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HomeMy WebLinkAboutRFP - 7649 DENTAL ADMINISTRATORRFP 7649 Dental Administrator Page 1 of 31 REQUEST FOR PROPOSAL 7649 DENTAL ADMINISTRATOR The City of Fort Collins (City) is requesting proposals from qualified firms to provide administrative services for dental programs for City employees. Proposals submission via email is preferred. Proposals shall be submitted in Microsoft Word or PDF format and e-mailed to: purchasing@fcgov.com. If electing to submit hard copy proposals instead, five (5) copies, 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 3:00 p.m. (our clock), June 13, 2014 and referenced as Proposal No. 7649. 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. The City encourages all disadvantaged business enterprises to submit proposals in response to all requests for proposals and will not be discriminated against on the grounds of race, color, national origin for all proposals for negotiated agreements. Questions concerning the scope of the project should be directed to the Project Manager, Amy Sharkey at (970) 416-2721 or asharkey@fcgov.com. Questions regarding bid submittal or process should be directed to Jill Wilson, Buyer at (970) 221-6216 or jwilson@fcgov.com. A copy of the Proposal may be obtained as follows: 1. Download the Proposal/Bid from the BuySpeed Webpage, www.fcgov.com/eprocurement 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, 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 RFP 7649 Dental Administrator Page 2 of 31 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, Gerry S. Paul Director of Purchasing & Risk Management RFP 7649 Dental Administrator Page 3 of 31 To participate in the RFP process, vendors need to sign and return this Business Associate Agreement. This agreement must be signed and returned prior to the City of Fort Collins providing Exhibits A, B, and C. BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("Agreement") is entered into on this ______ day of (the "Effective Date"), by and between City of Fort Collins ("Covered Entity") and __________________________________________ ("Business Associate"). RECITALS: WHEREAS, Covered Entity and Business Associate mutually desire to outline their individual responsibilities with respect to the use and/or disclosure of Protected Health Information ("PHI") as mandated by the Privacy Rule promulgated under the Administrative Simplifications subtitle of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") including all pertinent regulations issued by the U.S. Department of Health and Human Services as outlined in 45 C.F.R. Parts 160, 162 and 164; (“HIPAA Privacy Rules and/or Security Standards”); and WHEREAS, Covered Entity and Business Associate understand and agree that the HIPAA Privacy Rules and Security Standards requires the Covered Entity and Business Associate enter into a Business Associate Agreement which shall govern the use and/or disclosure of PHI and the security of PHI and ePHI. NOW, THEREFORE, the parties hereto agree as follows: Article I Definitions. When used in this Agreement and capitalized, the following terms have the following meanings: Section 1.01 "Breach" shall mean the unauthorized acquisition, access, use, or disclosure of PHI which comprises the security or privacy of such information. However, the term 'breach' shall not include (1) any unintentional acquisition, access, or use of PHI by an employee or individual acting under the authority of a covered entity or business associate if such acquisition, access, or use was made in good faith and within the course and scope of the employment or other professional relationship of such employee or individual, respectively, with the covered entity or business associate; and such information is not further acquired, accessed, used, or disclosed by any person; or (2) any inadvertent disclosure from an individual who is otherwise authorized to access protected health information at a facility operated by a covered entity or business associate to another similarly situated individual at same facility; and (3) any such information received as a result of such disclosure is not further acquired, accessed, used, or disclosed without authorization by any person. Section 1.02 "Electronic Protected Health Information" or “ePHI” shall mean Protected Health Information transmitted by electronic media or maintained in electronic media. RFP 7649 Dental Administrator Page 4 of 31 Section 1.03 "Individual" shall have the same meaning as the term "Individual" in 45 C.F.R. §164.501 and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R. §164.502(g). Section 1.04 "Privacy Rule" shall mean the Standards for Privacy of Individual Identifiable Health Information as set forth at 45 C.F.R. Parts 160 and 164 Subparts A and E. Section 1.05 "Protected Health Information" or "PHI" shall have the same meaning as the term "protected health information" in 45 C.F.R. § 164.501, limited to the information created or received by Business Associate from or on behalf of Covered Entity. Section 1.06 "Required by Law" shall have the same meaning as the term "required by law" in 45 C.F.R. § 164.501. Section 1.07 "Secretary" shall mean the Secretary of the Department of Health and Human Services or his or her designee. Section 1.08 “Security Incident” shall mean any attempted or successful unauthorized access, use, disclosure, modification or destruction of information or systems operations in an electronic information system. Section 1.09 “Security Rule” shall mean the Standards for Security of PHI, including ePHI, as set forth at 45 C.F.R. Parts 160 and 164 Subpart C. Section 1.10 “Unsecured Protected Health Information” shall mean protected health information that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology specified by the Secretary. Terms used but not defined in this Agreement shall have the same meaning as those terms in the HIPAA regulations. Article II. Obligations and Activities of Business Associate Regarding PHI. Section 2.01 Business Associate agrees to not use or further disclose PHI other than as permitted or required by this Agreement or as Required by Law. Section 2.02 Business Associate agrees to use appropriate safeguards to prevent use or disclosure of the PHI other than as provided for by this Agreement. Section 2.03 Business Associate agrees to ensure that any agents, including sub- contractors (excluding entities that are merely conduits), to whom it provides PHI agree to the same restrictions and conditions that apply to Business Associate with respect to such information. Section 2.04 Business Associate agrees to provide access, at the request of Covered Entity, and in a reasonable time and manner designated by Covered Entity, to PHI in a Designated Record Set that is not also in Covered Entity's possession, to Covered Entity in order for Covered Entity to meet the requirements under 45 C.F.R. § 164.524. Section 2.05 Business Associate agrees to make any amendment to PHI in a Designated Record Set that the Covered Entity directs or agrees to RFP 7649 Dental Administrator Page 5 of 31 pursuant to 45 C.F.R. § 164.526 in a reasonable time and manner designated by Covered Entity. Section 2.06 Business Associate agrees to make internal practices books and records relating to the use and disclosure of PHI available to the Secretary, in a reasonable time and manner as designated by the Covered Entity or Secretary, for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rule. Business Associate shall immediately notify Covered Entity upon receipt or notice of any request by the Secretary to conduct an investigation with respect to PHI received from the Covered Entity. Section 2.07 Business Associate agrees to document any disclosures of PHI that are not excepted under 45 C.F.R. § 164.528(a)(1) as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 C.F.R. § 164.528. Section 2.08 Business Associate agrees to provide to Covered Entity or an Individual, in a time and manner designated by Covered Entity, information collected in accordance with paragraph (g) above, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 C.F.R. § 164.528. Section 2.09 Business Associate agrees to use or disclose PHI pursuant to the request of Covered Entity; provided, however, that Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by Covered Entity. Article III. Permitted Uses and Disclosures of PHI by Business Associate. Section 3.01 Business Associate may use or disclose PHI to perform functions, activities or services for, or on behalf of, Covered Entity provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity. Section 3.02 Business Associate may use PHI for the proper management and administration of Business Associate and to carry out the legal responsibilities of Business Associate. Section 3.03 Business Associate may disclose PHI for the proper management and administration of Business Associate and to carry out the legal responsibilities of Business Associate if: (i) such disclosure is Required by Law, or (ii) Business Associate obtains reasonable assurances from the person to whom the information is disclosed that such information will remain confidential and used or further disclosed only as Required by Law or for the purposes for which it was disclosed to the person, and the person agrees to notify Business Associate of any instances of which it is aware that the confidentiality of the information has been breached. RFP 7649 Dental Administrator Page 6 of 31 Section 3.04 Business Associate shall limit the PHI to the extent practicable, to the limited data set or if needed by the Business Associate, to the minimum necessary to accomplish the intended purpose of such use, disclosure or request subject to exceptions set forth in the Privacy Rule. Section 3.05 Business Associate may use PHI to provide Data Aggregation services to Covered Entity as permitted by 42 C.F.R. § 164.504(e)(2)(i)(B). Article IV. Obligations of Covered Entity Regarding PHI. Section 4.01 Covered Entity shall provide Business Associate with the notice of privacy practices that Covered Entity produces in accordance with 45 C.F.R. § 164.520, as well as any changes to such notice. Section 4.02 Covered Entity shall provide Business Associate with any changes in, or revocation of, authorization by an Individual to use or disclose PHI, if such changes affect Business Associate's permitted or required uses and disclosures. Section 4.03 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 C.F.R. § 164.522, if such restrictions affect Business Associate's permitted or required uses and disclosures. Section 4.04 Covered Entity shall require all of its employees, agents and representatives to be appropriately informed of its legal obligations pursuant to this Agreement and the Privacy Rule and Security Standards required by HIPAA and will reasonably cooperate with Business Associate in the performance of the mutual obligations under this Agreement. Article V. Security of Protected Health Information. Section 5.01 Business Associate has implemented policies and procedures to ensure that its receipt, maintenance, or transmission of all protected health information (“PHI”), either electronic or otherwise, on behalf of Covered Entity complies with the applicable administrative, physical, and technical safeguards required protecting the confidentiality, availability and integrity of PHI as required by the HIPAA Privacy Rules and Security Standards. Section 5.02 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, availability and integrity of PHI as required by HIPAA Privacy Rules and Security Standards. Section 5.03 Business Associate agrees to report to Covered Entity any Security Incident (as defined 45 C.F.R. Part 164.304) of which it becomes aware. Business Associate agrees to report the Security Incident to the Covered Entity as soon as reasonably practicable, but not later than 10 business days from the date the Business Associate becomes aware of the incident. RFP 7649 Dental Administrator Page 7 of 31 Section 5.04 Business Associate agrees to establish procedures to mitigate, to the extent possible, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of this Agreement. Section 5.05 Business Associate agrees to immediately notify Covered Entity upon discovery of any Breach of Unsecured Protected Health Information (as defined in 45 C.F.R. §§ 164.402 and 164.410) and provide to Covered Entity, to the extent available to Business Associate, all information required to permit Covered Entity to comply with the requirements of 45 C.F.R. Part 164 Subpart D. Section 5.06 Covered Entity agrees and understands that the Covered Entity is independently responsible for the security of all PHI in its possession (electronic or otherwise), including all PHI that it receives from outside sources including the Business Associate. Article VI. Term and Termination. Section 6.01 Term. This Agreement shall be effective as of the Effective Date and shall remain in effect until the Business Associate relationship with the Covered Entity is terminated and all PHI is returned, destroyed or is otherwise protected as set forth in Section 7(d). Section 6.02 Termination by Covered Entity. Covered entity shall have the right to terminate this Agreement at any time by providing thirty (30) days’ written notice of such termination to Business Associate. Section 6.03 Termination for Cause by Covered Entity. Covered Entity may terminate its contract(s) or business association with Business Associate if Covered Entity determines that Business Associate has violated a material term of the contract, to include this Agreement. Section 6.04 Termination by Business Associate. This Agreement may be terminated by Business Associate upon 30 days prior written notice to Covered Entity in the event that Business Associate, acting in good faith, believes that the requirements of any law, legislation, consent decree, judicial action, governmental regulation or agency opinion, enacted, issued, or otherwise effective after the date of this Agreement and applicable to PHI or to this Agreement, cannot be met by Business Associate in a commercially reasonable manner and without significant additional expense. Section 6.05 Effect of Termination. Upon termination of this Agreement for any reason, at the request of Covered Entity, Business Associate shall return or destroy all PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. Business Associate shall not retain any copies of the PHI unless necessary for proper document retention/archival purposes only or if such PHI is stored as a result of backup email systems that store emails for emergency backup purposes. If the return or destruction of PHI is infeasible, Business Associate shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such PHI. RFP 7649 Dental Administrator Page 8 of 31 Article VII. Amendment. The parties may agree to amend this Agreement from time to time in any other respect that they deem appropriate. This Agreement shall not be amended except by written instrument executed by the parties. Article VIII. Severability. The parties intend this Agreement to be enforced as written. However, (i) if any portion or provision of this Agreement will to any extent be declared illegal or unenforceable by a duly authorized court having jurisdiction, then the remainder of this Agreement, or the application of such portion or provision in circumstances other than those as to which it is so declared illegal or unenforceable, will not be affected thereby, and each portion and provision of this Agreement will be valid and enforceable to the fullest extent permitted by law; and (ii) if any provision, or part thereof, is held to be unenforceable because of the duration of such provision, the Covered Entity and the Business Associate agree that the court making such determination will have the power to modify such provision, and such modified provision will then be enforceable to the fullest extent permitted by law. IN WITNESS WHEREOF, the parties have executed this Business Associate Agreement as of the Effective Date. BUSINESS ASSOCIATE: By: Print Name: Title: COVERED ENTITY: CITY OF FORT COLLINS By: Print Name: Title: Please return to: City of Fort Collins Attn: Purchasing- RFP 7649 P.O. Box 580 Fort Collins, CO 80522-0580 Or email back to: jwilson@fcgov.com RFP 7649 Dental Administrator Page 9 of 31 INTRODUCTION The City of Fort Collins is seeking a proposal from qualified firms for the following employee benefit plan:  Dental (comprehensive) TPA Services – self-funded with cost shared by employer and employees Documents provided after signed BAA is received: Current plan descriptions (Exhibit A), census data (Exhibit B), claims experience (Exhibit C) and questionnaires (attached herein and included in this package). Please 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. Your 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, it must clearly specify 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 1,570 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: Exhibits sent to organizations that have returned Business Associate Agreements After signed Business Associate Agreements are returned to the City of Fort Collins Written questions due to the City May 30, 2014 Written proposals due to the City June 13, 2014 Finalist vendors notified July 9, 2014 Finalists interviews Week of July 21, 2014 Contract negotiations (completed) September 30, 2014 Plan effective date January 1, 2015 RFP 7649 Dental Administrator Page 10 of 31 1.3 Proposal Submittals Proposal must clearly indicate the name of the responding organization, as well as the name, address, telephone number and email of the primary contact at your organization for this proposal. Proposal must include the contact name for local service and account management with whom the City can call directly. The City assumes no responsibility for liability for any costs incurred in responding to this RFP, including attending meetings, site visits and/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 you 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. Your company will be bound to comply with the provisions set forth in this RFP unless any and all deviations are explicitly stated in your proposal. 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, 2015 – December 31, 2016). Please confirm this time period is applicable to your proposed rate/fee guarantees. Administrative services for dental plan should be quoted for a self-funded plan. Define specifically what services are included in the fees your company has quoted. Specify any charges for services that your company has not included in the fees quoted above, including any start-up fees, materials, etc. Adhere to the instructions in this section when organizing your proposal. RFP 7649 Dental Administrator Page 11 of 31 1.6 Proposal Requirements Your 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 your proposal's 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) 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 RFP 7649 Dental Administrator Page 12 of 31 - 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 the 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 vendor by the City. The selected vendor 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 vendor.  Fee Administration Dental vendor 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 vendor.  Customer Service The selected vendor must have as its primary focus 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 vendor must provide an accounting reconciliation of any “central bank” accounts utilized. The selected vendor 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 1 st of the preceding year. RFP 7649 Dental Administrator Page 13 of 31  Right to Audit The selected vendor 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 vendor must provide monthly paid claim summaries and detailed claim listings, preferably in Excel format or through a secure website. The vendor 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. Please describe your 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 your 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. RFP 7649 Dental Administrator Page 14 of 31 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 Factor Qualification Standard 2.0 Scope of Proposal Does the proposal show an understanding of the City’s objectives and results desired from the plan(s)? Adherence to the services requested and described in the RFP. 2.0 Assigned Personnel Do the personnel administering the plan(s) have the needed skills and experience? Are sufficient people of the requisite skills assigned to the plan(s)? Quality of care and customer service. 1.0 Availability 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 assist meeting the plan(s) schedule? Is the account management team available to attend meetings as required by the Project Manager? 1.0 Motivation Is the firm interested in providing the services requested in this RFP? Quality of responses to the RFP’s Questionnaire sections. 2.0 Cost / Financial Effectiveness How competitive are the plan’s costs, rate guarantees and where applicable, provider’s contracts with area providers? 2.0 Benefit Management Capability Experience managing similar plans of this type and scope. Thoroughness in selecting providers and managing benefit plans. Actively seek to provide most appropriate level of service? RFP 7649 Dental Administrator Page 15 of 31 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 with this Professional? SECTION 4.0 PROPOSAL ACCEPTANCE: All proposals shall remain subject to initial acceptance ninety (90) days after the day of submittal. SECTION 5.0 AGREEMENT: Proposer to provide sample plan agreement for review by the City. RFP 7649 Dental Administrator Page 16 of 31 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 EXHIBIT D, attached and incorporated herein by reference; however, the City may include additional terms and conditions in the Agreement as deemed necessary. RFP 7649 Dental Administrator Page 17 of 31 SECTION 7.0 PROPOSAL CHECKLIST The following information is requested as part of the proposal process. Please indicate your included attachments by duplicating this checklist and marking the appropriate column (Yes or No): Yes No Description of Item _____ _____ Proposal for Group Dental _____ _____ Signed Business Associate Agreement _____ _____ Signed Proposal Compliance Letter _____ _____ Signed Plan Design Confirmation _____ _____ Completed and Signed Questionnaire(s) _____ _____ Dental Network Access Analysis (if applicable) _____ _____ Copy of your EOB for Dental 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, 2015 Signature of Authorized Representative: _____________________________________ RFP 7649 Dental Administrator Page 18 of 31 SECTION 8.0 QUESTIONNAIRES Group Dental Questionnaire attached below. Summary Description of Plan The City of Fort Collins currently offers one dental program. This Comprehensive Plan allows for a $1500 benefit per person each year. Orthodontic care is provided at a lifetime maximum of $1500 per eligible dependent up to age 26. This plan offers two cleanings/oral exams per year (twice in a 12-month period). Benefits for restorative services are subject to a $50 per individual or $100 per family fee. All benefits are paid on a percentage basis. The City provides coverage to eligible employees working 20 or more hours per week. Benefits are self-funded and the cost is shared between the City and employees. Currently, 1493 are enrolled for comprehensive coverage. Enrollment distribution between tiers of coverage are as follows: Level of Coverage Comprehensive Individual 492 w/child(ren) 181 w/spouse 338 w/family 482 Total 1493 RFP 7649 Dental Administrator Page 19 of 31 GROUP DENTAL QUESTIONNAIRE Administrative Services Only 1. Do you agree to provide without limitation services to all employees/dependents enrolled as of December 31, 2014? 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 dental services provider, you may be required to make the necessary adjustments in order to achieve replication. Otherwise, your selection may become null and void. 3. What is your monthly administrative fee; expressed in terms of dollars per month, per employee? 4. Include additional costs, if any, for adding a 3 rd exam to the plan provisions. 5. Include additional costs, if any, for adding adult orthodontia at a $1,500 lifetime coverage. 6. For each geographic area in which you have a network applicable to employee population, provide the following information:  Geo-Access, using 2 dental 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 (dentists, specialists, etc.). Also provide the website where provider information can be found. 7. For each network, describe the specific measures used by your organization to monitor participating provider access. Provide the most recent corresponding statistics available for:  Dentist to member ratios  Average waiting period for an appointment 8. What percentage of your providers have limited their practice to current patients? 9. What is your organization’s financial rating (e.g., Best & Co., S&P)? 10. Please describe your credentialing procedures. 11. What type of reimbursement/payment method is used to reimburse participating providers? Please provide a breakdown by method of review. 12. 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. RFP 7649 Dental Administrator Page 20 of 31 13. If provider discounts are used, state the basis of the agreement. Are discounts based on provider charges or actual cost of service? 14. Is there a formal committee that establishes quality assurance policies and reviews the results on a regular basis? 15. Do you capture all utilization data? 16. What claims experience and utilization reports are available? If there is additional cost, please specify. 17. Describe patient satisfaction surveys that you perform. 18. 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? 19. Please describe your method for calculating renewal rates. 20. Do you provide a toll-free number for employees to call with questions on claims, plan provisions or requests for dentist referrals? 21. Do you provide a care hotline that employees can call with questions about proper levels of care? 22. Will you provide a dedicated Representative for the City’s Human Resources Department with telephone and email contact information? 23. Will you perform pre-treatment estimates? If yes, what is your average turnaround time? 24. Please certify that you are in compliance with HIPAA privacy regulations and include a copy of your privacy statement or policy. RFP 7649 Dental Administrator Page 21 of 31 EXHIBIT D SAMPLE PROFESSIONAL SERVICES AGREEMENT (For informational purposes, do not fill in or submit with proposal) 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 , 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 ( ) pages, and incorporated herein by this reference. Irrespective of references in Exhibit A to certain named third parties, Professional shall be solely responsible for performance of all duties hereunder. 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 ( ) pages, and incorporated herein by this reference. 3. Contract Period. This Agreement shall commence , 200 , and shall continue in full force and effect until , 200 , unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed four (4) additional one year periods. Renewals and pricing changes shall be negotiated by and agreed to by both parties. The Denver Boulder Greeley CPIU published by the Colorado State Planning and Budget Office will be RFP 7649 Dental Administrator Page 22 of 31 used as a guide. Written notice of renewal shall be provided to the Professional and mailed no later than ninety (90) days prior to contract end. 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. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: Professional: City: Copy to: Attn: City of Fort Collins Attn: PO Box 580 Fort Collins, CO 80522 City of Fort Collins Attn: Purchasing Dept. PO Box 580 Fort Collins, CO 80522 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 harmless 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 negligent performance of any of the RFP 7649 Dental Administrator Page 23 of 31 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 $1,000,000, in accordance with Exhibit , consisting of one (1) page, attached hereto and incorporated herein. 6. Compensation. [Use this paragraph or Option 1 below.] In consideration of the services to be performed pursuant to this Agreement, the City agrees to pay Professional a fixed fee in the amount of ($ ) plus reimbursable direct costs. All such fees and costs shall not exceed ($ ). Monthly partial payments based upon the Professional's billings and itemized 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. [Optional] Insert Subcontractor Clause 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 shall be based upon the Professional's City-verified RFP 7649 Dental Administrator Page 24 of 31 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. 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, prepared on stable Mylar base material using a non-fading process to provide for long storage and high quality reproduction. "CD" disc of the as-built drawings shall also be submitted to the City in an AutoCAD version no older then the established city standard. 9. Monthly Report. 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 RFP 7649 Dental Administrator Page 25 of 31 for the payment of FICA, Workers' Compensation, other taxes or benefits or for any other purpose. 11. Subcontractors. Professional may not subcontract any of the Work set forth in the Exhibit A, Statement of Work without the prior written consent of the city, which shall not be unreasonably withheld. If any of the Work is subcontracted hereunder (with the consent of the City), then the following provisions shall apply: (a) the subcontractor must be a reputable, qualified firm with an established record of successful performance in its respective trade performing identical or substantially similar work, (b) the subcontractor will be required to comply with all applicable terms of this Agreement, (c) the subcontract will not create any contractual relationship between any such subcontractor and the City, nor will it obligate the City to pay or see to the payment of any subcontractor, and (d) the work of the subcontractor will be subject to inspection by the City to the same extent as the work of the Professional. 12. Personal Services. It is understood that the City enters into the 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 the Agreement without the prior written consent of the City. 13. Acceptance 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. 14. Default. Each and every term and condition hereof shall be deemed to be a material RFP 7649 Dental Administrator Page 26 of 31 element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default. 15. 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 party's reasonable attorney fees and costs incurred because of the default. 16. 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. 17. 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. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Professional represents and agrees that: a. As of the date of this Agreement: 1. Professional does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and RFP 7649 Dental Administrator Page 27 of 31 2. Professional will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the “e-Verify Program”) or the Department Program (the “Department Program”), an employment verification program established pursuant to Section 8-17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. b. Professional shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. c. Professional is prohibited from using the e-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Agreement is being performed. d. If Professional obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Professional shall: 1. Notify such subcontractor and the City within three days that Professional has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Professional shall not terminate the contract with the subcontractor if during such three days the RFP 7649 Dental Administrator Page 28 of 31 subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Professional shall comply with any reasonable request by the Colorado Department of Labor and Employment (the “Department”) made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. f. If Professional violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Professional shall be liable for actual and consequential damages to the City arising out of Professional’s violation of Subsection 8-17.5-102, C.R.S. g. The City will notify the Office of the Secretary of State if Professional violates this provision of this Agreement and the City terminates the Agreement for such breach. 19. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit " " - Confidentiality, consisting of one (1) pages, attached hereto and incorporated herein by this reference. RFP 7649 Dental Administrator Page 29 of 31 THE CITY OF FORT COLLINS, COLORADO By: _________________________________ Gerry Paul Director of Purchasing & Risk Management DATE: ______________________________ ATTEST: _________________________________ City Clerk APPROVED AS TO FORM: ________________________________ Assistant City Attorney [INSERT PROFESSIONAL'S NAME] OR [INSERT PARTNERSHIP NAME] OR [INSERT INDIVIDUAL'S NAME] OR By: __________________________________ Title: _______________________________ CORPORATE PRESIDENT OR VICE PRESIDENT Date: _______________________________ ATTEST: _________________________________ (Corporate Seal) Corporate Secretary RFP 7649 Dental Administrator Page 30 of 31 EXHIBIT INSURANCE REQUIREMENTS 1. The Professional will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Professional shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: "The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10) days written notice has been received by the City of Fort Collins." In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Professional, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Professional under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Professional 's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Professional shall maintain during the life of this Agreement for all of the Professional's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Professional shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Professional shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. RFP 7649 Dental Administrator Page 31 of 31 EXHIBIT CONFIDENTIALITY IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the “City”) pursuant to this Agreement (the “Agreement”), the Professional hereby acknowledges that it has been informed that the City has established policies and procedures with regard to the handling of confidential information and other sensitive materials. In consideration of access to certain information, data and material (hereinafter individually and collectively, regardless of nature, referred to as “information”) that are the property of and/or relate to the City or its employees, customers or suppliers, which access is related to the performance of services that the Professional has agreed to perform, the Professional hereby acknowledges and agrees as follows: That information that has or will come into its possession or knowledge in connection with the performance of services for the City may be confidential and/or proprietary. The Professional agrees to treat as confidential (a) all information that is owned by the City, or that relates to the business of the City, or that is used by the City in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City). The Professional shall not disclose any such information to any person not having a legitimate need-to-know for purposes authorized by the City. Further, the Professional shall not use such information to obtain any economic or other benefit for itself, or any third party, except as specifically authorized by the City. The foregoing to the contrary notwithstanding, the Professional understands that it shall have no obligation under this Agreement with respect to information and material that (a) becomes generally known to the public by publication or some means other than a breach of duty of this Agreement, or (b) is required by law, regulation or court order to be disclosed, provided that the request for such disclosure is proper and the disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the Professional shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure and shall promptly advise the City in writing of each such disclosure. In the event that the Professional ceases to perform services for the City, or the City so requests for any reason, the Professional shall promptly return to the City any and all information described hereinabove, including all copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or as to which it otherwise has access. The Professional understands and agrees that the City’s remedies at law for a breach of the Professional’s obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at law.