ATTACHMENT 4 – pROPOSAL wORKSHEET

Lake County board of county commissioners

benefit Administrative services rfp

I. GENERAL INFORMATION

A.Provide the following information about your Company:

Company Name
Service Center Location
Primary Contact for RFP
Contact’s Phone Number
Contact’s Email Address

B.References

Current Clients
Large Clients (Public Groups Preferred) / Group Size (EEs)
Please include at least four over 1,000 EEs / Product(s)
FSA, COBRA, Retiree, / Contact Name / Contact Title / Contact Telephone / Years as Client

C. Personnel to administer services proposed.

Name / Location / Years with Company in current role / Current Workload (number of current clients)
Account Service Rep.
Implementation Manager
Other

II. SERVICES

  1. ADMINISTRATIVE SERVICES

Service / Confirm / Deviation
  1. Confirm that you have reviewed the County’s current Section 125 Cafeteria Plan documents, developed recommended changes and will maintain the documents.

  1. Confirm that your Company will administer non-discrimination testing to medical FSA and dependent care FSA.

  1. Confirm that your Company will accept eligibility and enrollment information through an electronic file.

  1. Confirm that your Company will provide debit card usage for Medical FSA.

  1. Confirm that your Companywill ensure that debit cards are received by, and funds posted to returning participant’s cards, no later than October 1st of each plan year.

  1. Confirm that your Companywill provide account management reports to the County on a monthly basis.

  1. Confirm that your Companywill provide employer tracking services that include statistical information on FSAs, retiree, COBRA enrollments, transactions and past due premiums.

  1. Confirm that your Company will provide employees the ability to self-monitor the balance on their FSA.

  1. Confirm that your Company will administer the County’s initial and ongoing run out period.

  1. Confirm that your Company will provide administrative guidance on changes in FSA, COBRA, and/or Retiree administration laws.

  1. Confirm that your Company will retain records pursuant to current regulations including upon expiration of the contract.

  1. Confirm that your Company will provide annual enrollment assistance, including an on-site representative for 3-4 weeks to attend annual enrollment meetings.

  1. Confirm that your Company will allow the employer to update enrollment information via electronic filing and/or access to a Client Portal.

  1. Confirm that your Company will outline initial funding requirements for FSA accounts.

  1. Confirm that your Company will process COBRA elections within specified timeframes.

  1. Confirm that your company will mail initial COBRA notices to new enrollees and Qualifying Event Notices to eligible employees and dependents.

  1. Confirm that your company will conduct premium calculation, billing to enrollees, and management of ongoing premium collection process for COBRA and Retiree Services.

  1. Confirm that your company will coordinate with the Florida Retirement System (FRS), allowing for FRS deduction of premium payments, annual FRS reporting for premiums paid.

  1. Confirm that your company will allow for automatic bank account deductions for COBRA and Retiree premiums.

  1. Confirm that your company will assume liability for services rendered.

  1. Confirm your company will only one fee will be charged when a participant enrolls in both the Medical and DependentCare FSA.

  1. Confirm your company’s ability to interface directly with the County’s insurance carriers (medical, dental, FSA and vision) on COBRA enrollments, terminations on a monthly basis via an eligibility data transfer process.

  1. Confirm minimum participation requirements have been waived.

  1. Confirm the Contractor shall provide an annual account management performance survey to be completed by the County.

  1. Confirm the Contractor shall be responsible for all costs of producing, printing, and mailing/distributing adequate quantities of marketing and administrative supplies, as designated by the County. The format and content of all materials used for the County account shall be satisfactory to the County.

  1. Confirm that your Company will administer non-discrimination testing to medical FSA and Dependent Care FSA annually within ninety (90) days prior to start of Plan Year.

  1. Confirm that your Company will provide the County access to standard County-level reporting, including transactional summaries and monthly report of account activities in downloadable formats, including Microsoft Excel.

  1. Confirm that your Company will develop Participant education materials, including initial and new enrollee welcome letters and updates and revisions as a result of any federal or state mandate changes affecting benefits under employee benefits administrative services, to be reviewed and approved by the County.

  1. Confirm that your Company will provide a secure portal and / mobile application to allow participants the ability to monitor and submit claims using various technologies.

  1. Confirm that your Company will provide administrative guidance on COBRA, Federal and State laws.

  1. Confirm that your Company will provide COBRA Participants access to customer service for Participant inquiries.

  1. Confirm that your Company will process COBRA elections within specified timeframes.

  1. Confirm that your Company will send COBRA initial enrollment materials within specified timeframes.

  1. Confirm that your Company will facilitate open enrollment materials to current COBRA Participants.

  1. Confirm that your Company will conduct premium calculation, monthly billing to Participants, and management of ongoing premium collection process for COBRA.

  1. Confirm that your Company will retain records pursuant to applicable laws.

  1. Confirm that your Company will provide the necessary reporting to enable the County to perform employer responsibilities related to ACA enrollment for COBRA Participants.

Question / Response
  1. Indicate the current debit card vendor.

  1. Please provide percentage of claims that are automatically adjudicated via debit cards.

  1. Please describe the procedure for recovering and reporting debit card funds not substantiated.

  1. Describe the process and timeline for handling denied claims appeals.

  1. Describe the requirements and options available for initial and ongoing funding of the FSA accounts. Include reference to prefunding of the debit card and medical availability.

  1. If claims exceed deposits describe the steps theContractorshall take to cover claims costs.

  1. Describe any ability to interface with medical carrier for claims adjudication.

  1. Indicate the current debit card vendor.

  1. Please provide percentage of claims that are automatically adjudicated via debit cards.

  1. Please describe the procedure for recovering and reporting debit card funds not substantiated.

  1. Describe the process and timeline for handling denied claims appeals.

  1. Describe the requirements and options available for initial and ongoing funding of the FSA accounts. Include reference to prefunding of the debit card and medical availability.

  1. If claims exceed deposits describe the steps the Contractor shall take to cover claims costs.

  1. Describe any ability to interface with medical carrier for claims adjudication.

  1. Describe the notification process for COBRA participants nearing the end of their eligibility period.

  1. Indicate the review process used for certifying extended COBRA coverage.

  1. Please provide percentage of claims that are automatically adjudicated via debit cards.

  1. Please describe your procedure for recovering and reporting debit card funds not substantiated.

  1. Describe your process for handling claims submission, including frequency of reimbursement checks.

  1. How are FSAs maintained for employees who elect to continue depositing money into the account as part of their COBRA election?

  1. What are the safeguards for claims processed for terminated employees with an account balance?

  1. Describe your process and timeline for handling denied claims appeals.

  1. Define what information you require for claims processing for medical claims and verification for claims reimbursements.

  1. Define what information you require and verification needed for claims processing for dependent care claims. Specifically address how often you require verification of daycare providers.

  1. If claims exceed deposits describe the steps your company will take to cover claims costs.

  1. Describe your company’s non-discrimination testing process for public sector groups.

  1. Confirm your company’s ability to:
  2. send COBRA enrollment materials within a specified timeframe
  3. mail acknowledgement of COBRA participation to new enrollees
  4. administer notice of coverage termination and conversion rights
/ a.
b.
c.
  1. Confirm that your company will not charge more than a 2% surcharge for participants on extended COBRA for disability.

  1. Confirm sample copies have been provided (under Tab B) of the FSAs, COBRA, Retiree and education materials, claim forms, explanation of payments/billing statements and claims denial letter. Indicate whether these can be customized for Lake County.

  1. MEMBER SERVICES AND STAFFING

Service / Confirm / Deviation
  1. Confirm that your company will provide customer service (inbound and outbound) using various methods (email, phone, web) for all participants.

  1. Confirm that your company will assure that all customer service and claims staff are trained in the specific technical issues of the County’s account.

  1. Confirm that your company will be able to maintain appropriate staffing levels to serve participants in the respective programs.

  1. Confirm that covered persons will have year-round access to toll free customer service. This customer service function must be available, at the Proposer’s expense, during the enrollment period preceding the effective date of the Contract.

  1. Confirm that the telephonic customer service function will be available (at a minimum) from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday.

  1. Confirm that your company will have a telephone system and staff capacity adequate to respond to covered persons within 24 hours.

  1. Confirm that your company will record and maintain information regarding service-related or other complaints reported by covered employees, retirees and/or employee representatives.

  1. Confirm if your Company will provide customer notifications regarding account balance, pending reimbursements and recent plan updates using various methods of communication (email alerts, text messages).

  1. Confirm that your Company will administer, at least annually, customer service surveys and provide summary reports to the County.

  1. ACCOUNT MANAGEMENT

Service / Confirm / Deviation
  1. Confirm that your Company will provide a dedicated account manager who will be a single point of contact, is able to make decisions, or report to a person who can make decisions, concerning process changes, as required, to oversee this account.

  1. Confirm that your Company will notify the County of any changes in account management or contact persons immediately.

  1. Confirm that the account manager will maintain an up-to-date understanding and knowledge of the County’s account.

  1. Confirm that your Company will provide an annual account management performance survey to be completed by the County.

  1. Confirm that your company currently provides account management reports and premium remittance reports to clients such as Orange County Government on a monthly basis. Please provide sample reports per service under Tab B.

  1. COMMUNICATION AND MARKETING

Service / Confirm / Deviation
  1. Confirm that your Company, upon approval from the County, will be responsible for coordinating communication and marketing activities related to Services.

  1. Confirm that your Company will be responsible for all costs of producing, printing, and mailing/distributing adequate quantities of marketing and administrative supplies as designated by the County. The format and content of all materials used for the County account shall be satisfactory to the County.

  1. Confirm that your Company will provide electronic communications, upon approval by the County, directly to enrolled members.

  1. Confirm that your Company will allow the County to review and approve any informational materials provided to participants.

  1. IMPLEMENTATION

Service / Confirm / Deviation
  1. Confirm that your Company will designate an implementation team of experienced staff to work with the County and/or it’s consultants to effectively implement the program on schedule.

  1. Confirm that your Company will outline required timelines receiving and processing annual elections for October 1 plan year.

  1. Confirm that your Company will provide a testing environment to review online services 30 days prior to the effective date of coverage.

III. PLAN COST AND PERFORMANCE GUARANTEES

  1. FSA (Medical and Dependent Care) Administration

Current number of FSA participants 431

WITH Debit Card / 2018-2019 / 2019-2020 / 2020-2021 / 2021-2022Optional / 2022-2023 Optional
PEPM
Annual Total
Flexible Spending Account Service / Included in Proposal? / Additional Fee/Comments
Yes / No
Complete administration of Medicaland Dependent Care Flexible Spending Accounts
Enrollment material describing the benefits of FSA participation
Section 125 Compliant Plan Document preparation
Regulatory Updates and Plan Amendments
Customer service telephonic and web page support for all FSA participants
Direct deposit of FSA reimbursements
Debit card option for participants
FSA information via website or telephone
Accounting services including check writing, funding requests, reconciliation
Management reports, including ad hoc report requests
Electronic data exchange in the County’s approved format (set-up and ongoing)
Carrier set-up fees
Change in file layout
Eligibility reconciliation
Records retention
Banking Options
Non-discrimination testing
Travel cost to open enrollment meetings
Minimum Participation Fees
Implementation fee
Set up fee
Renewal fee
Other:
  1. COBRA Administration

Average number of employees 1197

2018-2019 / 2019-2020 / 2020-2021 / 2021-2022Optional / 2022-2023 Optional
PEPM
Annual total
COBRA Service / Included in Proposal? / Additional Fees/Comments
Yes / No
Process COBRA elections within specified timeframes
Mail acknowledgement of COBRA participation to new enrollees
Mail COBRA enrollment packets within specified timeframes
Mail Qualifying Event Notices to eligible employees and dependents
Premium calculation, billing to enrollees, and management of ongoing premium collection process
Pro rate monthly premium per effective date given by the County
Late notices and termination notices
Customer service for all COBRA participants
Directly interface enrollments, changes, and terminations to insurance carriers
Retain records pursuant to current regulations
Administrative guidance on changes in COBRA laws
Eligibility reconciliation with carriers
Liability for services rendered
Minimum participation fees
Open enrollment forms (paper or online)
Implementation fee
Set up fee
Renewal fee
Other:
  1. Retiree Billing Services

Current number of Retirees enrolled 85

2018-2019 / 2019-2020 / 2020-2021 / 2021-2022 Optional / 2022-2023 Optional
PPPM
Annual Total
Retiree Service / Included in Proposal? / Additional Fees/Comments
Yes / No
Premium calculation and billing to enrolleesand management of ongoing premium collection process
Pro rate monthly premium per effective date given by the County
Management of ongoing premium collection process
Coordination with FRS
Notice and premium payment to insurance carriers monthly
Premium reconciliation
Customer service for all Retiree participants
Eligibility reconciliation with carriers
Retain records
Directly interface enrollments, changes and terminations to insurance carriers
Coordination of enrollment with Medicare Supplemental Carrier
Coordination of enrollment with PDP carrier
Minimum participation fee
Open enrollment forms (paper or online)
Implementation fee
Set up fee
Renewal fee
Other:
  1. Performance Guarantees

Guarantee / Target / Penalty
  1. Implementation

  1. Premium Remittance & Reports

  1. Customer Service
  2. Average Speed of Answer
  3. Abandonment Rate
  4. Response to participant inquiry
  5. Resolution of participant inquiry

  1. COBRA Notification Timelines
As specified by the County
  1. Provide Account Management Reports -Monthly

  1. Delivery of Debit Cards
By Oct 1 of each PY
  1. Annual Account Management Performance Survey

  1. Turnaround for end of year forfeitures

Company:Page 1 of 8