 'CHECK ONE ONLY' MUST be answered with only ONE response option. PRESERVICE REVIEW i . Does your firm perform preservice review (also known as precertification, prior authorization) of proposed elective health care services? (al) [ ] a. Yes [ ] b. No (Proceed to next Section) 2. Indicate which services are reviewed under your preservice review program (check all applicable to your program): [ ] a. Elective inpatient medical/surgical admissions [ ] b. Elective outpatient surgery [ ] c. Diagnostic services [ ] d. Durable medical equipment [ ] e. Corrective appliances/prosthetics [ ] f. Skilled nursing facility [ ] g. Home health/home enteral/parenteral therapy [ ] h. Musculoskeletal services (e.g., chiropractic) [ ] i. Medical services (e.g., physical therapy, Dr's office visits) [ ] j. Psychiatric admissions (acute and residential) [ ] k. Psychiatric outpatient therapy services [ ] 1. Substance abuse (e.g., detoxification, rehabilitation) [ ] m. Other: 3. Precertification includes the analysis and determination of which of the following (may check ) more than one): [ ] a. Eligibility of coverage. [ ] b. Appropriate use of Plan (e.g. work -related injury which is excluded from the plan). [ ] c. Appropriate LEVEL OF CARE (e.g., inpatient versus outpatient). [ ] d. Reasonable LENGTH OF STAY for inpatient confinement. [ ] e. Actual MEDICAL NECESSITY and appropriateness of the surgery or service being requested (e.g., does service require performance). [ ] f. Necessity for the services of an ASSISTANT SURGEON with each operative procedure analysis. [ ] g. Necessity for a proposed PREOPERATIVE hospital day. (] h. Necessity for a proposed 23 hour observation stay following outpatient surgery. 42 [ ] i. Other: Explain 4. Indicate the type of review information which is communicated to the claims payor by your firm: (a4) Claims Mayor Approximate Method of Notification I�Totified Frequency (CHECK ONE) (CHEECK ONE) (CHECK ONE) a. Appropriate level of care a. [ ] Yes a. [ ] Daily a. [ ] Phone call (e.g. outpatient) b. [ ] No b. [ ] Weekly b. [ ] Phone call plus c. [ ] N/A c. [ ] 2x/month written followup d. [ ] Monthly c. [ ] Letter or e. [ ] > Monthly computer report d. [ ] Magnetic tape e. [ ] Combination of a+c, d or e b. Certified Length of stay a. [ ] Yes a. [ ] Daily a. [ ] Phone call b. [ ] No b. [ ] Weekly b. [ ] Phone call plus c. [ ] N/A c. [ ] 2x/month written followup d. [ ] Monthly c. [ ] Letter or ie. [ ] > Monthly computer report d. [ ] Magnetic tape j e. [ ] Combination of j a+c, d or e C. Procedure/service a. [ ] Yes a. [ ] Daily a. [ ] Phone call determined NOT to be b. [ ] No b. [ ] Weekly b. [ ] Phone call plus medically necessary c. [ ] N/A c. [ ] 2x/month written followup d. [ ] Monthly c. [ ] Letter or e. [ ] > Monthly computer report d. [ ] Magnetic tape e. [ ] Combination of a+c, d or e d. Procedures where assistant a. [ ] Yes a. [ ] Daily a. [ ] Phone call surgeon determined not to b. [ ] No b. [ ] Weekly b. [ ] Phone call plus be medically necessary c. [ ] N/A c. [ ] 2x/month written followup d. [ ] Monthly c. [ ] Letter or e. [ ] > Monthly computer report d. [ ] Magnetic tape e. [ ] Combination of a+c, d or e 43 e. Pre -op day(s) determined a. [ ] Yes a. [ ] Daily a. [ ] Phone call not to be medically b. [ ] No b. [ ] Weekly b. [ ] Phone call plus necessary c. [ ] N/A c. [ ] 2x/month written followup d. [ ] Monthly c. [ ] Letter or e. [ ] > Monthly computer report d. [ ] Magnetic tape e. [ ] Combination of a+c, d or e 5. Indicate the primary method for determining the appropriate length of stay for a hospital admission. (CHECK ONE ONLY) (0) [ ] a. HCIA/PAS book for Region Percentile Year [ ] b. Internally developed written LOS table [ ] C. Length of stay not preassigned [ ] d. Other purchased written LOS table (specify) [ ] e. Other: 6. Within the past twelve months, in what percent of all precertification cases was a letter of noncertification (denial) for MEDICAL NECESSITY/APPROPRIATENESS for the procedure/service issued? (Answer may require specific justification at a future date.) (CHECK ONE ONLY) (a6) . [ ] a. less than 1 % [ ] b. 1-2% [ ] c. 3-4% [ ] d. 5-6 % [ ] e. 7-8 % [ ] f. more than 8 % [ ] g, not applicable 7. What key written clinical criteria are utilized to determine the MEDICAL NECESSITY for a SURGICAL procedure. (CHECK ONE ONLY) (a8) [ ] a. We do not review medical necessity during presurgical review. [ ] b. Milliman & Robertson. [ ] c. Sims (Interquay). [ ] d. No written criteria utilized. Case information individually reviewed by Utilization Management staff nurse or physician reviewer. [ ] e. Internally developed written criteria set. [ ] f. Other purchased criteria: (Specify) [ ] g. Other: 44 E 9 10 11 For your non -worker's compensation clients, in the past 12 months, what percent of your preservice calls were classified as EMERGENT? (al3) [ ] a. Info not Available [ ]g.51-60% [ ] b. 0-10% [ ] h.61-70 % [ ] c. 11-20% [ ] i. 71-80% [ ] d. 21-30% [ ]j.81-90% [ ] e. 31-40% [ ] k. 91-100% [ ] f. 41-50% Indicate the category of staff who can make final DISAPPROVAL for a preservice request (may check more than one). [ ] a. Clerical [ ] b. LPN/LVN [ ] c. RN [ ] d. Physician Are there precertification cases which could be approved by your non -RN personnel? [ ] a. Yes, describe [ ] b. No What percentage of ALL preservice reviews require your physician advisor review for decision making? (Check one) (all) [ ] a. Less than 1 % [ ] b. 1 - 10% [] c. 11-19% [ ] d. 20 - 30 % [] e. 31 -40% [] f. 41-50% [ ] g. Greater than 50% 12. Indicate the MINIMUM number of hours your normal "business day" switchboard operation would coincide with an 8:00 a.m to 5:00 p.m. "business day" in ALL FOUR of the continental U.S. time zones (e.g., switchboard hours 8:00 a.m. to 5:00 p.m. Eastern time would coincide with a call availability of 6 hours Pacific time). (a26) hours 45 6. It is our understanding that we will also have the opportunity to bid on the Dental, Life and Disability products. We will need all of the necessary information to quote these products. Answer: We are not biddirwi these services for 1999. 7. Six pages of a Sloans Lake directory is included listing Fort Collins physicians in addition to Fairplay, Florence, Fort Lupton, etc. To complete an adequate comparison of networks are we to compare the primarily Fort Collins network and the other markets are used minimally. Answer: We use the Fort Collins Network mainly, the other cities were listed because they happened to be on the same pages. 8. Is the City of Fort Collins receptive to HMO benefits replacing POS benefits provided the HMO is comparable in it's features to a POS plan. Answer: The City currently offers HMO and POS - may consider not offering POS, but decision has not been made. 9. Is the intent to include PCS benefits under the specific stop loss. Answer: Yes 10. Is it possible to quote stop loss benefits for medical benefits excluding drug benefits to achieve lower fixed costs. Answer: Yes, should include proposed rates both ways. 11. What is an acceptable network match for the City of Fort Collins, do you have a range in mind, such as 70% or better match to existing providers or provided additional physicians are available to enhance the network. Answer: We do not have a range in mind, of course, the higher the better for employees. 12. Is it possible to include transplants in the medical quote and not have a carve out transplant benefit. Answer: Yes, just include a quote with and without the transplant benefits included. 13. Has the City performed an employee survey recently to obtain members perception of the plan? Answer: No A diskette of the Proposal questionnaire is available, please call (970) 221-6775 or fax your request to (970) 221-6707 or Download the Questionnaire from the Purchasing Webpage, Current Bids page, at: www.ci.fort-collins.co.us\CITY_HALL\PURCHASING under Proposals. RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE PROPOSAL STATING THAT THIS ADDENDUM HAS BEEN RECEIVED. 13. Do you have a toll -free (1-800) telephone number for receipt of patient/provider calls? (CHECK ONE ONLY) (a27) [ ] a. No [ ] b. Will add prior to this client's implementation date. [ ] c. Yes (Indicate): 1-800- 14. Considering the size of the proposed client and possible volume of incoming phone calls, indicate your telephone system capabilities. (Check one.) (a31) [ ] a. Present system clearly adequate to manage the anticipated volume of calls. [ ] b. Present system will need to be expanded, which will occur PRIOR TO the implementation date for Utilization Management services. [ ] c. Present system will need to be expanded, which will occur SHORTLY AFTER the implementation date for Utilization Management services. 15. What type of system is available for receipt of preservice calls BEFORE/AFTER your normal working hours? (Check one.) (02) [ ] a. Answering machine with recorded message given. [ ] b. Answering machine will accept receipt of messages. [ ] c. Answering service to receive messages. [ ] d. Open 24 hours a day. (] e. No provisions, except during normal business hours. 16. If a client wanted OUTPATIENT SURGERIES precertified, what specific services would you include in the presurgical review? (May check more than one.) (a33) [ J a. We do not offer outpatient surgery precertification. [ ] b. Medical necessity for the surgery. [ ] c. Necessity for an assistant surgeon. [ ] d. Necessity for a 23 hour/observation overnight stay. [ ] e. Necessity for a post -op recovery center. [ ] f. Other: APPEAL/GRIEVANCE/RECONSIDERATION PROCESS 1. Do you have a formal written appeal/grievance/reconsideration process? (b1) [ ] a. Yes [ ] b. No 2. Is there information regarding the option for an appeal, the timeframe and the mailing address in the body of any denial notification letter? (W) [ ] a. Yes [ ] b. No 3. In the last 12 months, considering 100% of your firm's appealed PRESERVICE review denials, what % of these UPHELD upon completion of the appeal? (b7) 4. In the last 12 months, considering 100% of your firm's appealed CONCURRENT review denials, what % of these were UPHELD upon completion of the appeal? (M) CONCURRENT/CONTINUED STAY REVIEW 1. Does your firm perform concurrent review services? [ ] a. Yes [ ] b. No (Proceed to next Section) 2. Indicate the locations which are reviewed under your concurrent review program. (d2) [ ] a. Review of cases in acute medical/surgical facilities [ ] b. Review of cases in long term rehabilitation facilities [ ] c. Review of cases in skilled nursing facilities [ ] d. Review of cases in acute psychiatric facilities [ ] e. Review of cases in substance abuse rehabilitation facilities 3. Concurrent Review is performed: (CHECK ONE ONLY) (0) [ ] a. Telephonically for all cases. [ ] b. Telephonically in MOST cases with occasional onsite review needed. [ ] c. Onsite in all cases. [ ] d. Onsite in MOST cases and telephonically where staff not available for onsite record review. [ ] e. Other: 4. Concurrent review staff are: (d4) a. _% Full-time employees of the Utilization Management firm. b. _% Part-time employees of the Utilization Management firm. C. _% Subcontracted/consulting reviewers (e.g., on -call only, registry, home health agency personnel). 100% TOTAL 47 5. Check the category of staff who MOST FREQUENTLY perform telephonic concurrent review. (CHECK ONE ONLY) (0) [ ] a. Not applicable (Concurrent review performed only onsite.) [ ] b. LPN/LVN [ ] c. Trained clerical [ ] d. RN [ ] e. Physician [ ] f. Other: 6. Average number of concurrent reviews performed PER STAFF PER DAY: (CHECK ONE ONLY) (d8) [ ] a. 1 - 10 [] b. 11-20 [ ] c. 21 - 30 [ ] d. 31 - 40 [ ] e. 41 - 50 [ ] f. 51 -60 [ ] g. More than 60 7. What percent of concurrent case reviews require your physician advisor intervention/review decision? (CHECK ONE ONLY) (0) [ ] a. 0 % [l b. 1-10% [] C. 11-20% [ ] d. 21 - 30% [] e. 31 -40% [ ] f. 41 - 50% [] g. 51 -60% [ ] g. More than 60 % 8. Is discharge planning an integral part of your concurrent review process and included in the fee for this program? (CHECK ONE ONLY) (d15) [ ] a. Yes [ ] b. Yes, but separate fee for discharge planning services. [ ] c. No, discharge planning not part of concurrent review process or the fee. [ ] d. Other: CASE MANAGEMENT 1. Does your firm have an ACTIVE case management program? (fl) 48 [ ] a. Yes [ ] b. No (Proceed to Next Section) 2. For the most current one year period, indicate the number of COMPLETED AND BILLED case management cases. (CHECK ONE ONLY) (f2) [ ] a. 0 [] b. 1-40 [] c. 41-80 [] d. 81-120 [ ] e. If greater than 120 cases, indicate: /year. 3. During case management, does your staff NEGOTIATE FEE REDUCTIONS with providers and vendors? (CHECK ONE ONLY) (2) [ ] a. Yes [ ] b. No [ ] c. No, but willing to develop for this client. 4. What is the AVERAGE percent fee discount this client could expect your firm to negotiate for service/equipment, etc.? (CHECK ONE ONLY) (f4) a. Fees not typically negotiated. [] b. 1-5% [] c. 6-10% [] d. 11-14% [] e. 15-20% (] f. 21 - 25 % [ ] g. 26 - 30 % [ ] h. More than 30% 5. Given your fum's average case management scenario, indicate the percent of total savings attributed to the following three categories: (2) 49 TOTAL 100yo 6. What is the AVERAGE amount of time (billable hours) this client should expect that your Utilization Management firm spends on a TYPICAL case management case from initiation to closure? (CHECK ONE ONLY) (fl1) [ ] a. 0 - 1.5 hours [ ] b. greater than 1.5 - 4 hours [ ] c. greater than 4 - 7 hours [ ] d. greater than 7 - 10 hours [ ] e. greater than 10 - 15 hours [ ] f. greater than 15 hours (specify) hrs. 50 STATISTICAL REPORTING 1. Indicate your fmn's ability to provide the following data for this client: (gl) 51 o. Length of stay by employee a. b. C. d. vs. dependent p. Number of pre -certified cases a. b. C. d. by procedure name or ICD-9 q. Admit and discharge date by a. b. C. d. patient name or ID/SS# r. Length of stay by patient a. b. C. d. name or ID/SS# s. Number and name of cases a. b. C. d. receiving a second surgical opinion t. Admits by physician name a. b. C. d. u. Bed days by physician name a. b. C. d. v. Average length of stay by a. b. C. d. physician name 52 2. If the following information (3 grids) was needed from your Utilization Management firm at least quarterly, indicate your firm's ability to provide this required information. (CHECK ONE ONLY) (g3) [ ] a. Yes, capable of providing the information contained in the three grids on a quarterly basis at NO additional cost. [ ] b. Yes, capable of providing the information contained in the three grids on a quarterly basis WITH additional cost. [ ] c. No, unable. GRID 1 Original Precertification Cases Number Approved Number Avoided* Number Denied* Number Waived* Inpatient medical/surgical Outpatient surgery Inpatient psychiatric/ substance abuse Outpatient psychiatric/ substance abuse Outpatient services (e.g. doctor office, PT, OT, chiropractic, etc.) Equipment/appliances Diagnostic tests TOTAL * Definitions of terms in preceding grid: AVOIDED = cases where your firm's staff persuaded physician to seek an alternate more cost effective route/service than had been called into certify without having to issue a denial (e.g., physician concurred with your Utilization Management firm's recommendation). WAIVED = cases where client overtumed Utilization Management firm's recommendation for denial/noncertification. DENIED = cases where your firm issued a letter of noncertification (e.g., denied necessity for service). 53 GRID 2* The cases which were (a) avoided, (d) denied and (w) waived are to be specifically recorded and provided as an attachment to the Utilization Management Grid #1 to include: Enrollee Sex Original Requesting Date Review Rationale Age Request Dr of Status: for: Service (a) (a) (d) (d) (w) (w) GRID 3 Concurrent/Continued Stay Number of Cases Total Length of Stay Average Length of Stay Inpatient medical Inpatient surgical Maternity/obstetrics Psychiatric Substance abuse TOTAL 3. How often should the client expect to receive a ROUTINE report from your firm indicating overall utilization and savings? (CHECK ONE ONLY) (g4) [ ] a. Weekly [ ] b. Monthly [ ] c. Quarterly [ ] d. Semi-annually (every 6 months) [ ] e. Annually 4. Are you able to provide an annual summary of the client's utilization statistics and your firm' s overall savings? (g5) [ ] a. Yes [ ] b. No 54 5. I 7 Indicate your STANDARD METHOD OF REPORTING SAVINGS from review of INPATIENT hospitalization. (CHECK ONE ONLY) (g6) [ ] a. Inpatient hospital savings reports not available. [ ] b. Basically as the difference between days requested and days approved/certified. [ ] c. Basically as a comparison of days or length of stay utilized versus normative or case mix adjusted days or length of stay. [ ] d. Other: Describe: Indicate the STANDARD METHOD OF REPORTING SAVINGS from review of OUTPATIENT surgery. (CHECK ONE ONLY) (g7) [ ] a. Outpatient surgical review not available. [ ] b. Outpatient surgical review available but specific reporting not delineated. [ ] c. Dollar value times the number of cases determined not to be medically necessary. [ ] d. Other: Describe: Indicate if the outcome of your review activities in the following categories is able to be provided on client reports. (CHECK ONLY THOSE WHICH CAN BE PROVIDED.) (g8) a. Number of cases determined to be medically necessary. b. Number of cases determined to be NOT medically necessary. C. Number of cases diverted from inpatient to outpatient. d. Number of cases where requested assistant surgeon was approved. e. Number of cases where requested assistant surgeon was NOT approved. f. Number of cases where a proposed preop day was approved. g. Number of cases where a proposed preop day was NOT approved. h. Number of cases where a proposed 23 hour observation stay following outpatient surgery was approved. i. Number of cases where a proposed 23 hour observation stay following outpatient surgery was NOT approved. j. Number of cases where outpatient surgery was approved. k. Number of cases where outpatient surgery was NOT approved. 55 List for Question #4 LISA SEELEY AETNA/U S HEALTHCARE 7979 E TUFTS AVE PKWY STE 1000 DENVER CO 80237 JOHN C HASTINGS SR ACCOUNT EXECUTIVE CIGNA COMPANIES 3900 E MEXICO AVE STE 1250 DENVER CO 80210 JANE ANN LAKE FLMI ACCOUNT EXECUTIVE GREAT WEST LIFE ASSURANCE CO MELLON FINANCIAL CENTER 1775 SHERMAN STE 3000 DENVER CO 80203 B EDWARD BENNETT MUTUAL OF OMAHA 600 GRANT ST STE 900 DENVER CO 80203 JIM HUMPHREY EXECUTIVE DIRECTOR NORTHCARE 2020 6TH ST STE 2 GREELEY CO 80631 6333 COLETTE MILLSTONE PCS INC 9501 E SHEA BLVD SCOTTSDALE AZ 85260 6719 ELIAS ACOSTA BLUE CROSS BLUE SHIELD OF COLORADO 700 BROADWAY DENVER CO 80273 GARY L HATTENDORF EXPRESS SCRIPTS/VALUE RX 1700 N DESERT T\DRIVE TEMPE AZ 85281 MICHAEL J DOW REGIONAL SALES DIRECTOR ING MEDICAL RISK SOLUTIONS 1290 BROADWAY STE 777 DENVER CO 80203 5699 PHILIP G REISBECK NATIONAL HEALTH SYSTEMS INC 155 INVERNESS DR WEST STE 300 ENGLEWOOD CO 80112 CHRISTINE LAWRENCE ACCOUNT EXECUTIVE PACIFICARE 6455 S YOSEMITE ST ENGLEWOOD CO 80111 JOHN WOOD REGIONAL MANAGER PACIFIC LIFE INSURANCE CO 6300 S SYRACUSE WAY STE 485 ENGLEWOOD CO 80111 DARRIS SHERMAN JEFF GIADONE THE PRUDENTIAL INSURANCE CO OF AMERICA QUALMED INC 4643 S ULSTER ST STE 1000 3900 E MEXICO AVE STE 800 DENVER CO 80237 DENVER CO 80210 QUALITY CONTROL 1. Do you have a mechanism to ensure that data entry is ACCURATE and COMPLETE? (jl) [ ] a. No [ ] b. Yes, explain: 2. Do you have a mechanism to ensure the consistent application of written screening criteria by your nurse reviewers? 02) [ ] a. No [ ] b. Yes, explain: 3. When reviewing a case for which no specific written criteria exists, is the case AUTOMATICALLY referred to a physician advisor? 07) [) a. No (Describe your protocol) [ ] b. Yes 4. Do you have a mechanism to monitor whether your PHYSICIAN ADVISOR REVIEW DECISIONS are reasonable and cost effective? 03) [ ] a. No [ ] b. Yes, explain: 5. Does your Utilization Management firm maintain PRODUCTIVITY STANDARDS for nurse reviewers (e.g., "X number of reviews must be completed each day", etc.)? 04) [ ] a. No [ ] b. Yes, describe: Cel Do you monitor to assure that reviews are completed in a TIMELY manner? [ ] a. No [ ] b. Yes, explain how: 56 05) GENERAL QUESTIONS 1. How long has your organization been performing Utilization Management services? (CHECK ONE ONLY) (nl) [ ] a. Less than 1 year [ ] b. 1 - 3 years [] c. 4 - 6 years [ ] d. 7 - 9 years [ ] e. 10 or more years 2. Are your services local, national, or international? (CHECK ONE ONLY) (n2) [ ] a. Local only [ ] b. National, some states* [) c. National, all states [ ] d. National, all states plus international * Indicate the states you SERVE or DO NOT SERVE (whichever is shorter). 3. What percent of your primary operational staff involved in preservice, concurrent and case management review have been with your firm for ONE YEAR OR LONGER? % (0) 4. Are there any specific reporting or administrative procedures you would require of this client prior to implementation of your program? (n4) [ ] a. Yes, explain: [ ] b. No 5. Considering this client's START DATE for U.R. SERVICES, do you foresee any difficulty in the installation of your program? Give timeline proposed. (n5) [ ] a. No [ ] b. Yes, explain: 6. Would you be agreeable to a periodic (e.g., quarterly) "round table" meeting with the client, Utilization Management firm, claims payor and consulting organization to discuss both positiv e 57 and negative areas of the working relationship? If yes, consider this cost in your proposed fees. (n9) [ ] a. Yes [ ] b. No 7. Indicate your firm's per occurrence liability INSURANCE LIMIT with regard to errors, omission, negligence, malpractice. (CHECK ONE ONLY) (MO) (] a. < $1,000,000 [] d. $5,000,000 [] b. $1,000,000 [] e. > $5,000,000 but < $10,000,000 [ ] c. > $1M but < $5M [ ] f. >=$10,000,000 8. On cases where any adverse decision has been rendered, are you willing to retain hard copy U.R. and medical information files for a period of one year POST contract termination? (CHECK ONE ONLY) (n15) [ ] a. Yes, at no added cost [ ] b. Yes, with an added cost $ [ ] c. No, explain: 9. Do you have educational material which informs enrollees regarding your U.R. services and Procedures? (CHECK ONE ONLY) (n18) [ ] a. Yes, available for this client at no added cost [ ] b. Yes, available for this client with an added cost of $ [ ] c. No, but can develop at no added cost [ ] d. No, but can develop with an added cost of $ [ ] e. No, not available 10. Is your firm willing to assist this client if a dispute arises over payment/nonpayment for healt h care services which your firm recommended were not medically necessary, appropriate and/or reasonable? (CHECK ONE ONLY) (n20) Yes, within our proposed fees Yes, for an added cost $ No, explain: 11. Is your firm willing to assist the City with medical appeals when special questions or situations arise? 12. What is your response time for returning phone calls/messages? 13. When approval or denial is granted for a procedure, what is the procedure for notification, who is contacted and what is the timeline? 58 14. Will a U.M. representative be assigned solely to the City? If not, what will the arrangement be? 15. What organization would provide the utilization review services, where is its headquarters and where will the utilization review services be provided? 16. Will your firm agree to modify procedures to meet the needs of the City? 17. The City is considering the addition of an Employee Advocacy Program which would provide assistance to employees regarding self care, general medical care, second opinions, selection of providers, etc. This program would be accessible to employees through a WATS telephone service during normal business hours. This service would be provided by personnel with the appropriate medical background to accurately answer questions. If the City were to add an Employee Advocacy Program: a) What type of personnel would provide these services? What type of credentials would these individuals possess? b) How would quality be assured and measured through this program? c) How many hours per day would this service be accessible through a live attendant? Days per week? d) Have you implemented a similar program for any other clients? If so, what were the financial impacts on the Plan compared to the investment? 18. Describe how psychiatric/substance abuse reviews will differ from other utilization services. Are these services subcontracted or provided within your organization? If done within, what are the credentials of the individuals performing this service? 19. Are there any other services that are subcontracted? 20. Are there or have there been any lawsuits brought against your company? Please describe in detail. 59 REQUESTED ATTACHMENTS Please provide the following: 1. PRESERVICE REVIEW a. Include a sample preservice confirmation/approval notice/letter. b. Include a preservice denial/nonconfi oration notice/letter. 2. CONCURRENT REVIEW a. Provide a sample letter indicating that continued stay is longer able to be certified/approved. 3. CASE MANAGEMENT a. Include a sample case management summary report with savings analysis. (Do not identify the patient or providers of service.) b. Include a sample bill which this client could expect to receive for a case management patient. 4. REPORTS a. Include a sample standard report package with an explanation of abbreviations and categories of data. b. Include samples of customized report capabilities. 5. APPEAL PROCESS a. Attach a copy of the detailed appeal process a patient, physician or provider would need to follow in the resolution of a complaint/disagreement including key timeframes. b. Attach a sample appeal closure letter which would be forwarded to a physician. 6. ADMINISTRATIVE a. Include sample education material which informs enrollees regarding your Utilization Review firm's overall services. b. Include a sample Utilization Review contract. :1 STOP -LOSS INSURANCE OUOTATION FORM (continued) POS/EPO Plans Only (15/12) Rate Per Eligible Per Month Expected Incurred Claims Per Month Individual Stop -Loss coverage based on all claims incurred after October 1 1998 and paid after POS $ EPO $ POS $ EPO $ January 1, 1999 with the following deductibles: $120,000 Employee Employee + Spouse Employee + Child(ren) Employee + Family $135,000 Employee Employee + Spouse Employee + Child(ren) Employee + Family $150,000 Employee Employee + Spouse Employee + Child(ren) Employee + Family $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Note: Excludes Medicare Retirees. Coverage must include prescription drugs and exclude organ transplant coverage. For purposes of your quote, please assume the following eligibility far the POS plan and EPO plan: POS EPO Employee 30 185 Employee + Spouse 10 100 Employee + Child(ren) 15 95 Employee + Family 25 205 Total 80 585 How do the above charges differ assuming you are selected to provide stop -loss coverage for all plans? 64 STOP -LOSS INSURANCE QUOTATION FORM Please provide an individual stop -loss quotation for the following deductibles. The following must be a schedule of stop -loss premium rates before any dividends or experience refunds. nly (15/12) 7[Tlnndiividual Rate Per Eligible Per Month Expected Incurred Claims Per Month p-Loss coverage based on all claims incurred after October 1. 1998 and paid after January 1, $ $ 1999 with the following deductibles: $120,000 Employee Employee + Spouse Employee + Child(ren) Employee + Family $135,000 Employee Employee + Spouse Employee + Child(ren) Employee + Family $150,000 Employee Employee + Spouse Employee + Child(ren) Employee + Family $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Note: Excludes Medicare Retirees. Coverage must include prescription drugs and exclude organ transplant coverage. For purposes of your quote, please assume the following eligibility for the PPO plans, Employee 190 Employee + Spouse 130 Employee + Child(ren) 60 Employee + Family 220 Total 600 63 STOP -LOSS INSURANCE QUESTIONS TO BE ANSWERED 1. Please explain your company's renewal action procedures with respect to the stop -loss contract. Can individuals be excluded or given higher deductibles due to adverse claim experience? If so, describe under what circumstances. 2. How often would your company audit claims payments and procedures? 3. Is a claim audit necessary before stop -loss claims can be paid? If so, please describe the nature and length of the process. 4. How soon after a claim is submitted to your company can reimbursement be expected by the City? 5. How are discrepancies between your company's definition of a usual, customary and reasonable charge and that of the claim administrator handled? 6. Will your company underwrite stop -loss coverage without also acting as the claim administrator? If yes, describe your TPA approval process and length of time to complete. 7. Your company must assume responsibility under stop -loss for existing COBRA continuees at the time coverage is effective. Please confirm your acceptance of this requirement. 8. Does your company allow for rating credits if certain claim administrators, claim audits or utilization review programs are utilized? If so, please list these administrato rs and/or programs as well as the corresponding credit. 9. Describe the precise term of coverage under your quoted individual stop -loss provisions (e.g., claims incurred on or after the plan effective date and paid within 120 days of the end of the contract year or termination, whichever is earlier). 10. Please define a paid claim. 11. What is the approximate size of your stop -loss portfolio in terms of annual premiums and lives covered? Is there any reinsurance of the pool? If so, please describe. 12. Are premiums established solely on the basis of the experience of that pool, or are other factors such as plan's own experience and reinsurance rates considered as well? 13. Are there any events that can occur during the term of the stop -loss contract that permit you to adjust your rates (e.g., changes in enrollment or benefits of certain magnitude)? 14. Are there any dollar limits under your stop -loss liability? 65 15. Do you agree to cover all charges permitted under the terms of the plan? If not, what exclusions and/or limitations exist with respect to what your contract will cover? 16. Does your stop -loss coverage contain any mental health or other restrictions? If so, please explain. 17. On individual claims exceeding the individual stop -loss deductible, is the City responsible for payment or will your company provide a draft book or actually process and pay the claim? If the City is responsible, will you require the City to make an actual payment or will you reimburse the City on submitted expenses? 18. Will your company provide an annual experience accounting report for a stop -loss policy showing premium paid, benefits paid (if any) and retention charges? 19. Will you agree to conform with the provisions of the Plan in regard to pre-existing conditions? 20. Will you consider alcoholic, chemical dependency or drug addiction treatment, as provided for in the plans of benefits, as eligible expenses under a stop -loss contract? 21. These specifications have asked for your proposal to underwrite individual stop -loss coverage on a "15/12" basis. The attachment point would be based on those claims incurred October 1, 1998 through December 31, 1999 and paid within the contract year, January 1, 1999 through December 31, 1999. Is this your understanding of the individual stop -loss specifications? 22. Confirm that your proposal is net of organ transplant coverage. PRESCRIPTION DRUG PLAN SPECIFIC INFORMATION Claims History - PPO Prescription Drugs Number Total Paid Claims of Items I) Paid I ...........: January 1 through December 31, 1996 4,782 $204,149� January 1 through December 31, 1997 4,266i $221,361 January 1 through March 31, 1998 (2) 3,098 $85,456 (1) Represents number of line items, not necessarily number of claims. Note, all prescriptions filled for an individual per month are combined into one line item. (2) Prescription drug program changed from cash and carry to card plan effective January 1, 1998. Figures include 791 claims totalling $46,338 of cash and carry run -out claims paid by National Health Systems. Claims History - POS Prescription Drugs - implemented January 1 1997 Number Total Paid CTains of Items (J) Paid January 1 through December 31, 1997 Not available $34,3881 January 1 through j March 31, 1998 1 Not available i $11,6171 1 Claims Histo_ry - EPO Prescription Drugs Number Total:::- Patd Claims 41Items (J) Paid January 1 through � December 31, 1996 i Not available $157,5841 January 1 through December 31, 1997 I Not available $191,2741 January 1 through i March 31, 1998 I Not available $62,5821 I LISA FENTON FREE ROCKY MOUNTAIN HMO WADE N HALL DIRECTOR OF SALES 2775 CROSSROADS BLVD RX AMERICA P 0 BOX 60129 369 BILLY MITCHELL ROAD GRAND JUNCTION CO 81506 SLAT LAKE CITY, UT 84116 DAN DEL BIANCO TONY LICATA SAFECO INSURANCE CO SLOANS LAKE MANAGED CARE INC 165 S UNION BLVD STE 310 1355 S COLORADO BLVD #902 LAKEWOOD CO 80228 2211 DENVER CO 8222 ARLEIGH K KENNEDY CAROL LEE SUN LIFE OF CANADA UNITED HEATHCARE 1401 17TH ST STE 610 6251 GREENWOOD PLAZA BLVD DENVER CO 80202 ENGLEWOOD CO 80111 4910 MS OLIVIA GAILAND MR JOSEPH ZAZYEZNY FIRST HEALTH SERVICES CORP NATIONAL PRESCRIPTION ADMINISTRATORS 4300 COX RD 711 RIDGEDALE AVE GLEN ALLEN VA 23060 EAST HANOVER NJ 07936 MR TOM DAVIS MS CARLA GUILLEN SPECTERA INC INTRACORP 8720 CASTLE CREEK PKWY 222 S HARBOR BLVD STE 500 INDIANAPOLIS IN 46250 ANAHEIM CA 92805 NYL CARE HEALTH PLANS INC MS KAREN PRICE ONE LIBERTY PLAZA PROFESSIONAL PHARMACY SERVICES INC NEW YORK NY 10006 SPRING CREEK PHARMACY 2001 S SHIELDS FORT COLLINS CO 80526 MS SUSAN WILLIAMS AMERICAN STOP LOSS RESTAT 44 FRONT STREET STE 300 P 0 BOX 758 WORCESTER MA 01608 WEST BEND WI 53095 0758 PRESCRIPTION DRUG PLAN FEE QUOTATIONS Please provide your fee quotations to provide prescription drug benefits as described in this section. Your quotation should be in the following format. PPO PLANS ONLY Retail Only Generic Dispensing Fee $ /Rx Brand Dispensing Fee $ /Rx Generic Discount Below AWP* % (AWP based on quantities of 30) Brand Discount Below AWP** % (AWP based on quantities of 30) Administration Fees $ /Rx (per prescription) Other Fees Identification Cards $ /ee DUR Program $ /ee MAC Pricing $ /ee Other Fees (List in detail) $ lee * If MAC, please indicate the average discount %. ** Indicate Source of AWP. For purposes of your quote, please assume 605 eligibles in the PPO plans. 69 PRESCRIPTION DRUG PLAN FEE QUOTATIONS (continued) PPO PLANS ONLY Mail Order Only Generic Dispensing Fee $ /Rx Brand Dispensing Fee $ /Rx Generic Discount Below AWP* (AWP based on quantities of 90) % Brand Discount Below AWP** (AWP based on quantities of 90) % Administration Fees (per prescription) $ /Rx Other Fees Identification Cards $ /ee DUR Program $ /ee MAC Pricing $ /ee Other Fees (List in detail) $ /ee * If MAC, please indicate the average discount %. ** Indicate Source of AWP. For purposes of your quote, please assume 605 eligibles in the PPO plans. 70 PRESCRIPTION DRUG PLAN FEE QUOTATIONS lcontinuedl POS/EPO PLANS ONLY Retail Only POS EPO Generic Dispensing Fee $ /Rx $ /Rx Brand Dispensing Fee $ /Rx $ /Rx Generic Discount Below AWP* (AWP based on quantities of 30) Brand Discount Below AWP** (AWP based on quantities of 30) Administration Fees (per prescription) $ /Rx $ /Rx Other Fees Identification Cards $ /ee $ /ee DUR Program $ lee $ lee MAC Pricing $ /ee $ /ee Other Fees (List in detail) $ /ee $ lee * If MAC, please indicate the average discount %. ** Indicate Source of AWP. For purposes of your quote, please assume 80 eligibles in the POS plan and 585 in the EPO plan. 71 PRESCRIPTION DRUG PLAN QUESTIONS TO BE ANSWERED In order for your proposal to be considered and accepted, your organization must provide answers to the questions presented in this section. Each question must be answered specifically and in detail. Reference should not be made to a prior response, or to your contract, unless the question involved specifically provides such an option. Be sure to refer to the earlier sections of this request for proposal (RFP) before responding to any of the questions, so that you have a complete understanding of all of this client's requirements with respect to the bid. If your proposal is different in any way (whether more or less favorable) from that indicated in this request for proposals, clearly identify those differences in your executive summary. If you do not, the submission of your proposal will be deemed a certification that you will comply in every respect (including, but not limited to, coverage provided, funding method requested, benefit exclusions and limitations, underwriting provisions, etc.) with the requirements set forth in this RFP. If you are unable to perform jLny required service, indicate clearly: a) what you are currently unable to do, and, b) what steps will be taken (if any) to meet the requirement, the timetable for that process and who will be responsible for the implementation, along with that person's qualifications. Please include any additional information in your proposal which you consider useful to the client. However, responses to all of the questions set forth below must be provided. A. General Issues (Experience, Solvency, Membership) How long has your organization been providing prescription drug services? How long has your organization been providing retail pharmacy network services? Mail order maintenance prescription drug programs? Prescription drug utilization review services? 2. Is your retail pharmacy network solely owned and operated by your organization? If not, explain the contractual relationship you have. 3. Is your firm anticipating expansion or reorganization in the next year? Please explain. 4. How many clients use your retail pharmacy program and how many covered persons does this represent? How many clients and covered persons use your mail order pharmacy program? Please provide the information in the following format: 3 years prior, 1 year prior and current. 5. Is your organization capable of providing a program which integrates the retail and the mail order components, if that is what the City ultimately decides to implement? 6. Provide samples of your standard reports which permit analysis of the retail drug program and of the mail order drug program and which display the results of your drug utilization review program. Is there a charge for your standard reports? Are ad hoc reports available? Is there an extra fee? 73 7. Can you provide management reports that can isolate the components of cost increases in the prescription drug benefit? For example, leading drugs dispensed, increases in utilization, development of trends, physician outliers, high patient utilizers and/or possible abusers? Is ther e an extra fee for any of them? 8. Have you implemented innovative cost containment measures for any of your other clients in the last year? If yes, please elaborate upon the progress and what quantitative effect it had. How does this distinguish you from your competitors? 9. Will dedicated customer service representatives be assigned to this account? Are customer service representatives separated from the claim processing unit, or do claim processors have customer service responsibilities? Do customer service representatives have on-line access to up-to-date claim processing information? Do customer service representatives have authority to approve claims? 10. How do members select a network pharmacy? Do you provide member support services for selecting and/or locating network pharmacies? 11. Describe the member grievance protocols in place. What is the average response time for general plan and eligibility questions? Complicated claim questions? 12. If your organization has offices in more than one city, please state the location of the office which will be responsible for services provided to the city. 13. Does your organization mandate plan design? If yes, in what way? B. Coveraae Issues Provide a list of the standard coverage exclusions and limitations for your network and non - network options. 2. Describe the coverage portability for members who temporarily reside or transfer to non - network service areas. C. Retail Pharmacy Network 1. Please submit a current listing of participating pharmacies in the City's service area (i.e., Northern Colorado and the Denver metropolitan area) and their normal days and hours of operation. 2. Can the plan sponsor or plan participant nominate pharmacies to be considered for inclusion in the network panel? If so, what steps would be required to be made by the plan sponsor and/or participant? 3. What pricing guide does your organization use for your retail pharmacy program? Red Book? Blue Book? Medispan? First Data Bank? Other? How often is this standard updated? 74 4. Please describe in detail the prescription dispensing routines of your pharmacies. In addition to a description of the overall process, please advise how your pharmacies address the following issues: - plan dispensing limitations including quantity and dosage guidelines - excluded drug lists - physician/pharmacist communications - generic over brand name dispensing - irregularities in the prescribing or receiving of drugs 5. Does your recordkeeping system permit interface with and access to the prescription histories being simultaneously established at other participating pharmacies? If such intrapharmacy communication exists, how are the plan dispensing limitations accommodated? 6. How are complaints from and problems presented by participants handled? 7. What is your generic fill rate in the following generic environments: MAC A MAC B MAC C Do you guarantee a generic fill rate? If so, what are the penalties if it is not achieved? 8. Describe the claims payment process, for retail pharmacy claims, from date of receipt to full adjudication of checks to providers or patients. Will all claims be paid in accordance with the benefit program described in this RFP? Be sure to explain how patient submit/direct pay claims are handled. If the process is different for network and non -network claims, please discuss separately. For example, do you batch process checks to network providers? If so, explain. 9. Describe in detail the auditing program and procedures maintained by your organization. Will you permit an audit by an external auditor at the request of the client? 10. How often are pharmacy directories updated and dispersed to plan members? 11. Are there financial incentives to network pharmacies that are tied to utilization rates, compliance goals, quality of care outcomes or other performance results? If so, please explain. 12. Do you track and collect data on reimbursements to specific pharmacies? What data are captured and tracked? Are pharmacies terminated for abusive or excessive billing practices? 13. How is eligibility verified? Can your system accept the eligibility list on tape or must it be on hard copy? How often can eligibility be updated? D. Mail Order Prescription Drug Program 14. Please indicate if the mail order facility is owned by your organization. If not, name the mail order company you are proposing to use. Where is the facility located? What is the relationship 75 between your organization and the mail order company? How are claim systems, billing systems, and reporting systems linked? 15. What is the turnaround time between receipt of a prescription and shipment of the filled prescription? 16. Describe in detail the process involved in getting a mail order prescription filled. List each step beginning with the initial contact with the mail order pharmacy. Clearly identify the parts of the process that involve written communication by the participant. Do you offer any alternativ e to communications in writing? Identify who performs each step (pharmacist, technician, etc.). 17. What pricing guide is used for your mail order prescription drug program? Blue Book? Red Book? Medispan? First Data Bank? Other? How often is it updated? 18. Describe the claims payment process for mail order claims. Will all claims be paid in accordance with the benefit program described in this RFP? What form of payment can you accept from the claimant? Can refills be phoned in with purchases made by credit card? How many working days do you recommend that a patient submit a claim prior to the run out of the current prescription supply in order to ensure that the new prescription reaches the member before the existing supply is depleted? What is the average time in days between receipt of claim and delivery to patient? (include delivery time) 19. How long can a drug be dispensed before a new prescription is required? Is it possible to dispense a small initial supply, then the balance of the 90-day supply after it is certain no drug reaction has occurred? 20. What are your internal controls to see that a correct prescription has been dispensed and charged to the City? 21. What is your generic fill rate for mail order drugs? 22. If an individual has lost eligibility under the Plan, is it possible for that participant to continue to receive maintenance drugs with your company and be billed directly? If so, what is the cost to the individual? 23. How are patients advised that their prescriptions are about to run out? How much advance notice is given? 24. What delivery system do you use (UPS, Postal Service, Federal Express)? If you use the Postal Service, do you use first or third class mail? Is there a charge to the participant for the delivery service? 25. How is eligibility verified? Can your system accept the eligibility list on tape or must it be on hard copy? How often can eligibility be updated? E. Claims Paying Services and Abilities 76 1. For non -network claims, what is the number of working days for a claim to be processed (check issued) from the date of receipt, without coordination of benefits? On what basis do you make that representation (e.g., average turnaround time over the past 12 months)? Describe separately for network and non -network claims, if results vary by type of provider. The percent of claims processed within 10 working days: The percent of claims processed within 30 working days: 2. For the claim office proposed, please provide the following for the last two calendar years: a. Financial accuracy as a percent of total claims dollars paid (include over and underpayments). b. Coding accuracy as a percent of total claims submitted. 3. How do you avoid duplicate payments of the same claim? If duplicate payments or overpayments are made, what are your procedures for recovery of the overpayments or duplicate payments? 4. Describe the methods used to track claims. If on-line, can claim tracking be made available to clients? 5. Please explain your COB procedures (include all options offered) and the average savings that you obtain and how COB savings are calculated. How do you know if there is other coverage? How often are records updated for new information on other coverage? What information is required from the plan sponsor in order to administer this provision? Is there an additional fee involved? If so, what is the cost? 6. Please explain your standard subrogation policy provisions and procedures and any options that are available, along with their advantages and disadvantages. 7. Describe the degree of flexibility, and any limitations, of your system in handling various plan designs. F. Drug Utilization Review (DUR) The City desires a prescription utilization review program that would provide monitoring of both the retail prescription program and mail order maintenance drug program. Please describe your prescription drug utilization review program separately for pharmacy network and mail order claims. In addition to a description of the program and how it functions, please advise how your drug utilization review program addresses the following issues: - quality and cost of patient's recommended therapy - physician prescribing patterns - pharmacy dispensing practices - therapeutic and dosing regimes - generic monitoring 77 member education 2. Please list the staff that performs the prescription drug utilization review and describe their role s in the process. What are their qualifications? 3. Is utilization review performed on all prescriptions? If not, what criteria are used to select the prescriptions reviewed? 4. Please advise us as to what criteria are used to evaluate the prescriptions reviewed after they at e selected. 5. How often are the criteria updated? 6. Describe the educational material provided to plan members, prescribing physicians and network pharmacies. Provide samples. 7. Please describe your assessment and intervention procedures for dealing with prescribing physicians and pharmacies. Who is responsible for communication? To whom are these communications directed? 8. Do you offer any disease management programs? If so, for which conditions? Are you willing to offer these programs on a pilot basis at no cost to the City? 9. Do you correspond with prescribing physicians? On what percentage of prescriptions? What degree of success have you had in changing prescribing patterns? What are the cost savings generated through this practice? How is this cost savings calculated? 10. What ongoing quality assurance measures are taken? 11. What is the expected percentage of total prescription plan cost savings that will result from the implementation of your DUR program? G. Fommulary 12. Can your formulary be offered on a voluntary basis or must it be mandatory? Is it open or closed? 13. What is the total number of products included? Provide a complete list, including the name of the manufacturer of each drug product, with your proposal. 14. When was your formulary first established? 15. How often is it updated? How often do you communicate updates to physicians? 16. What is the title of the person or body within your organization which maintains and updates the formulary? 17. What is the total number of covered persons currently using your formulary program? 78 18. How often is the formulary printed and distributed to clients? 19. What is the potential, average cost -savings to a client? Will you guarantee a specific dollar amount per dispensed prescription to be rebated to a client? If no, why not? If yes, state the amount. Does the guarantee apply to all prescriptions dispensed or just those that are on the formulary? Is the guaranteed amount the actual rebate to the client or would the client only receive a certain percentage of the guaranteed amount? 20. Describe the method used to develop and maintain your formulary. Please provide the credentials of the individual(s) involved in the ongoing development of the formulary. 21. Describe the process you use to encourage physicians to prescribe the drugs listed on your formulary if a client wishes it to be voluntary for its employees. 22. How often do you receive formulary rebates from the pharmaceutical manufacturing companies? 23. When can the plan sponsor expect the first formulary rebate check? After the first check, what is the ongoing frequency of formulary rebate checks? 24. Are you willing to guarantee in the contract the timing of formulary rebate checks? If your company is owned by a prescription drug manufacturer, answer the following questions. Otherwise, skip to Section H. 25. What percentage of the drugs included in your formulary are manufactured by your parent company? If greater than 50%, explain why the drugs manufactured by your owner predominate the formulary. 26. How do you guarantee to clients that you can avoid the inherent conflict of interest resulting from your managed prescription drug program being owned by a drug manufacturer? 27. How do you guarantee to clients that in developing your formulary you continue to include the drugs, regardless of manufacturer, that not only have the desired therapeutic outcomes but are also most cost-effective? H. Fees Explain how maximum allowable charges are determined geographically. a. By the location of the plan, or pharmacy? Other? b. How are specific areas delineated (e.g., five digit zip, 3 digit zip, county)? 2. Are there any additional fees other than those specified above which might be charged to the client? If so, please identify them in detail. 3. For the retail program please indicate your pricing formula for the ingredient component. Does the price formula include maximum allowable costs (MAC), average wholesale price (AWP), 79 MR SCOTT BURNS RX AMERICA 369 BILLY MITCHELL ROAD SALT LAKE CITY UT 84116 OCCUPATIONAL HEALTH MANAGEMENT SERVICES 1045 GARFIELD FORT COLLINS CO 80524 NORTHERN COLORADO MEDICAL CENTER 1801 16TH ST GREELEY CO 80631 IRWIN HARRIS CRAWFORD & COMPANY 7000 YOSEMITE ST SUITE 150 ENGLEWOOD CO 80155 6502 POUDRE VALLEY HOSPITAL 1024 S LEMAY AVE FORT COLLINS CO 80524 FRONTIER ADJUSTERS 2919 ALAMO AVE FORT COLLINS CO 80525 MCKEE MEDICAL CENTER 2000 BOISE AVE LOVELAND CO 80538 5006 formulary or usual, reasonable and customary charges? What discount is applied for generic drugs, for brand drugs? Is there a dispensing fee? (Please list dispensing fee individually for each state.) For what period of time is this formula guaranteed? If MAC pricing is used, please provide the current percentage off AWP equivalent. (Please exclude the value of any "lesser of provisions, MAC savings and rebates.) 4. For the mail order program please indicate your pricing formula for the ingredient component. Does the pricing formula include maximum allowable costs (MAC), formulary, average wholesale price (AWP), or usual, reasonable and customary charges? What discount is applied for brand name and for generics? If MAC pricing is used, please provide the current percentage off AWP equivalent. Is there a dispensing fee? If so, what is it? What is your mail order fee? For what period of time is this formula guaranteed? 5. What percent of your network pharmacy contracts will include the "lesser of retail price, MAC price or discounted price" provision? % How do you determine that plan members always receive this lowest price? What procedures are established to ensure that the pharmacy is in compliance with this provision? 6. Does your firm set the professional dispensing fee or will you permit the City to set this fee? What fee do you recommend? 7. When are fees due and what is the grace period for payment of fees under your policy? If fees are paid subsequently, is a penalty and/or interest charge assessed? If yes, please explain in detail. Are there any options available with respect to the grace period? If so, please explain the option(s) and any charge that is made for them. I. Contractual Issues Will your contract have a hold harmless provision that indemnifies the plan sponsor against liability that arises as the result of negligent acts, errors, omissions, fraud and other criminal acts committed by your network providers, officers, employees and agents of the organization? Will you agree to such a provision? 2. Please provide a sample contract for an integrated retail and mail order prescription drug program. 3. What is the term of your contract and what are its termination provisions? 4. The plan sponsor wishes to include in the contract the right to cancel the contract at any time should it find performance of the organization paying claims [or performing non -claims paying functions] to be unsatisfactory. In addition, the plan sponsor wishes to include a clause to the effect that, upon contract termination, the cost of any work required by a new administrator to bring records in unsatisfactory condition up-to-date shall be the obligation of your firm and such expenses shall be reimbursed by your firm. Do you agree to include these provisions in your contract? :E 5. Does the contract provide the plan sponsor the right to audit the performance of the plan and services provided? Indicate what services, records and access will be made available to the plan sponsor at no additional charge. Also indicate frequency and notice requirements that are part of the right to audit provision. 6. Do you agree that the fees, rates, performance guarantees, provider credentialing, provider access, quality assessment and monitoring responses you provided in this proposal are legally binding? For what period of time are these responses valid. 7. Do you agree during the duration of any contract, and for 12 months after termination, that any direct contact, direct marketing, educational material, and other communication made to plan participants, other than responses to individual member inquiries regarding individual medical claim or member services issues, are strictly prohibited without the authorization and approval of the plan sponsor? 8. Do you agree that all data specific to this Plan shall be the property of and shall be used exclusively for this Plan at the direction of the plan sponsor? Your proposal must specifically answer this question. 9. Do you carry comprehensive general and professional liability insurance? For what amount? And with whom? J. Implementation 1. Provide a proposed implementation plan and timetable, beginning with the award of business to effective date of coverage. Include: - Steps required to implement the program. - Role played by the plan sponsor/vendor. - Eligibility feed. - Production and distribution of ID cards, directories, and enrollment materials. - Contacts and personnel assigned to each step of the implementation process. - Establishment of bank accounts, check stock, on-line plan information. 2. Describe how you will communicate the retail and mail order prescription drug program to employees. Please attach sample communication materials you have produced for your clients, in the appendix. Are the cost of these communication materials included in your regular fee fo r the use of the network? If not, what is the additional cost? Are customized communications available? What is the cost? 3. Is your organization willing to contribute an allowance to an outside ve ndor for communicating any program changes? If so, what is the maximum allowance available? 4. Identify separately any start-up costs and how you proposed to recover them. Describe any other charges not included in proposed fees (e.g., toll -free lines, printing). Can they be amortized over several years of the contract? Be sure to address: Initial set-up charges Development of communications materials 81 Participation at employee education meetings Other charges (please specify Total first year start-up fees 5. Please identify the individual responsible for the account in the event of claim disputes, service problems, etc. 6. In the event the City desires employee meetings to present your proposed plan, are representatives from your company available to make presentations? If "yes", are there any additional costs associated with these services? 5. Do you agree that if this proposal results in your company being awarded a contract and if, in the preparation of that contract, there are inconsistencies between what was proposed and accepted versus the contract language that has been generated and executed, that any controversy arising over such discrepancy will be resolved in favor of the language contained in the proposal or correspondence relating to your proposal? 6. Are there any outstanding legal actions pending against your organization? If so, please explain the nature and current status of the action(s). 7. Please state the time line your company intends to follow to commence work as of January 1, 1999. 8. What is your perspective on the health care industry in five years? What changes do you foresee? 11. If you have obtained national accreditation, please state through which agency and when it was obtained. 82 EXHIBIT B' YEAR 2000 COMPLIANCE CERTIFICATION AND INDEMNITY Section 1. Contractor hereby certifies that all information resources or systems to be provided or used in connection with the performance of this Agreement are "Year 2000 Compliant", except as otherwise expressly described in Section 2, below. "Year 2000 Compliant' shall mean that information resources meet the following criteria: a. Data structures (e.g., databases, data files) provide 4-digit date century recognition. For example, "1996" provides date century recognition; "96" does not. b. Stored data contains date century recognition, including (but not limited to) data stored in databases and hardware/device internal system dates. C. Calculations and programs logic accommodate both same century and multi -century formulas and date values. Calculations and logic include (but are not limited to) sort algorithms, calendar generation, event recognition, and all processing actions that use or produce date values. d. Interfaces (to and from other systems or organizations) prevent non -compliant dates and data from entering any state system. e. User interfaces (i.e., screens; reports; etc.) accurately show 4 digit years. f. Year 2000 is correctly treated as a leap year within all calculation and calendar logic. Section 2. Contractor has identified the following information resources or systems that will be provided or used in connection with the performance of this Agreement that are not, or will not by December 1, 1998, be Year 2000 Compliant: 83 Section 3. a. Contractor hereby certifies that the instances of information resources or systems not Year 2000 Compliant identified in Section 2, above, will be Year 2000 Compliant no later than December 11 1998, and that Contractor shall notify the City of the status of Year 2000 Compliance for such resources or systems upon the earlier of the date Year 2000 Compliance is achieved or on June 30, 1999. b. Contractor hereby certifies that the instances of information resources or systems identified in Section 2, above, as not Year 2000 Compliant, and for which Year 2000 Compliance is or will not be achieved by December 1, 1998, are not related to and do not impair the performance by Contractor of the terms of this Agreement, and do not produce new non -compliant information resources or systems. Section 4. Contractor agrees to notify the City immediately of any information resources or systems that are not Year 2000 Compliant upon encountering the same in connection with the performance of the Agreement, including without limitation any information resources or systems in use by Contractor in the performance of the Agreement or information resources or systems of the City regarding which Contractor obtains information in the course of its performance of the Agreement. Section 5. Contractor agrees to permit examination, by the City or agents thereof, of any and all information resources and systems in use in connection with this Agreement, and related Year 2000 Compliance implementation plans, in order to evaluate Year 2000 Compliance and potential implications of the same for the City and for performance of the Agreement. Section 6. The Contractor shall indemnify and hold harmless the City, and its officers, agents and employees, from and against all claims, damages, losses, and expenses, including attorneys fees, arising out of or resulting from the Contractor's failure to disclose instances of information resourec es or systems that are notYear 2000 Compliant, or failure to comply with the terms of this Exhibit C. 84 R * * r s tr T a CD (D O m . co 0 (D CD m m c o 0 'a CD = m � O m C v m �• Co =. = W 0 a Cn cD .m, e7 3 L: RL m C) v 0 0 !c O 0 m <y n M o N N m y 0 W m X » CD w N y co N N.3.0 T Z Z 0 m '1 0 n m n m 0. .. o= 0 U) m In y cnI O °cw EL m a m ° ii < O D CD• (ZD O O (n N �00 oy'3m0 m0 mo m0 m0 >> m 0 a •� 0, <_ o <_. O 5. O< ". CD (D 3 N a O CD CO CD y � N ;: 0O O rr' 7 Z d CD m Q N •a < N N .p N ti' C B en �' CD V N N ° x .m. 3 _d ? _ <_ m I < m < m < m a' < m o * O N a m : 0' a a 5 a c7• a c7' E o a 0 i 0 RD o ° CD CD CD CD o< y a ° o 0 0 o c ?` ap r 0 m a 0 fD � o 0 0 0 0 cn m c m O �• p' O O 0 0 j _may. rmY rm•F M 2) 0 rCs N 0 cn o m * V O* o o a Cj p m 0 0 m 3 Lnn CD O o N 0 c CD o C = 0 m+ c ° CD CD CL y m CD ' CD C7 0 = CD 3 m 0 m m -� CO �• "� CD Cn CDN�. •r, C m CD < CO O 0 p p o�O° do O x'II * 30 Om o 'm ° O O_m ca a �. O x o 3 to m ccCD Z 7 J 0 m CD f� 0 0 v, O cn o d * m O a CD N fA < O O N O\ CO 3 O e O O X O a i•i CCDi. ' .N.. N< O CD N CD m° to m< .* CD m 0 Vin cn m dQ_a 0 00 0 c N p + 3 ., °< 0 0 3 0 CD 5. CD m 0 0 CD 0 3mo. °= m 5 0 a ��..a 0`=om 3 3 mmaN. v .. 3 m 3MCL m v, Z A m m ' cD 0 0' N+ m m v' cn m m a m m ., � m 3 2 CD °. o .. < co °« cn 0 0 a O "" =r o 3 m v N c 0 Q,om o3 3 0 s20o 0 �m 0 Q°oCD 0 0 v " d c0 CD'"'� 0 cnm 0a O ,' D' o v ' °' o m O m v O fD o 3 m 0 c° = CD o 3 m m m 3' DTi 3 7po -I X 0 0 c0 n o � ° ; - y 00 r 0 o -C& co a * cn0d * 0 cn C0 * p 0 v' o n u, < CD O �Co 7 o y� o CD \ < O 3 O < O < p N Z N I 0 ] 0 m 0 CD m m o a o 0 0 -+. N C cn < 0m m < aN-• o N CD �_ O = m m 0 .a CD " 0 3' rt CD m p N a am to cn D �' to m 0� 3 3 a � m 0 m .+ m 0 v -rl cn o CD : m-°0 03 a° 0 0m 0 O O 2 c N0 m09 x• * 0m < O Om DT7 3 � V c° �-' m a �0. D x o 3 ca to < Z ai m ° N N tM CD n °< u'ma * Ln O m * Q3 Qoao 0 * 0 0 sn C m 0 0 , CD v' .N•' H CD 0 0 � m CD x. C ) (7 .Ni N CTl 3 C m 0 .w 0 < C O _. w N < cn N O 3� CD o o o c'- 3 o °< ° m< 3 DCD m7 ° o o < p o m CS a _ - N C M -w '� Ci ° 3 N m Q a "Nt. N y m O_ G=7 O_ N i? Z O. 0 m �' 0 3' =! . m {ncnm m a m co., m X m <m,, ° m r! <CD.. 0 o 0 a co �o m.c0 "'m al14 0a Q'03 0 Q°o O SpoCD V m 00 CD Om.m . 1 o v m m CD 3 0 m 0 o_m CD � 0 3 O o x o� m° 0 iv `D 0 K CO ° -w CO w 'v m m m 9 v :n 3 r ' N i C D D 7, 0 m W e Z m O �D . rn p �Z C_ m .a CD ymm0) 3 3 0 3 0 m TCO N 0 ; S 0 - CD�N O Cn tCD N m N1m_. G a H d m d O N 0 ° _• '< Z 7' N N CD CD k mcn `G n 00 f {DO tD Q° 3 a O 0 OO M Ccr i K m P. A to m $ � M m m N o 0 ° �' o D ct � J 3 C 0 , m o 3 °� H•00 Q 00r0 oNCCD Om °o 0 CD cco 0 a °o M w' a rn ; m . ° a < x ° 0 �n 3• ° m m CD 30 s CD o M, v,rn 0 CD < < d < Cr �. CO 0 CD CD cD '+ p x 0 m CD N I O .'"„'G CSp 0 7 ,, O '+ ° O 9 m (r N �, 0 C7 C) 7 m p CD a a 3 CD C d a a p ° ° CD 7 N Cu O < co p f c S X 3- O O ° OI O N m . CD CD 3 0 m u , O < 3 co c 7 CD + a .. '+ * CCDD O O CA a c 0 ► NJ-O {A o•0 0 0 {? O(nMcc 'o CDccn !CL ccnn � �3om° c <'.�tom CD CD I CD 0 3< m m aN. m CD CL h o a CD a y ' ° °' o CD m v 07 H ° .. a m m 0) e 0 v ° - a q, j 3 c a Co J CD 0 7• ins O O 3 m �cno3 •`CD f o3 O01• CD < a 9 T o d J w0Od. . r: NO CD _I 00 3 m o -� o CD Z D c o�. > (O >a cc r Z m O CD J n < . ° CD m u} so m 0 to v v 0 C� p 0 0 as O O p CA fp ' O c CD N V Z 47 C CD I CD 0d N NO -� 'i c M 0 �? �� H< c � N N� O CD CD O ° c O a� O n 70 9 ° 3 07 cn O < m°° ° 0 'm cyi to a '� D c �o 0 a 0 n o w>> o o 0 0 a y a = m 3 Q a 3 y a a � 3°° m Q 3 o a O c m o y= m c°CD m a� _2JCD 0,m a�= �jOJ aR°p3 ink N o m v �^ m 20 -. C to a O O Z m o° m T e ° H m y H �; o �_ ° O v d C w N :' a°° 7 7 CS .. O O t0 ° a ii —I o 3 �� m -^ �, O 0 0 a CD O. CD CD __ O r N J— O id = '° 'O n O fR M N .Ot O CD 02 o m e c m N D m a New * a.y.3<o d.w'?�G <0 y3 Jam CD x w m co H o o c CD CCD < 0 CD = CD m <` 0.3 00 fD. ch �^ N L n°i ° N ~ '` ° :•r w < Ill "'I w ^* '� CD s 0. CD a Cp N '� CD�i _ 7 M O w ctc �� �cn03 CtIor D CO 03 fnj m a '0 [� 0 H to ��a� m0�-�0 �? CD O Z - CD o p � ,. cc a Z N to 'p - n C) = O (� O O pb 0 Cn n N ,D•' f0 N ro CD 0 0 CD 0N 07 3 N 0< N, 0 0 0 0 N< w N< a, to N N Cn �n°0'm< o0mF N 0a30004 o `<ma =gym°mm d a C ,�., Doi o y a a M 3� o d Q a Q a 3 0 Q a m a a CD c Ln m < m am < m 0 cD r. � ° 3< m o �0 a° m W �m Q'03 0 a�0 Q,J 0 ¢,Jm a0 m o fp � cnm •', CDSi O a. m 0m v d a o a O a 0M � d. �° M N� o ce o M. --I �� o �urn O u < CD N O 7' CT .. O 0 CO O CD -� CD Oa O� 'IC'F M �•1' b ° m ZTi\E,; m M W 1 1 o H � f N a y d N C d m b c CA o To =aW m C tr N O Olb _ � o ttz w o3W o Oa W p N to m y N C M 0 W G j Q cr m m 0 c W v co M yc° N COa ° ` a dxW m a N zh cbq W n N N mO w. m m om C) W d $ m C) Ce� 3 m ° 3 c m a S aa� W to » 1CD W fA a a o o' Imo � m 4 o m � n o N c to W aoa �wg -ivi n n 0>a m n : d '7 (AO ? O S 7 ~ tD 7 ty d N m to CD * CD, 2 l N co (a d ra �, to N N f1 m 3 CD .d+ f0 'O T N .F 0f H y dCD i CD 17 ` C N � 0 0 t\n d ' 0)� 0) 'O •O •p 3� CD 3� CD 7: C d o CA d O 0)�� 0 n CD O 1 'O -a 'D CD d• '< tD d CD C �. tD O <. d. < d O d Q< d . •p 0 F O d a o_ " 0 7 0 0. m 0 0. m ? •o Ci G. 1 d 0 ti O n go Q p Q= a rt = d tD , ° j _ _ O rm CD CDt� n.0 n. = C)m o a Na d C� C m v wcn o O d o o 7< o m CD N fA I m a �. ... a d N CD N * °f ="N s O O CD S�SN �°�0 CJ7SN = C) 0o CD0 O O 3 d om =0 o v d * o o0' oco O * 00 0 tn�nw � Otn 00 O O ;' y 0\ O d 7 t0 O O pOtdii O\ o o \< c� N 0 p 00y :� CD v<i•�< < O N <? < W N O 3 <0 o a N O y 9 d °�i o N• O O CD Joao. m 3 am < CD w °t 0-0 � 9 00 m O Z�'� a 0� �3 _I Oa c 3 d o. m = CD O O 3 �n CDf71 to 7 N. CD CD = Z o '0 CD « O Q y Cc N CD O 4Y * N S N * 'I` to * °f =• N d iD d .t * S in o SZ° O * < (7 %J 3.m c OOD * 3 d Ooo �.o.00D N) o �< �� �n �T.� d a cn 0 y o O� tyo O o m o oa O d w 0 0 Oo o R°< N y CD m 3C� 0 a ,.* �. 3 d 0 .rt 3J 0 .y d ,..� N -1. d O C) 0- Op 3 d 0 n + m N fJ1 m O •0 0 Z 0 CD C. O NN d d -w U1 N �, S -w d Ol = to .+ N t0 \ 0 0 •-1. 0 d S d d ti, CD a — -. o d a � N N 7 T i JOo< o _ JOfew to o m' 3. o °: y CD d M m 00 a ' 00 " y m < m n=i 0-0 o O 700 0� n . 0 N Q cD 0 = .+\ Da to �00d a 3 0 (n 'O d � Q o C N CD y M d o d 'O N CD e C- o f7 = N = 0 S Ruh d CD C=Y r r ti ••+0 a> * �-• 0 y * * om oco 3•d oco m O7� occ o�icnc�"i,o v`, Oto O� 00CA d O� \ dD St<p �OtC 00 CD O\ ao < m < < 5 N 0 <_ 0 2 m 0 rn 0 _ d 0 O Q m o d ,.. O N w ,-i c0 -� d a O,may, 3 0 o S 41 O O 0 7 tD N• O d 0 0 N 3 :i .•i H d Co 9 r co ti: 7 rn d _ 0. l�D < (0 0 3 � 0- 07 0 o �_ 3 N V -I C ce O t d CD tp _ 1 Z d < d tD O O CL oO v, CD o_ CD _ D< -i r 0 o w. Co V �3 rn t Co 0) d p a \ 7•N� Z N tv OCD 3 OC-D o cc *a. Q1 0 -M * 0 0 1n r d 0 Z t� 0 ,+ .+ * o 3 d O co =tn 3 d O oo -tp d CD 0< 0 0 OD N = * �o co N CD O O w 00 —y Oo 00 ...y pa d tS 0d C 00 _aOCD .* O� Qo< <.rnCD m 00. c l0 O O. CD N \ 0 CD 0_ O 00 O Q 0 " -0CCDD 0) cD D o c O I N 00 d O S a° c tp O A n a n n i a 0 Q to N f N N 0 O A a c ti Q m v a N 0 O m fA ID Cm0 N 0 CD V O S 0 a m 0 a 7 c a 7 f0 (n 0 •o O m 0 0 c C d 7 O N tv 00 �DDNN -13 R° �m c� am 3 a Z Om0WDF;<S°3200CD D � 90 ��H�•� 3=mam�v�N3mC) m 3 m • H S m °a< m N 3 .dirt " O. N 7 N m ui O d d .di, N 7 < A Z m m c N Z_.N mmw�RD o v_.. y_ 7 .._ s: a3 �o d 00 m mw2•y m�n�'-��e 0:°°o°a c�c to CL; :� S N d d 0 O N Q In N Cp CD Q ,� 0_ 7 CD y O =w — m CD d CO n 0 y �' C p O _ a d d O •� y m m 0 0 Co Cmp W , 0 m Z -I RD H N - a o ° ;� n ° CD to.a Q°X 3 m N 7' D c m a a CP a (n 3 3 0 O 0) C m� CS CO en CS m y. N.00 CD 0 V cZ= G Q d �' 0 -3 CD 0 -0 3 m 'ran m "h cWD C� 3 3 ° ° NfD CD CD y (D t N O V! r M y' 3� X N N • n 0 CD y o CD C CO � 'cD N m d Co O 0 o< O O y Oo0 O^ 3< O O � Om O oO» CD CD 'O CD CD N O CD CL C"DCA 0aO X C Li <N i O _ CD 5 " °: v ° 3 0 ct CD 0 v I to 0 CD E O * ' 3 Z ! O O N 0 0 < o a 0 0» CD 0 <* I m v, <n m k �* ^ 0 R0 �■ ° N• 07 0 C� +r y 7= C� » m -< CO 0 CD X C d -+ N •P v 0 0 to d CSD Ul 0 0 Co 0 0 0 CD ° .+ d N•,. m °< D m o m o0o 3 O m c CD 00 0 w< m m H C� H 0; O a a CD .Nr O c a Z m a) O C^ N �, d o m o '! o o. m 0� 3 m 0 °' T y m a y O N •G m Q o 0 3 i d \ C O a d S d d N ti 3 ' a T Q I n d d N d d 3 '"' CD d ••+ N CO �° 0 7 C m - N CJ• �D 3' `�° 0 3 m 0 O a rr- N < o a X k S-92% S N * * n y O S p * r+ CD < 0r) m C .p I ma M O 1 N NN 000 d j 00) oCD = N n ao< y O p i o Oa a �0m O O m CD .< d 3 C m '0 I�� 3 CD CD O M N O o 0 V r CD y d a 0 1 o o a �cci d 0 �3 O _ X m O CD CD V N• `• a Z O G � Z N 0 N m O * < • O a = 0 O » CD O <a I 0 X C +A <& <* �1 PO m k O <Nma yy° NOOao rt �3• Cd• 7 SN a C� * CD n o ma o N 0o 000 m 01 oCo m C CD .Ni d o' 0 o O 0O< y m3 ca < oN C) 0 o3 < o0 o ° �m m °° 1 3 o CD m m m m! o o a 3� �o da 0Q 0==r _a 0m C CD 0 F 'o = S �Qo (A d co d > 3 m + U1 CT 0 CD \ 1 co90 o '* CD00,m O A n Ul < S M C O m m S a +w3m 'c'c3om a 3 r 010 n a> > m d W N m'm m<< C 0 z ° 0 o m i e i N d a CD CD i 'r' e` m 031 D C O N 9 �: O O S A U1 to k• fG°D 'c" O 3_°< ° a 4 'o c• o d c 3 cNr' e m am CD m z2 3 m "� 0 0 m " m f �* a'o m m a 0 a m F 3csm2 y m$�� o a<_. -.0 0) o 0 ea g o D CD CD m f -.03 cm N A S n O Of m m d m 7 ti m a of o. eD CD N °. 0 j N O * ri < y O< 0 o vi cl oO m m U l0?0C- cCCD0D30 D0o.0C M. � »a aa� 3 o" d"m o aa dm o o '<c��D���30<0° =oR*m 2 TN , w 0 0 c 3 V ° o°�o. °o da mo= a N o ti o0 0 0, `� y m z I m m 9 ° 0 — n < +n 1 I -.to° *•+=^p " 0 < yr m O O < m o c N o1 00 0 m..* N� .: O C m< 0 .0 y C � m V I m O s �om.op��+m°�m� ov .m. �mm° c o I < Via° m y am 01 0.m 3 m o °; m =i m° o �.*.,Q gm 3 A $ 0 0 "ice z o (D o so 3 N ® o O O CD CD v ra °fD, Co '� o m m N o. 0) m m 7 O = G p O •p 7 .i .� o 0 3 .O.t 0)s O � d r 1 g to ° fC S CD cL CD D) CD a ,oCL (D m o.a� 3 c c m m 3 c m .m m a�2 m ���c��orc° s0 V S ' Lo C=cRD'D O 'D CD ° 7 F O 'O a j a .min CL o C) w < :i �. m O 0 N $ 0 3 m y - 3 z .. to CDco G 0 p p1 O! C N f? 0 N C'J ' m 7 S "�' O" O< IN moo: m.w w w3 c0 o 0 •0 C so9 co O �0a : mm cc EL Do m�am d mam 3 -* tc mo, m d co ,t < RDo3'� c o»'"3 m om< < > a o w v -0 .. %R m OR m m�CL CD CD to co