CITIZENS PROPERTY INSURANCE CORPORATION
VENDOR QUESTIONNAIRE

INSTRUCTIONS:

This Questionnaire is intended to cover all Services requested in the ITN. Please provide a response to each of the questions in this attachment. Responses should include your complete response, where applicable, to both STD and Leave Administration. To the extent that you have provided an answer to the question in another area of your Reply, repeat your answer in the space provided AND provide a reference to the original answer. The space for answers below will expand as necessary. Please be thorough but concise in your response.Individual responses should be limited to two pages. If a response attachment is required, the attachment must be provided in either MS Word, Excel, or Adobe PDF format, unless otherwise specified. See Section 3.7 of the ITN for additional details regarding the evaluation process.

QUESTIONNAIRE SECTIONS:

These are the sections that represent the various areas of the Vendor Questionnaire that require specific responses, comments, and explanation.

MAXIMUM Points
General Information/Corporate Background / Not Scored
Section A - Administrative and Support Services
  • Ability to maintain the plan design
  • Program staff/key personnel
  • Reporting
  • Data security
  • Implementation
  • Integration with other products
/ 20
Section B - Claims Processing / 20
Section C - Member Services / 20
Section D – Innovation and Best Practices / 20
TOTAL / 80
GENERAL INFORMATION AND CORPORATE BACKGROUND
  1. Provide the full legal name of your company.

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  1. Provide the Federal ID Number associated with your company

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  1. Provide the name, title, phone number, and email address for your primary point of contract regarding this ITN.

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  1. What is the length of time (years) that your company has existed? Please detail any past mergers, acquisitions, reorganizations, and other names your company has operated under, if applicable.

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SECTION A
ADMINISTRATIVE AND SUPPORT SERVICES(up to 20 points)
  1. Provide a summary of Vendor’s experience providing the requested Services. Include information pertaining to your company’s book of business and number of private and governmental clients located in Florida with an employee base of up to 5,000 and offering a self-funded Short Term Disability (STD) plan.

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  1. Identify five (5) clients for whom the Vendor currently provides STD and FMLA administrative services. For each client for whom you are able, please provide the company name, primary point of contact (name, title, email address) familiar with the Services, and the number of employees for whom benefits are administered. Citizens is particularly interested in self-funded public sector entities in Florida.

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  1. Describe any differentiating characteristics or competitive advantages that Vendor has relative to competitors in providing employee benefits and administrative services to clients with similar or related business activities.

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  1. What standard and routine reports do you propose to provide to Citizens and on what frequency? Provide sample reports with your Reply.

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  1. Provide the names and titles of individuals who will be assigned work on the Citizens account. Include an estimate of each key individual’s time dedicated to Citizens as well as key responsibilities. Include an organizational chart identifying the team and reporting structures

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  1. Please review Citizens’ Leave Policy (Appendix 1) for the benefits currently offered. You will be asked to duplicate and administer the current benefits as closely as possible. Please identify all changes to the current Citizens’ Leave Policy that would be necessary for you to perform the Services. What features are you unable or unwilling to administer and why? Provide detail and alternate language in areas where you cannot exactly match the current leave offerings.

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  1. Describe your system security protocols, back-up protocols, disaster recovery plan, past breaches and corrective actions, and the measures you take to ensure data integrity.

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  1. Describe the system/mechanisms you propose to track and analyze regular and intermittent leave hours.

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  1. Describe how the system can be configured to automatically notify human resources/benefits and supervisor/manager concerning Leave Events for their direct reports.

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  1. Generally, what is your process for handling open claims upon expiration or termination of the agreement? Will you charge Citizens a fee for the transfer of open claims? If there is a fee, explain what is included in the fee and how it would be charged to Citizens (such fees should be included in Vendor’s Response to Attachment I, Price Sheet).

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SECTION B
CLAIMS PROCESSING(up to 20 points)
  1. What is your process for determining that STD and Leave Events are administered in accordance with Citizens’ Leave Policy parameters? What safeguards and procedures do you have in place to ensure Eligible Employees’ Leave Events are administered correctly?

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  1. From which location of the Vendorwill Citizens’ Short Term Disability and Leave Requests be processed?

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  1. What means are used to notify Eligible Employees of the status of requests for Short Term Disability and Leave Requests? How are determination decisions communicated to Eligible Employees? What is the usual turnaround time?

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  1. What consultative resources will you make available to ensure disability determinations are made in accordance with Citizens Leave Policy and applicable laws?

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  1. What are your general timing and quality standards for the handling of Short Term Disability and Leave Requests?

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  1. What protocols are in place for the auditing of performance?

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  1. What is your appeals process?

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  1. What is your appeal disposition rate?

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  1. What is your process for obtaining additional information (i.e. tracking down paperwork, contacting medical providers, communicating the need for additional documentation) in order to approve Short Term Disability or Leave Requests?

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  1. Describe any unique claims processing systems that Vendor offers that may generate cost savings to the Citizens.

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  1. Describe how or what tools the Vendor has to identify and assist Eligible Employees in applying for benefits for offsetting purposes (i.e., assisting claimants in applying for Social Security disability benefits that may be offset against disability claims payments)

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  1. If applicable, describe the medical review process to be utilized for disability claims that would be transitioned from the incumbent administrator. How will the new Vendor handle previous disability benefit determinations from the incumbent with which it may disagree?

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  1. How does the Vendor verify whether an individual qualifies for disability benefits? What criteria is used by the claim reviewer to process an initial disability request into a qualified short term disability?

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  1. What reporting is available to demonstrate the Vendor’s accuracy and timeliness in processing Short Term Disability and Leave Event requests?

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  1. What is the average number of working days for a Leave Event to be processed from the date of receipt, for a routine Leave Event?

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SECTION C
MEMBER SERVICES(up to 20 points)
  1. Outline the structure of your service team(s) (including numbers of representatives, titles, experience and qualifications, etc.) that would be available in providing Services to Eligible Employees?

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  1. Where are your services centers that will handle calls and inquiries from Eligible Employees?

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  1. Describe your Customer Service unit in terms of:
  • Method(s) in which Customer Service can be accessed (i.e., phone, web chat, email, etc.)
  • Hours of operation
  • Handling of complaints and escalation procedures

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  1. Describe the training received by each employee category (i.e., claims processors, customer service representatives, supervisors, etc.)

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  1. Are customer service representatives separated from the Short Term Disability determinations unit, or do claims processors also have determination responsibilities?

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  1. Do customer service representatives have the authority to approve Short Term Disability Leave Events?

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  1. Can Eligible Employees access specific Short Term Disability and Leave Events information via the Vendor’s website or application to view the status of requests and make inquiries?

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  1. How are patterns of customer service inquiries monitored and the subsequent data used to improve Short Term Disability and Leave Events processing activities?

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  1. Describe the Vendor’s procedure for handling customer service complaints and inquiries, including how these are prioritized.

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  1. Describe the Vendor’s problem resolution methods.

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  1. Does the Vendor provide support to spouses and dependents of a disabled employee? If so, please describe this support.

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  1. What reporting will the Vendor provide Citizens to demonstrate the level and quality of its interaction with Eligible Employees?

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SECTION D
INNOVATION AND BEST PRACTICES(up to 20 points)
  1. Please provide proposed performance measures (or service levels) and credits, to be included in the Contract in accordance with Section 2.4 of this ITN to monitor Contract compliance. Such performance measures may include items such as:
  • Vendor account management to include acknowledgement of all communications, including but not limited to those via telephone or email, within one (1) business day;
  • Member calls to be answered within thirty (30) seconds or less, and the abandonment rate should be three and a half percent (3.5%) or less, based on an annual average;
  • Initial decisions for STD claims to be rendered within the following standards: (a) fifty percent (50%) within five (5) business days of receipt of claim; and, (b) eighty percent (80%) within ten (10) business days of receipt of claim, and;
  • STD claims to be paid and coded within the following standards: (a) ninety-five percent (95%) of claim dollars paid correctly; and, (b) ninety-five percent (95%) of claims coded correctly.

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  1. How will you handle integration with LTD if it is offered and provided through a separate insurance carrier? See Section 2.3(D) of the ITN.

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  1. In assisting Citizens with group plan coverages, identify the Citizens Leave Policies and/or benefits that require coordination and explain how coordination would work.

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  1. Describe the Vendor’s disability rehabilitation program(s), if any.

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  1. Once an individual has been accepted to disability status, how does the Vendor determine the duration of the disability? (For example: what if there is a conflict between the recommended duration between a provider and a medical standard? How does the Vendor handle disability cases that no longer meet the clinical criteria for disability? Who re-evaluates a case for continuing disability?)

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  1. Does the Vendor create an individual care plan for each disability case? If so, please describe.

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  1. Describe Vendor’s most effective means to detect fraud, abuse, and other improprieties.

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ITN No. 18-0001, Administration of Short Term Disability and LeavePage 1 of 9

Attachment H