WCPS RFP No. 2017-18 (Addendum 1)

Group Dental and Vision Insurance

Item / Agree / Reject / Agree, with the following exceptions
1. Confirm you have provided references of three current and three former clients and have completed the required Reference Proposal Form.
2. You will waive the actively-at-work clause and cover current and future disabled plan members, and COBRA beneficiaries as actives until they are no longer eligible for coverage.
3. You are willing to coordinate with outside vendors (e.g. COBRA and FSA administrators). The additional cost, if any, for coordination with other vendors is specifically identified in your financial response.
4. Bidders must be rated A, A+ or A++ by A.M. Best or an equivalent rating bureau.
5. A dedicated account management team will support the WCPS’s benefit staff.
6. You agree to provide assistance during the implementation process (including but not limited to informed support at employee meetings), then be available for quarterly, face-to-face meetings with the WCPS benefit staff to discuss outstanding issues.
7. You agree to the proposed performance guarantees provided in the RFP.
8. You will accept electronic reporting of eligibility.
9. You agree to provide a website portal for which WCPS could input/enter eligibility information (during open enrollment and/or changes throughout the plan year), in lieu of faxing or mailing original forms.
10. You agree to notify WCPS of contract termination no later than 120 days prior to the renewal date. WCPS will notify the administrator of contract termination no later than 60 days prior to the date of termination.
11. You are able to administer the current plan designs.
12. WCPS reserves the right to accept or reject any subcontractor the vendor may include in their proposal.
13. Each entity submitting a proposal, waives any right of confidentiality as to the proposal documents. If an entity submitting a proposal considers certain material in the proposal proprietary information, it shall clearly designate those portions of the proposal it wishes to remain confidential. As a public entity, WCPS is subject to making records available for public view.
14. Paid claims reports will be provided within 30 business days of the end of the reportingperiod. Utilization reports as agreed to by WCPS on a quarterly basis.

By signing the Signature and Addenda Acknowledgment, the Representative of the firm does hereby attest that he/she has read fully the terms and conditions of the RFP documents and does understand them.

SECTION VI – TECHNICAL QUESTIONNAIRE

Overview/Background

  1. Identify any recent or anticipated changes in ownership, including but not limited to, acquisitions, mergers, acquisition of new venture capital, etc. Describe the potential impact if any of these events have occurred within the last year or are planned within the upcoming year.
  1. Please provide a brief summary of your firm’s plan administration capabilities. Include experience working with employers similar to WCPS, number of years in business and any special areas of expertise.
  1. Provide the following information regarding your current book of business.

Product / # of Employers/ Plan Sponsors / # of Plan Members / # of years Plan has been offered / Funding Options (ASO, Insured or both) / Estimated # of in-network providers in MD / Estimated # of in-network providers in PA/VA/WV
PPO Dental
Vision
  1. If any subcontractors will be utilized for any of the services you intend to provide to the County, please furnish the following information:

a) Name of each contractor and length of time you have utilized them.

b) Describe the services or products the Contractor will provide and the number of years in operation.

c) Describe the terms of your arrangement with each subcontractor listed above, including duration of contract, quality controls, liability insurance, and termination provisions.

d) Confirm that you are accountable for the performance of all subcontractors.

e) Do you have any plans for future subcontractors? If so, please detail.

f) How are any subcontractors paid?

  1. List all past, current or pending legal and regulatory actions brought against your company (and the company’s parent firm, if applicable) by any financial institution, government agency, or private organization in the past five years.

Implementation

  1. Confirm you have included a detailed implementation work plan that illustrates all key activities, due dates, and responsible parties in your proposal. Assume award of the contract by March 7, 2017 for a plan effective date of July 1, 2017.
  1. What specific data do you need from the incumbent administrator/carrier for an effective implementation?
  1. What is your deadline for receiving eligibility in order to issue and deliver accurate ID cards prior to July 1, 2017?
  1. Are you able to administer the current plans as described in the summary of benefits? If no, indicate deviations or conditions on Proposal Form T2.
  1. Describe the process for employees that have treatment in process as of July 1, 2017 or have recently received pre-approval for services when the new vendor takes over the contract?
  1. How do you communicate plan or administrative changes to members? Please confirm that all communication to employees of WCPS will be provided to the employer and not released without prior employer approval.
  1. Will any services performed to support the WCPS plan be provided offshore? If yes, please describe.
  1. Regarding WCPS data, describe how your company uses this data. Is any WCPS data shared with outside entities? If so, who? Do you receive fees from anyone for use of this data? If so, from whom are these fees received?

Compliance/Security

  1. Describe how you would maintain confidentiality and demonstrate compliance with HIPAA Security, Privacy and Electronic Data Exchange requirements.
  1. What procedures/systems do you have in place in the event of a data breach?
  1. Is the data your plan receives, transmits, and stores encrypted in transit and at rest?

Account Management

  1. Identify all the Account Management and Service team members that will be assigned to WCPS. Include name, address, phone, title and role, as well as line of business if necessary.
  • Name:
  • Title:
  • Address:
  • Phone:
  • Email:
  • Primary Role:
  • Manager’s Name:
  • Manager’s Title:
  1. Over the last two years, what has been the incidence of account management turnover for the unit/department which will service WCPS?
  1. Describe your problem resolution procedures. Who is responsible for handling escalated issues? What is the frequency of communication to WCPS during escalation?
  1. What level of support do you provide clients regarding changes in Federal and State legislative events that require communication to their benefit plan participants? Please provide samples of Notices you have developed to assist clients with changes in benefit plan administration requirements.
  1. Will you survey WCPS benefits staff on their satisfaction with your organization and the account team? If yes, please provide a sample report.

Reporting/Systems

  1. Describe your standard reporting package and include samples. How often are these reports provided?
  1. Describe any additional reports that are available and identify any associated cost in your Price Proposal.
  1. Can WCPS access all reports electronically?
  1. Which of the following services are currently available through your website?

Member Services Can members:

  • Access provider information
  • Access Provider Directories
  • Access Provider Directories with Driving Directions
  • Participate in community forums
  • Access benefit summaries
  • Enroll online
  • Check eligibility
  • Order replacement ID cards
  • File a claim
  • Obtain costs for vision or dental procedures for specific providers
  • Download printable versions of claims forms
  • Look up claim status in real time
  • Submit appeals
  • Submit inquiries to customer service via email
  • Access educational material

Provider Support Can providers:

  • Verify in “real time” the eligibility status of members
  • Submit claims
  • Access member benefit summaries
  • Request pre-determination of benefits

WCPS StaffCan WCPS staff:

  • Add/delete/edit eligibility in real time
  • Obtain reports specific to their members
  • Submit retroactive termination requests-state limits
  • Correspond with account management and customer service for problem resolution
  1. Identify your employee and employer website location(s). Can you provide demo access to your website for authorized representatives of WCPS or Bolton Partners during the bid evaluation phase?
  1. Can WCPS provide a link from their website to yours through a secure single sign-on?
  1. Describe your Disaster Recovery Plan for data backup. Has the disaster recovery plan been tested? If so, when was your disaster recovery plan last tested? What is the normal frequency of your testing?

Eligibility

  1. Can you accept full-file eligibility transfers or do you require “changes-only” files for eligibility maintenance?
  1. Identify the average number of business days required to update your eligibility system following receipt of a “clean” data file from WCPS. How quickly is eligibility information available in the system once you receive it?
  1. Describe assistance that can be provided to WCPS to develop an eligibility file.

Customer Service/Member Satisfaction

  1. Where is the location of your customer service operation that will be used for WCPS members?
  1. Is your customer service operation combined with the claims unit or handled separately?
  1. Do Customer Service Representatives (CSRs) have the ability to answer claims questions as well as benefits and eligibility questions?
  1. Are CSRs authorized to make real time claim payment adjustments? If so, what is the criteria/limitation of adjustments they can perform?
  1. How many full-time CSRs are employed at the location that will be used for WCPS members?
  1. What are the hours available to speak with a “live” representative? Is there a toll-free number to your claim office?
  1. Will a designated customer service team be assigned to WCPS? If yes, how many individuals will be assigned to the designated team?
  1. Provide the following member services statistics for the most recent four quarters:

Quarter / Avg. Telephone Answer Time / Abandonment Rate / Average Waiting Time / Average Call Time
Quarter 3 2015
Quarter 4 2015
Quarter 1 2016
Quarter 2 2016
  1. What has been the ratio of client service representatives to members over the past three years?
  1. Can you provide a designated toll-free Customer Service number prior to the Plan Effective Date to answer questions from potential members?
  1. Do you currently perform membership satisfaction surveys? If yes, what percent of members indicated that they were “satisfied or very satisfied” with the overall program? Provide a copy of the latest results of the survey.
  1. Do you use any third party organizations to objectively measure the quality of your call center? If yes, what was the latest result?

Claims Administration

  1. Where will your organization process dental claims for WCPS? Where will you process vision claims?
  1. Describe the organization, methods and procedures that would be used by your claims office(s) to respond to routine claim inquiries from plan members.
  1. Describe the claim payment expected performance and actual recent results (for 2015 and 2016YTD), for the claim office(s) which will administer your plan(s).

Metric / 2015 Dental / 2015 Vision / 2016 YTD
Dental / 2016 YTD
Vision
Payment Accuracy
Coding Accuracy
Financial Accuracy
Claim Turnaround Time
- Clean claim
- Claim requiring add’l info
  1. Approximately what percentage of such claim inquiries can you completely resolve at first contact? Within 48 hours after first contact?
  1. How often are benefit payments and Explanation of Benefit statements produced and released to members and providers?
  1. Describe any cost/utilization management programsyou offer that differentiate you from other dental or vision plans.
  1. Can you provide claims data to integrate with WCPS medical plan data for Disease Management programs?

Administrative Services

  1. Provide a list of services provided under a self-insured arrangement.
  1. Provide a specific list identifying services that would not be provided as part of a self-insured quote.

Dental Provider Networks - Complete if you are quoting on the Dental Plan. If quoting Vision only respond N/A

  1. List the different dental networks you offer and indicate what network(s) your offer assumes. You must complete the Proposal Forms for each Dental Network included in your offer.
  1. Do you own the Dental Networks you are proposing? If not, please provide detailed information about any entity that you sub-contract with for network services, including:
    a) Length of time you have worked with them

b) Geographic areas with leased networks

c) Length of your contractual agreement

d) Quality Assurance programs in place with network vendor

e) Confirmation you will take full responsibility for the quality of your network vendor providers and performance

  1. Provide references of three (3) current major provider practices in Washington County that have participated in your network for more than five (5) years.
  • Practice Name:
  • Contact Name:
  • Contact Phone:
  • Contact Email:
  • Original Contract Date:
  • Covered Members:
  1. Provide references of three (3) former major provider practices in Washington County who have terminated their contract within the past two (2) years.
  • Practice Name:
  • Contact Name:
  • Contact Phone:
  • Contact Email:
  • Original Contract Date:
  • Covered Members:
  1. Indicate any significant changes you anticipate between the submission of this proposal and July 1, 2017 (e.g., provider contracting efforts, provider termination, network reductions, etc.)
  1. How do you manage your network and evaluate provider performance? How do you deal with providers who are not meeting these standards?
  1. What was your network provider turnover rate in 2015? 2016 YTD?
  1. Will you accept nominations for individual providers to be added to your network? If so, please describe how this process works.
  1. What member-to-provider ratios currently exist in your dental network that would service WCPS plan members?
  1. What percentage of participating dentists have limited their practice to current enrollment? Please differentiate for each plan you are quoting.
  1. Describe your criteria and process for network provider selection.
  1. How do you determine network fees for dental claims? How often do you update your fee schedule?
  1. How do you determine fees for Out-of-Network Claims? Indicate what data base you use to determine eligible charges, and percent payable. Confirm this is what your proposal assumes.
  1. How often do you update your OON schedules?
  1. Verify that you have a “hold harmless” agreement that prohibits providers from billing more than the plan’s designated coinsurance or copayment.
  1. Do you employ licensed dentists to review complex claims? If so, how many full-time dental consultants do you have on staff?
  1. Provide your minimum requirements for malpractice and liability insurance.
  1. Provide the percentage of providers rejected out of total applicants for the past three years.
  1. Provide the proportion of providers in the community that were selected to participate in the networks that you propose to use for WCPS employer groups.
  1. Do you have a process for excluding or penalizing providers who do not meet performance standards?
  1. For what percent of your covered members who receive services do you collect client-specific medical condition data?
  1. If you collect medical condition data, on behalf of how many clients are you currently sharing the data with their health plans or data aggregators?
  1. If applicable, how has your sharing of medical condition data contributed to positive outcomes or cost savings?
  1. Do you retain any portion of network savings? Are any services capitated or fixed and billed through the bank account. If yes, describe.

Vision Provider Networks - Complete if you are quoting on the Vision Plan. If quoting Dental only respond N/A

  1. Do you have a process for excluding or penalizing providers who do not meet performance standards?
  1. How many OD/MD office locations do you have nationally, in Maryland and in Washington County(count each office only once, no matter how many ODs/MDs are in that office)? Exclude optician locations.
  1. How many ODs do you have in Maryland and in Washington County (count each only once) and how many MDs (counting each only once)?
  1. Do all of your provider locations offer both eye exams and dispense eyewear at the same location? If no, how many of your locations offer only exam OR dispensing (not both at the same location)?
  1. Is your doctor credentialing program certified by NCQA? If so, please provide a copy of the credentialing certificate.
  1. Do you own the Vision Network you are proposing? If not, please provide detailed information about any entity that you sub-contract with for network services, including:

a) Length of time you have worked with them

b) Geographic areas with leased networks

c) Length of your contractual agreement

d) Quality Assurance programs in place with network vendor

e) Confirmation you will take full responsibility for the quality of your network vendor providers and performance

  1. Provide references of three (3) current major provider practices in Washington County that have participated in your network for more than five (5) years.
  • Practice Name:
  • Contact Name:
  • Contact Phone:
  • Contact Email:
  • Original Contract Date:
  • Covered Members:
  1. Provide references of three (3) former major provider practices in Washington County who have terminated their contract within the past two (2) years.
  • Practice Name:
  • Contact Name:
  • Contact Phone:
  • Contact Email:
  • Original Contract Date:
  • Covered Members:
  1. Describe your optical lab model. Are providers required to use company-owned optical labs? Explain.
  1. Please confirm by checking the boxes below to indicate which of these components are included atno additional charge in the standard comprehensive eye exam given by your network doctors:

☐Case history