Board of Education
Jeff N. Heiner, President
Jennifer Zundel, Vice President
Douglas B. Barker
Don E. Belnap
Susan Richards
Shane B. Story
Joyce Wilson
Sandy Coroles, Superintendent
Zane K. Woolstenhulme, Business Administrator
Request for Proposals # 6-003
Employee Benefits Advisor-Advocacy Services
General Information
A. Purpose
Ogden City School District (the “District”) is accepting proposals from qualified forward-thinking employee benefits advisory firms to act as an advisor and advocate to Ogden City School District (“the District” in matters of employee benefits, including but not limited to group insurance programs. Respondents are strongly encouraged to carefully read the entire request for proposals.
It is anticipated this RFP may result in a contract award to a single contractor.
This RFP is designed to provide interested parties with sufficient basic information to submit proposals meeting minimum requirements, but is not intended to limit a proposal’s content or exclude any relevant or essential data. Respondents are at liberty and are encouraged to expand upon the specifications to evidence service capability under any agreement.
The District recognizes the value of having a Benefits Advisor who is readily available on short notice. Therefore, all other things being equal, the District intends to retain a Benefits Advisor residing in and doing substantial business in Utah.
B. Background
Ogden City School District has a student enrollment of approximately 12,000 students. The District currently operates 14 elementary schools, three (3) Jr. High schools, two (2) high schools, and one (1) Alternative high school. District offices are located at 1950 Monroe Blvd, Ogden, Utah. The District has approximately 1600 employees. About 850 employees are currently enrolled in one of the District’s three group health plans. The health insurance plans are modified self-funded plans. The current carrier is EMI Health.
1950 Monroe Blvd., Ogden, UT, 84401-0619
801-737-7300, www.ogdensd.org
Affirmative Action · Equal Opportunity · ADA Employer
C. Scope of Services
The selected firm will work under the direction of the Business Administrator and Human Resources Executive Director. The scope of service includes, but may not be limited to the following:
1. Advice and assistance reviewing the District Employee Benefits Program on a continuing basis to ensure those plans are in compliance with state and federal requirements (i.e., HIPAA, COBRA, ERISA, USERRA, FMLA, etc.) and their adequacy of benefits with respect to other plans. Recommend alternative benefit designs or delivery systems as dictated by emerging plan costs and benefit practices.
2. Advise the District on all pertinent matters as they relate to the Affordable Care Act and review the District’s plans to ensure compliance with the ACA.
3. Assist in reviewing and reaffirming or changing the goals and of objectives of the benefit design. Notification, monitoring and providing information on pending or new legislation and changes in tax law, as well as benefit and funding trends that may affect the benefits program, applying assumptions to various scenarios, often on short notice. Advise the District of market and like business benefit trends. Recommend appropriate action to be taken by the District.
4. Advise and assist the District with writing plan modifications and new plans, assist in the amendment approval process, and submitting written reports and other documents as required by the Federal Government.
5. Advise and assist in the preparation / development of “Requests For Proposals” for projects necessary to implement the benefit plans.
6. Advise and assist in reviewing contracts, plan documents, insurance policies and other documents for applicability, accuracy and consistency. Prepare and deliver necessary reports to the District.
7. Prepare alternative funding analysis and conduct actuarial analysis of claims, reserves and funds requirements as requested.
8. Provide comprehensive underwriting/financial analysis services (i.e., project total annual funding levels, per member per year funding levels, generate specific dollar amount scenarios, forecast alternative funding scenarios, project future medical inflation scenarios, etc.).
9. Maintain records of the financial and claims experience, condition, and progress of District plans and provide reports as requested.
10. Review all benefit services for technical accuracy.
11. Participate with and advocate for the District when requested in communications and actions with the insurance and healthcare reimbursement carriers; and with boards or other independent bodies.
12. Assist the District in development and preparation of communication materials. Help coordinate the design, editing, printing, and production of those materials. Give advice and make recommendations when necessary and appropriate.
13. Be available for meetings as required and provide a backup service person that is knowledgeable about the District’s Employee Benefits Program.
14. Assist and advocate for the District in adjudication of specific claims as requested.
15. Participate in appropriate audits of vendors, if requested of third party claims administrators, based on a statistically valid stratified random sample that achieves a minimum 95% confidence level and prepare comprehensive and detailed reports, and recommendations of the audit findings, review results with plan administrators. Such audits may include, but not be limited to:
o A detailed operation review of the third party claims administrator, which may include, but not be limited to:
· Claims payment system;
· Claims procedure and office work flow;
· Forms and communication process;
· Training programs and employee evaluation process;
· Exception processing;
· Cost containment procedures
· Quality and quantity of procedural manuals provided to claims processing, customer service, etc.
· Internal audit system;
· Mail receipt and tracking;
· Evaluation of the security of records and data;
· Evaluation of customer service, including communication of plan benefits and procedures; and
· Security and override procedures relating to approval of claims and access to records.
o A comprehensive, and objective review of the received and processed claims to determine whether the claims are adjudicated according to contractual performance standards, appropriate benefits, and industry standards which includes, but is not limited to;
· A statistically valid stratified random sample that achieves a minimum 95% confidence level;
· On-site review of transactions processed by the third party claims administrator, including the reprocessing of claims to evaluate the third party claims administrators process and systems relating to such areas as: eligibility, coding, pricing including proper application of allowable charges and discount arrangements, deductible accumulators, identification of duplicate bills, application of plan benefits, COB, medical necessity, ineligible/eligible charges, compliance with master plan documents, timeliness of processing, interaction with other vendors, and file documentation.
16. Work cooperatively, provide liaison services with other companies and consultants as the District may see fit in putting together an effective Employee Benefits Program including coordination of reporting and assistance resolving claims.
17. Participate in the preparation and presentation of applicable financial reports.
18. Perform special projects as requested by the District. For example:
o Develop and assist in implementation of new insurance plans.
o Assist in drafting, reviewing, issuing and evaluating request for proposals and invitations to bid.
o Provide advice and advocate for the District in contract negotiations and renewals.
o Assist in developing the costs associated with various issues involving benefit plans.
o Assist with special employee communication projects which may result from legislative or regulatory changes.
o Prepare special reports showing claims experience.
19. Be responsible for maintaining the confidentiality District records and data, which cannot be sold, shared, or otherwise disclosed to other companies or individuals without written permission from the District.
20. Assist the District with development of performance guarantees relating to vendors’ performance of services to the District and evaluate the performance of vendors.
21. Ability to provide full service single source (non-carrier) online enrollment.
22. Ability to provide full service COBRA Administrator
23. Provide support and advice in administering the District Wellness Program.
D. Proposal Response
Each respondent should set forth its most compelling case for being selected as Benefits Advisor based on the scope of services required. All proposals must be organized and tabbed to comply with the following sections:
1. Transmittal Letter (2 pages Maximum)
The letter of transmittal should include: a) an introduction of the firm, including name, address, telephone number and email address of primary contact and others authorized to deal with this proposal response; b) A general statement of interest and what sets your firm apart from other potential respondents.
2. Executive Summary (2 pages Maximum)
The executive summary should briefly describe the firm’s philosophical approach to addressing benefit planning issues and its summarized approach to completing the scope of services outlined. Clearly indicate any options or alternatives being proposed and clearly disclose any major requirements included in the scope of services the firm cannot address.
3. Detailed Discussion (6 pages Maximum)
This section constitutes the major portion of the proposal and must contain at least the following information:
A) Provide a brief narrative of the firm. Describe the firm’s organization and list of the firm’s personnel capabilities, programs, computer resources, and other value-added resources available to the District.
B) Briefly summarize your firm’s experience and overall qualifications as a Benefits Advisor to school districts and other relevant government entities. Describe any relevant employee benefit innovations your firm has developed. Provide three (3) to five (5) references of existing benefit advisory clients.
C) Provide summary resumes and credentials for the professionals anticipated to be assigned to work with the District. (Professional resumes will not count toward six page maximum.)
D) Provide a statement regarding your Firm’s ability to provide the scope of services requested.
E) Clearly outline the firm’s vision and approach for accomplishing the tasks outlined in the scope of services.
F) Provide a sample of relevant reports available. (Not more than 5)
4. Protected / Proprietary Information
Protected information should be clearly identifiable and included in the Detailed Discussion section of the proposal. Do not incorporate protected information throughout the proposal. Rather, provide a reference in the proposal response directing readers to the specific area of this Protected Information Section.
5. Fee Proposal (1 page Maximum --- Separately Sealed)
A) The District is interested primarily in a Fee for Services arrangement under this agreement. All respondents must include a fee for services proposal.
B) Fee proposals should enumerate any costs the District can expect to be charged and specify the types of services that would generate the additional charges.
C) Assuming a fee for services proposal is accepted by the District, respondents must include a statement that the respondent agrees to relinquish the right to any compensation for services to the District outside of this agreement; that they agree to relinquish any overrides or other commissions associated with the District benefits program whether voluntary or otherwise offered by the District; and that they will advocate on behalf of the District to have any potential overrides and commissions credited back to the District whether in the form of reduced product premiums or other remuneration.
D) Respondents are welcome to submit alternative fee proposals for consideration.
E. Evaluation Criteria
The proposal will be analyzed and respondents may be requested to meet with a committee of District officials for an oral presentation. Proposals, however, may be accepted without oral presentation and the District reserves the right to accept or reject any proposal. It is also the right of the District to waive any formality or technicality if determined to be in the best interest of the school district.
Evaluation Rubric
Overall qualifications, experience and references 30%
Fee Proposal and Fee Schedule 30% Perception of Firms Ability to Accomplish Scope of Service 40%
Award shall be made to the respondent deemed most capable of accomplishing the Scope of Services required, taking into account the proposals and evaluation factors here outlined.
F. Term of Agreement:
The Contract resulting from this RFP shall be renewable annually for up to five (5) years.
Tentative date for formal approval by the Board is November 19, 2015.
Effective date of contract will be January 1, 2016
Annual renewal is contingent upon the District’s satisfaction with the services provided and overall performance of the firm.
G. Due Date
To qualify as a responsive proposal, five (5) hard copies of the proposals and one (1) electronic copy of the proposal must be received by Ken Crawford, Director of Purchasing, (1950 Monroe Blvd., Ogden, Utah 84401) not later than 2:00 PM Friday,, October 23, 2015.
H. Tentative Timeline (Subject to modification)
RFP Advertised: --- September 25, 2015
Deadline for Questions: October 16, 2015
RFP Response Deadline: --- October 23, 2015
Proposal Evaluation: --- October 26 thru November 12, 2015
Board Action: --- November 19, 2015
Contract effective date: --- January 1, 2016
I. Questions and Contact Info.
All questions should be directed to Ken Crawford and be received before 5:00PM, October 16, 2015. Questions must be submitted electronically via BidSync.com., reference RFP# 6-003.
Contact with any other district employee or school board member during the tentative timeline period will be grounds for disqualification.