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HomeMy WebLinkAboutRFP - 7055 BENEFITS - VISIONF6rt Collins ` Purchasing ADDENDUM No. 2 7055 Benefits — Vision SPECIFICATIONS AND CONTRACT DOCUMENTS Description of RFP: 7055 Benefits —Vision OPENING DATE: 2:00 P.M. (Our Clock) August 13, 2009 Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707 fcgov. com/purchasing To all prospective bidders under the specifications and contract documents described above, the following changes are hereby made. Questions and Answers: 1. Provide the RFP questionnaire as a Word document. Included in attached RFP document Word file. 2. Provide Vision Claims data for the last 12 months Attached as two (2) Utilization Report files. One (1) for 2008 and one (1) for 2009 YTD. 3. Provide current and renewal rates. Fullv Insured 2007 and 2008 Rates: Employee $ 6.39 Employee + Spouse $12.77 Employee + Child(ren) $12.77 Family $20.56 Fullv Insured 2009 Rates: Employee $ 6.86 Employee + Spouse $13.72 Employee + Child(ren) $13.72 Family $22.08 4. Provide the full Summary Plan Documents (SPD). Attached as a separate file. Please contact David Carey, CPPB, Buyer, with any questions regarding this addendum at (970) 416-2191 or email dcareyCDfcgov.com . RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE BID/QUOTE STATING THAT THIS ADDENDUM HAS BEEN RECEIVED. where renewal is a way of life Section 3.0 Evaluation The Request for Proposal (RFP) is intended to assess which vendors have the ability to meet The City's long-term goals and objectives as previously defined. The proposals will be evaluated per the review and assessment criteria listed below. 3.1 Evaluation and Assessment of Proposal An evaluation committee shall rank the interested firms based on their written proposals using the ranking system set forth below. Firms shall be evaluated on the following criteria: From 1 to 5, with 1 being a poor rating, 3 an average rating, and 5 an outstanding rating. Recommended weighing factors for the criteria are listed adjacent to the qualification. Weighting Qualification Standard Factor Does the proposal show an understanding of the City's 2.0 Scope of Proposal objectives and results desired from the plan(s)? Adherence to the services requested and described in the RFP. Do the personnel administering the plan(s) have the needed skills and experience? Are sufficient people of 2.0 Assigned Personnel the requisite skills assigned to the plan(s)? Quality of care and customer service. Can the plan(s) be completed in the time frame required? Can targeted effective date be met? Are other qualified personnel available, if required, to 1.0 Availability assist meeting the plan(s) schedule? Is the account management team available to attend meetings as required by the Project Manager? Is the firm interested in providing the services 1.0 Motivation requested in this RFP? Quality of responses to the RFP's Questionnaire sections. How competitive are the plan's costs, rate guarantees 2.0 Cost / Financial and where applicable, provider's contracts with area Effectiveness providers? Experience managing similar plans of this type and 2.0 Benefit Management scope. Thoroughness in selecting providers and Capability managing benefit plans. Actively seek to provide most appropriate level of service? The City may, at its option, choose the highest ranked firm based on the written proposals or select up to three of the top rated firms for oral interviews. Based on results of the written evaluation, the City will select finalists for consideration. Any or all proposals may be rejected by the City. Finalists may be asked to make formal presentations of their proposals, as well as to demonstrate their systems and procedures for administering the City's plans. Site visits may take place at the finalists' home offices and/or the claims and administrative facility/facilities that would provide service to the City. 3.2 Reference Evaluation (Top -ranked firms) The Project Manager will check references using the following qualification and standard criteria. The evaluation rankings will be labeled Outstanding/Satisfactory/Unsatisfactory. QUALIFICATION STANDARD Overall Performance Would you hire this Professional again? Did they show the skills required for this project? Did they show flexibility and willingness to "go the extra mile" to ensure that the employees were given the appropriate amount and level of service? Timetable Did the vendor effectively manage the customer's time? Were requests for information met in a timely manner? Completeness Was the Professional responsive to client needs; did the Professional anticipate problems? Were problems solved quickly and effectively? Budget Was the original Scope of Work completed within the project budget? Job Knowledge Did the Professional possess the appropriate knowledge, skills and abilities, and resources to effectively administer this program? Was the contract operated smoothly? Other What problems (if any) did you encounter encounter with this Professional? Section 4.0 Proposal Acceptance: All proposals shall remain subject to initial acceptance 90 days after the day of submittal. Section 5.0 Agreement: Proposer to provide sample plan agreement for review by the City. Section 6.0 Proposal Process Information and Requirements 6.1 Intent The intent of this RFP is to confirm key information about specific proposers, receive financial proposals and (where applicable) identify network access compatibilities with the City's employees. The following describes the anticipated proposal process, including confidentiality, timing, expected response format and requirements for interaction regarding questions. Please note that The City reserves the right to accept or reject any and all proposals, to waive any technicalities or irregularities therein, to award contracts, or to withdraw this request for proposal without awarding a contract. Your response to this RFP and any subsequent correspondence related to this .proposal process will be considered part of the contract, if one is awarded to you. Under no circumstances are commissions related to the City's benefits payable to anyone in conjunction with this request. 6.2 Confidentiality All data included in this RFP, as well as any census data and attachments, are proprietary to the City. It is for your exclusive use in preparing a proposal and must not be shared with any other firm or used for any other purpose. The use of the City's name in any way as a potential customer is strictly prohibited. 6.3 Miscellaneous The City shall not infringe upon any intellectual property right of any vendor, but specifically reserves the right to use any concept or methods contained in this proposal. Any desired restrictions on the use of information contained in the proposal should be clearly stated. Responses containing your proprietary data shall be safeguarded with the same. degree of protection as the City's own proprietary data. All such proprietary data contained in your proposal must be clearly identified. Failure to respond due'to the proprietary nature of data in your response may be construed as non -responsive and could result in disqualification. The City shall not be under any obligation to return any materials submitted in response to this RFP. The City's contractual selection of a vendor is final. The methodology by which the proposals are evaluated and vendors are selected is confidential and proprietary to the City. The City expects to enter into a written Agreement (the "Agreement") with the chosen vendor ("Chosen Vendor") that shall incorporate this RFP into your proposal. The anticipated terms and conditions of the Agreement are set forth in this RFP; however, the City may include additional terms and conditions in the Agreement as deemed necessary. 10 Section 7.0 Proposal Checklist The following information is requested as part of the proposal process. Indicate included attachments by duplicating this checklist and marking the appropriate column (Yes or No): Yes No Description of Item Proposal for Vision Care Signed Business Associate Agreement Signed Proposal Compliance Letter Signed Plan Design Confirmation Completed and Signed Questionnaire(s) Vision Network Access Analysis (if applicable) Copy of your EOB for Vision Services (if applicable) Proposed Implementation Timeline for the City. Audited Financial Statements and/or Department of Insurance filings for the past two years (Only if requested by the City) Provider "Report Cards" used to provide feedback on clinical and non -clinical performance measures Copy of your Policy Assuring Member Satisfaction Samples of all Standard and Optional Reports you are proposing to provide on an account specific basis Data Specifications for all plans • In what format can you receive and transmit eligibility data including additions and deletions? • Please submit a copy of your file format specifications for electronic transmissions. • Do you have any limitations with electronic payroll systems? Please describe your technology capabilities. • Describe the security parameters for your systems both for the employer and the employees (ex: passwords). Do you require an email address for online access? Copy of your Banking Services Agreement Copy of your Customer Satisfaction Survey Copy of your Administrative Services Agreement or Insurance Contract that will be in effect January 1, 2010 Signature of Authorized Representative: 11 Section 8.0 Questionnaires Questionnaire below. Vision Care TPA Services Summary Description of Plan The City makes available to eligible employees working 20 or more hours per week a Vision Care Plan. This plan is funded solely by employee contributions, and is fully insured. The plan provides: • Vision exam: once every 12 months from last date of service; you pay a $15 copay • Eye glasses: $15 copay • Lenses: once every 12 months from last date of service • Frames: once every 24 months from last date of service (approximate allowance for 2007 is $105.00) OR • Contact Lenses: once every 12 months from last date of service; plan covers up to $105 of cost. • Polycarbonate lenses for children • Lasik procedure available from participating certified provider at up to a 25% discount. • Services available from a participating provider, or any provider of your choice. Currently, 876 employees are enrolled for coverage. Enrollment distribution between tiers of coverage is: Individual: 332 w/child(ren): 78 w/spouse: 256 w/family: 210 A recent census is included with this RFP as a separate pdf. 12 QUESTIONNAIRE Vision Care — Administrative Services Only Please refer to plan booklet for current plan provisions. 1. Do you agree to provide services to all employees/dependents enrolled as of December 31, 2009? 2. Will you agree to replicate each of the current plan's provisions? If not, please list the specific provisions you will not replicate, along with the reason you elect not to replicate the provision(s). If you do not identify those specific provisions you cannot replicate and you are selected as the City's vision services administrator, you may be required to make the necessary adjustments in order to achieve replication. Otherwise, your selection may become void. 3. What is your monthly administrative fee, expressed in terms of dollars per month per employee? 4. For each geographic area in which you have a network applicable to employee population, provide the following information: • Geo-Access, using 2 vision providers in 10 miles; provide a map if available • Most recent participating provider directory and summary of the number of participating providers in each of the applicable areas (ophthalmologists, optometrists, opticians, etc.). Also provide the website where provider information can be found. 5. For each network, describe the specific measures used by your organization to monitor participating provider access. Provide the most recent corresponding statistics available for: • provider to member ratios • Average waiting period for an appointment 6. What percentage of your providers has limited their practice to current patients? 7. Please describe your credentialing procedures. 8. Will you provide a dedicated Representative for the City's Human Resources Department with telephone and email contact information? 9. What type of reimbursement/payment methods is used to reimburse participating providers? Please provide a breakdown by method of review. 10. In addition to routine reimbursement and any withholding provisions, can your providers increase the total reimbursement received from your plan, e.g., by provider incentive programs? If so, please explain. 11. If provider discounts are used, state the basis of the agreement. Are discounts based. on provider charges or actual cost of service? 12. Is there a formal committee that sets quality assurance policy and review the outcome on a regular basis? 13 13. Do you capture all utilization data? 14. What claims experience and utilization reports are available? If there is additional cost, please specify. 15. Describe patient satisfaction surveys that you perform. 16. Do you have an agreement that prohibits providers from billing or collecting from patients more than the designated coinsurance or co -payment in the plan design? 17. Please describe your method for calculating renewal rates. 18. Do you provide a toll -free number for employees to call with questions on claims, plan provisions or requests for vision referrals? 19. Do you provide a care line that employees can call with questions about proper levels of care? 20. Will you provide COBRA services? 21. Please certify that you are in compliance with HIPAA privacy regulations, and include a copy of your privacy statement or policy. 22. What is your organization's financial rating (e.g., Best & Co., S&P)? 23. Can your firm certify compliance with HIPAA health information security and privacy regulations per attached Exhibit A? 14 EXHIBIT A HIPAA HEALTH INFORMATION PRIVACY & SECURITY A. Obligations and Activities of the Business Associate 1. Business Associate agrees to not use or disclose Protected Health Information other than as permitted or required in the Administrative Services Agreement of which this Appendix is a part or as required by law. 2. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Appendix. 3. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Appendix. 4. Business Associate agrees to report to the Plan Sponsor (City of Fort Collins, Colorado) any use or disclosure of the Protected Health Information not provided for by this Appendix of which it becomes aware. 5. Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Business Associate on behalf of the Plan Sponsor agrees to the same restrictions and conditions that apply through this Appendix to Business Associate with respect to such information. 6. Business Associate agrees to make internal practices, books, and records, including policies and procedures and Protected Health Information, relating to the use and disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of, the Plan Sponsor available to the Plan Sponsor, or to the Secretary, in a time and manner or designated by the Secretary, for purposes of the Secretary determining the Plan Sponsor's compliance with the Privacy Rule. 7. Business Associate agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Plan Sponsor to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR § 164.528. 8. Business Associate agrees to provide to the Plan Sponsor or an Individual, in a reasonable time and manner, information collected in accordance with Section A.7. of this Provision, to permit Plan Sponsor to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR § 164.528. B. Permitted Uses and Disclosures by Business Associate 1. Except as otherwise limited in this Appendix, Business Associate may use or disclose Protected Health Information on behalf of, or to provide services to, the Plan Sponsor for the following purposes, if such use or disclosure of Protected Health Information would not violate the Privacy Rule if done by the Plan Sponsor or the minimum necessary policies and procedures of the Plan Sponsor: performing plan administration functions, obtaining premium bids from insurance companies or other health plans for providing insurance coverage under or on behalf of the group health plan, or modifying, amending, or terminating the group health plan. 2. Except as otherwise limited in this Appendix, Business Associate may use Protected Health Information to provide data aggregation services to the Plan Sponsor as permitted by 42 CFR § 164.504(e)(2)(i)(B). 3. Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with § 164.5020)(1). 15 C. Obligations of Plan Sponsor 1. Plan Sponsor shall notify Business Associate of any restriction to the use or disclosure of Protected Health Information that the Plan Sponsor has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of Protected Health Information. 2. Plan Sponsor shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by Plan Sponsor. D. Termination 1. In addition to the termination provisions set forth in the Administrative Services Agreement of which this Appendix is a part, the following termination provisions are applicable: a. Upon the Plan Sponsor's knowledge of a material breach by Business Associate of this Appendix, the Plan Sponsor shall either: i. Provide an opportunity for Business Associate to cure the breach or end the violation and terminate the Administrative Services Agreement of which this Appendix is a part if Business Associate does not cure the breach or end the violation within the time specified by Plan Sponsor; or ii. Immediately terminate the Administrative Services Agreement of which this Appendix is a part if Business Associate has breached a material term of this Appendix and cure is not possible; or iii. If neither termination nor cure are feasible, the Plan Sponsor shall report the violation to the Secretary. E. Effect of Termination 1. Except as provided in paragraph (2) of this section E, upon termination of the Administrative Services Agreement of which this Appendix is a part, for any reason, Business Associate shall return or destroy all Protected Health Information received from the Plan Sponsor, or created or received by Business Associate on behalf of the Plan Sponsor. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. 2. In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to the Plan Sponsor notification of the conditions that make return or destruction infeasible. Upon the Plan Sponsor's agreement that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Appendix to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information. F. Miscellaneous 1. The Parties agree to take such action as is necessary to amend this Appendix from time to time as is necessary for Plan Sponsor to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. 2. The respective rights and obligations of Business Associate under Section E of this Provision shall survive the termination of the Administrative Services Agreement of which this Appendix is a part. 3. Any ambiguity in this Appendix shall be resolved to permit the Plan Sponsor to comply with HIPAA. 16 G. Security Standards 1. Business Associate agrees that it will implement policies and procedures to ensure that its creation, receipt, maintenance, or transmission of electronic protected health information ("ePHI") on behalf of Plan Sponsor complies with the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR Part 164. 2. Business Associate agrees that it will ensure that agents or subcontractors agree to implement the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR Part 164. 3. Business Associate agrees that it will report security violations to the Plan Sponsor. H. Definitions 1. "Protected Health Information" shall have the same meaning as the term "protected health information" in 45 CFR § 164.501, limited to the information created or received by Business Associate from or on behalf of the Plan Sponsor. 2. "Secretary" shall mean the Secretary of the Department of Health and Human Services or his designee. 17 Financial Services Purchasing Division 215 N. Mason St. 2"d Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707 fcgov.com/Purchasing ADDENDUM No. 1 7055 Benefits — Vision SPECIFICATIONS AND CONTRACT DOCUMENTS Description of RFP: 7055 Benefits —Vision OPENING DATE: 2:00 P.M. (Our Clock) August 13, 2009 To all prospective bidders under the specifications and contract documents described above, the following changes are hereby made. Questions and Answers: 1.. Provide Summary of Plan Description (SPD) for the vision plan. These are needed so that we can ensure that we copy over the benefits as requested. Attached as a separate file. 2. Can you please provide the RFP document in Word so that we can respond to the questions? Attached as a separate file. 3. Can you please provide the Census document in Excel? Attached as a separate file. Please contact David Carey, CPPB, Buyer, with any questions regarding this addendum at (970) 416-2191 or email dcarey(a fcgov.com . RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE BID/QUOTE STATING THAT THIS ADDENDUM HAS BEEN RECEIVED. where renewal is a way of life City Financial Services of Purchasing Division 215 N. Mason St. 2"' Floor rt Collins PO Box 580 Fort Collins, CO 80522 �,,��sincg �Putcha 970.221.6775 970.221.6707 fcgov.com/Purchasing REQUEST FOR PROPOSAL 7055 Benefits - Vision The City of Fort Collins is seeking proposals from qualified firms for employee Vision Care TPA Service benefit plan. Written proposals, six (6) will be received at the City of Fort Collins' Purchasing Division, 215 North Mason St., 2nd floor, Fort Collins, Colorado 80524. Proposals will be received before 2:00 p.m. (our clock), August 13, 2009. Proposal No.7055. If delivered, they are to be sent to 215 North Mason Street, 2nd Floor, Fort Collins, Colorado 80524. If mailed, the address is P.O. Box 580, Fort Collins, 80522-0580. Questions concerning the scope of the project should be directed to Project Manager Amy Sharkey, Human Resources Benefits Manager, (970) 416-2721, ash arkey(a fcgov.com. Questions regarding bid submittal or process should be directed to David Carey, CPPB, Buyer, (970) 221- 2191, dcarey(a fcgov.com A copy of the Proposal may be obtained as follows: 1. Download the Proposal/Bid from the BuySpeed Webpage, www.fcqov.com/eprocurement 2. Come by Purchasing at 215 North Mason St., 2nd floor, Fort Collins, and request a copy of the Bid. The City of Fort Collins is subject to public information laws, which permit access to most records and documents. Proprietary information in your response must be clearly identified and will be protected to the extent legally permissible. Proposals may not be marked 'Proprietary' in their entirety. Information considered proprietary is limited to material treated as confidential in the normal conduct of business, trade secrets, discount information, and individual product or service pricing. Summary price information may not be designated as proprietary as such information may be carried forward into other public documents. All provisions of any contract resulting from this request for proposal will be public information. 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 City of Fort Collins reserves the right to reject any and all proposals and to waive any irregularities or informalities. Sincerely, James B. O'Neill II, CPPO, FNIGP Director of Purchasing & Risk Management where renewal is a way of life Proposal Number7055 Benefits -Vision To participate in the RFP process vendors need to sign and return this Business Associate Agreement. BUSINESS ASSOCIATE AGREEMENT — SECURITY STANDARDS This agreement is entered into between and the City of Fort Collins. (Business Associate) Business Associate agrees that it will implement policies and procedures to ensure that its creation, receipt, maintenance, or transmission of electronic protected health information ("ePHI") on behalf of the City of Fort Collins complies with the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR Part 164. Business Associate agrees that it will ensure that agents or subcontractors agree to implement the applicable administrative, physical, and technical safeguards required to protect the confidentiality and integrity of ePHI under the Security Standards 45 CFR Part 164. Business Associate agrees that it will report security incidents to the City of Fort Collins, Security Manager. By: PRINT NAME TITLE Please return to: City of Fort Collins Attn: Purchasing P.O. Box 580 Ft. Collins, CO 80522-0580 Or fax back to: (970) 221-6707 Date: 2 Introduction The City of Fort Collins is seeking proposals from qualified firms for the following employee benefit plan: • Vision Care TPA Services — fully insured and completely employee paid Current plan descriptions are available upon request. Included with this RFP are: census data, claims experience and questionnaires. Answer the respective questionnaire in the format provided. Rates must be quoted net of broker or other commissions, since the City does not pay commissions. The City intends to replicate current plan provisions. Firm's answers must be responsive to the current plan design and questions posed; otherwise, your organization may be deemed non- responsive and disqualified from consideration. If firm is unable to administer the plans as written, must specify clearly and specifically where firm's response deviates from current plan design. Section 1.0 Proposal Requirements 1.1 General Description The City provides employee benefits to approximately 1,450 active employees. Based on the proposals received, The City may select one carrier/administrator for all plans, or separate carriers/administrators. The City believes that an essential factor in managing the cost/service/quality balance is the relationship with each of its business partners. The City will review the selected vendor as an active partner in assuring employee satisfaction. 1.2 Timetable The following is a proposed timetable developed for this project. You will be notified of any significant changes which might occur: ITEM: DATE: Appendices sent to organizations that have returned Business Associate Agreements As agreements are returned to the City of Fort Collins Written questions due to the City July 29, 2009 Written proposals due to the City Au ust 13, 2009, 2:00 P.M. our clock Finalist vendors notified Se tember 3, 2009 Finalists interviews September 10 and/or 11, 2009 Contract negotiations (completed) October 12, 2009 Plan effective date January 1, 2010 3 1.3 Proposal Submittals Proposal must clearly indicate the name of the responding organization, as well as the name, address and telephone number of the primary contact at your organization for this proposal. Your proposal must include the contact name for local service and account management whom the City can call directly. Proposals due no later than 2:00 p.m. (our clock) on August 13, 2009. Submit six (6) copies of your proposal to: If delivered: City of Fort Collins, Purchasing 215 North Mason, 2nd Floor Fort Collins, Colorado 80524 If mailed: City of Fort Collins, Purchasing PO Box 580 Fort Collins, CO 80522-0580 Questions regarding this RFP are due to The City no later than July 29, 2009. A written response to substantive questions will be provided to all proposers. The City assumes no responsibility for liability for any costs you may incur in responding to this RFP, including attending meetings, site visits or negotiations. 1.4 Deviations from RFP Specifications All responses to this RFP must be prepared in accordance with the Proposal Requirements set forth in Section IV of this RFP. The City reserves the right to refuse any proposal not prepared according to the Proposal Requirements of Section 1.5 and 1.6. The City retains the right to directly negotiate the finer points of your proposal that comply in spirit with this RFP and that satisfy the City's objectives for effective, interactive and proactive claims and (where applicable) network administration. The City shall not be bound to accept the proposal with the lowest price. The RFP may be amended or revoked at any time prior to final execution of an Agreement by the City. Any deviations from this RFP must be clearly identified and explained in your proposal. These deviations are to be delineated as instructed in the Proposal Requirements as set forth in Section 1.5 of this RFP. It is intended that firm should conform to these specifications as much as possible. Do not quote alternative plan designs unless absolutely necessary. Please quote the requested financial arrangements only. Firm will be bound to comply with the provisions set forth in this RFP unless any and all deviations are explicitly stated in your proposal. 4 1.5 Proposal Instructions Do not deviate from the requested formats. Provide your proposed rates and fees as specified in this RFP. The City is seeking an initial premium/administration cost that runs for at least 24 months (January 1, 2010 — December 31, 2011). Please confirm the time period applicable to your proposed rate/fee guarantees. Administrative services for vision plan should be quoted for a fully insured plan. Define specifically what services are included in the fees quoted. Specify any charges for services that are have not included in the fees quoted above, including any start-up fees, materials, etc.. Adhere to the instructions in this section when organizing proposal. 1.6 Proposal Requirements Response should be organized in the following sections: Section I: Executive Summary Section II: Proposal Compliance Letter (Signed by an authorized officer of your organization signifying firm's proposal is in complete adherence with the RFP specifications, except as specifically noted in the appropriate sections) Section III: Business Associate Agreement (Signed by an authorized officer of your organization) Section IV: Checklist of Items included with Proposal Section V: Plan Design Confirmation (Statement indicating your willingness to replicate current plan provisions or indicating clearly deviations from current plan design) Section VI: Questionnaire Responses Section VII: Performance Guarantees Section VIII: Financial Exhibits Section IX: Items Included with Proposal (As indicated on the Checklist included in Section III. These items should be indexed in the order listed on the checklist, with a copy of the index included in this section) 19 Section 2.0 Services to Be Provided In addition to the plan provisions set forth in the attachments, the City has specific vendor requirements needed to support its day-to-day operations. 2.1 Specific Requirements • Account Management The account executive and service representative(s) will deal directly with the City. This environment requires the account management team to: ➢ Be able to devote the time necessary to the account, including being available for frequent telephone and on -site consultations with the City. Proposers who are not committed to serious account service will not receive serious consideration; ➢ Be extremely responsive; ➢ Be comprised of individuals with specialized knowledge of the proposing company's: - Claims and Eligibility Systems - Provider Networks (where applicable) - Systems Reporting Capabilities - Claims Adjudication Policies and Procedures - Administrative Services Contract Wording - Standard and Non -Standard Banking Arrangements - Relationships with Third Parties ➢ Be thoroughly familiar with virtually all of the proposing company's functions that relate directly or indirectly to the account. ➢ Act on behalf of the City in "cutting through red tape". This facet of account management cannot be emphasized enough — the account management team must be able to effectively advance the interests of the City through the vendor's corporate structure. • Enrollment/Eligibility The City will provide initial enrollments electronically or on paper. The initial enrollment and updates will be provided directly to the selected firm by the City. The selected firm will perform direct eligibility certification to providers and verify coverage as a part of the claims management and adjudication process. A quarterly reconciliation between payroll and eligibility will be required of the selected firm. • Fee Administration Selected firm will invoice the City. The City may calculate the fees/ premiums payable on a monthly basis and will submit these fees directly to the selected firm. COBRA Administration Where applicable, COBRA Administration will be conducted by the chosen firm and eligibility information will be provided by the City. Supportive services required by the selected firm will be as follows: ➢ Accept information from the City on COBRA participants 0 ➢ Send COBRA notifications to plan participants at termination ➢ Claims adjudication inquiries ➢ COBRA member service inquiries related to benefits and claims Customer Service The selected firm must have as its primary focus on efficient and effective processing of all inquiries. Satisfactory customer service will include prompt, courteous and accurate responses to the City and employee inquiries regarding claim submissions, applicable provider networks, plan design and provisions, etc. A toll free number should be available for eligibility certification and claim submission inquiries. • Financial Accounting On a monthly basis, the selected firm must provide an accounting reconciliation of any "central bank" accounts utilized. The selected firm must provide a quarterly written report detailing all administrative expenses charged outside the Administrative Services Agreement. The selected vendor must present a report detailing and justifying proposed fees for the coming year by September 1st of the preceding year. Right to Audit The selected firm must agree to allow the City, or its representative, the right to audit all claims, applicable provider credentialing, financial data and other information relevant to the City's account. Data and Management Information Reporting The selected firm must provide monthly paid claim summaries and detailed claim listings, preferably in Excel format or through a secure website. The firm must also provide its standard reporting package. Ad hoc reports will periodically be requested. Enrollment, claims and premium/fee information must be accurate and supplied in a timely manner upon request. Describe online claim reporting and look -up capabilities that will be available to the City. • "No Loss/No Gain" for Covered Employees It is critical that there will be no loss of coverage for any employees. Therefore it is required that the proposal waives any "actively at work", "dependent confinement", or any other rules that would prevent 100% continuity of coverage for any employees or dependents that are currently covered under the plans. 7