REVISED 2/3/2017

ATTACHMENT 1

RFP 17-0011, Insurance, Group DentalWorksheet

WORKSHEET INSTRUCTIONS: Answer the questions in the following worksheet as completely as possible. Do not refer the reader to another section of your response, unless the question indicates that you may do so. You may expand the spacing in the worksheet to accommodate your responses.

IMPORTANT: In addition to printing this worksheet and including it in your proposal, you must return it in WORD format (not PDF) on two (2) CDs or USBs. Please include the CDs or USBs in the proposal you mark “original.”

Company Name:
Address:
RFP Contact Name: / Contact Phone:
Contact Email: / Contact Fax:
  1. Mandatory Minimum Qualifications
/ Yes / No
  1. Proposer providing the insurance must have been licensed in the state of Florida to provide dental insurance products for at least the last five (5) years.

  1. Proposer providing the insurance must have at least three (3) years of experience insuring and servicing groups with 1,500 lives and above.

  1. A minimum two (2) year rate guarantee is required.

  1. Minimum participation requirements shall be waived

  1. Proposer shall administer the plan’s benefit period (Deductibles and plan Maximum)on a plan year basis. (October 1 – September 30).

  1. Administrative Services

  1. List the number of covered lives your company currently insures under dental PPO plans.
/ Lake County / Florida
  1. List the number of covered lives your company currently insures under dental DHMO plans.
/ Lake County / Florida
  1. Indicate your company’s retention of clients for dental PPO plans for the last 3 years:
/ Lake / Florida
% / %
4 Indicate your company’s retention of clients for dental HMO plans for the last 3 years: / Lake / Florida
% / %
  1. Provide information regarding the personnel your company will assign to the County.

Function / Name / Location / Current Number of Clients
Dental Director
Account/Service Manager
Implementation Manager
Annual Enrollment Support
Question / Response
  1. Confirm your dental plan proposals are forvoluntaryDental plans are for beingsought bytheCounty for an effectivedateofOctober1, 2017. ThePlanYearis October1 through September30 eachyear.

  1. Confirm you will providean experienced servicemanager, with expert support and access, MondaythroughFriday, 8:00 am to 5:00 pm EST.

  1. Confirm you will provideImplementation Enrollment support in approximately fifteen (15)locations. This must be completed within atwo-week period. Presenters from thevendor(s)shall follow ascript of enrollment highlightsand benefit changes.

  1. Confirm you provideatoll freenumberfor covered individuals to access memberservices and/orclaims department.

  1. Confirm you will accept theself-billingpracticeoftheCounty, which includes remittanceand an employeelist ofdeductions followingeach payroll.

  1. Confirm you will accept paper enrollment forms duringannual enrollment via facsimileorpaper enrollment forms that havebeen scannedand emailed inthe format established andcurrentlyutilized bytheCounty. Anyeligibilitymapping and interfacecosts shall beincluded.

  1. Confirm you will provideonlineportal access to the County’s administrativeteam to allow enrollment ofnew hires, verifyor changeeligibility, requestIDcards, obtain standard reports, and anymakestatus changes.

  1. Confirm your proposal includes ID cards/ wallet cards, educational brochures, plandocuments, claim forms, certificates of coverageand other materials that clearly explain how to use the dental benefit to its maximum levels and participate in the annual enrollment process to explain the benefits of the program.

  1. Provide the location of customer service office and hours and days of operation.

  1. Current customer service telephonic performance.
  2. Average speed of answer
  3. Call abandonment rate
  4. Claim turnaround time
/ a.
b.
c.
  1. Confirm that no pre-existing condition limit will be applied to any current insured that has satisfied the pre-existing condition limit of the current carrier/administrator.

  1. Confirm that proposal shall include provisions for picking up previously disabled employees and dependents without regard to the “actively at work” requirement.

  1. Confirm that you will accept participants with dental work in progress (transition of care) including but not limited to general dentistry and orthodontia.

  1. Does your company utilize ID cards? If yes, do you utilize identification numbers other than SSN on ID cards?

  1. Will you print and mail ID cards (if applicable), Provider Directories, and Certificates of Coverage to each covered employee’s home?

  1. Will you provide electronic copies (PDF) of the Certificate of Coverages for inclusion on the County website?

  1. Confirm that you shall provide experience reports on a quarterly and annual basis that provide membership, premium and claims cost by service type. Include samples of the reporting package you will provide under Tab—F (Additional Information).

  1. Confirm that you will conduct quarterly satisfaction surveys among County members who have utilized the plan and share the results with the County?

  1. Will you review your Lake County Area Provider Satisfaction Survey results with the County on an annual basis?

  1. Confirm your ability to accept paper enrollment forms during annual enrollment via scanned email and/or via facsimile.

C.PLAN DESIGN

Provide a response to the following issues:

Questions / Response
  1. Do the proposed benefits meet or exceed the coverage limits in-force? Deviations/Enhancements must be noted in your proposal.

  1. Confirm your proposal does not include waiting periods for services under the plan for anyone eligible, regardless of whether they were covered previously.

  1. Describe your process for handling member work in progress during the transition to your Company including but not limited to general dentistry and orthodontia. Describe any differences if using an in-network or out-of-network dentist.

  1. Confirm youagreetomatchtheCounty’sdefinitionofEligibleParticipants andofEligibleDependents,includinglegally marriedspouseandchildrenupto the end oftheyearin which theyturn agetwenty-six(26).

  1. Review the following plan design and list any deviations from this design (enhancements or reductions) from this design including cost and Service Types. If deviations are not listed, it is assumed the current plan design is proposed by your company.

Current PPO / In-Network / Out-of-Network / Confirm or List
Deviations/Enhancements
Deductible (Single/Family) / $50/$150 / $50/$150
Deductible - Waived for Type I / Yes
Annual Maximum / $1,000
Waiting Periods / 12 month waiting period for Type III services. Credit for time served on preceding group dental plan applied.
Type I - Preventative Services
Oral Examination
Prophylaxis
Topical Fluoride
X rays
Sealants
Space Maintainers / 100% / 100%
Type II - Basic Services
Simple Restorative (amalgam, synthetic, or composite filings)
Emergency Palliative Treatment
Tooth Extraction
Endontics / 80% / 80%
Type III - Major Services
Major Restorative (crowns/inlays/onlays)
Periodontics
Bridge and Denture Repair
Prosthetics / 50% / 50%
Type IV - Orthodontics / None / None
Out of Network Reimbursement / Fee Schedule
Balance Billing / None for participating Providers.

Provide a response to the following issues:

Question / Response
  1. Confirm you have completed the tab entitled PPO on Attachment “2” – DHMO and PPO Dental Procedures Cost Comparison in full and have submitted a hard copy along with two (2) electronic copies in Excel format with your proposal.

  1. DHMO Plan: Confirm you have completed the tab entitled DHMO on Attachment 2 – DHMO and PPO Dental Procedure Cost Comparison in full and have submitted a hard copy along with two (2) electronic copies in Excel format with your proposal.

  1. Describe available discounts for the following procedures.

Procedure / DHMO / PPO
Teeth Whitening
Implants
Orthodontics
  1. Increased Annual Maximums: Does your plan have a feature that allows members to increase their annual maximum amount for the following year? If so, please describe in detail.

  1. Describe any value added benefit design features in your proposed plan.

  1. Include a complete copy of your plan design with your proposal.

9. Certificate of Coverage Deviations: Please list any deviations in coverage not previously listed when comparing your proposed coverage to the Comp Benefits/Humana certificates

Certificate of Coverage Deviations / Low Option DHMO / PPO
C.NETWORK

1. Indicate the number of specialist dentists in your network having offices in Lake and Sumter Counties. Only count a dentist with multiple offices once.

Specialist Dentists in Lake County / DHMO / PPO
Pediatric dentists
Endodontists
Oral Surgeons
Orthodontists
Prosthodontists
Issue / Response
2. Complete the network provider spreadsheet (Attachment 3). Place an “X” next to all providers currently in your DHMO and PPO network. If your network has additional providers not in the current carrier’s network, list those on the worksheet tab labeled “Additional Providers.” The completion of this network spreadsheet is mandatory.
  1. Confirm you will maintain anetwork ofpreferred dental providers for enrollees. Thenetwork must be comprehensivein Central Florida and provide adequate access to services. Changes in networks shall not beofsignificant disruption to the County’s members.

  1. Confirm you will implement and follow quality review procedures fordental providers. Review practicepatterns through claims and encounterdatato determinethequalityof services. Be prepared to take appropriate action in the event that a providerno longermeets establishedqualitystandards.

5. Indicate the availability of network providers on a statewide and national basis for your DHMO and PPO plan.
6. How will you provide members with in-network benefits in areas where no specialists are in-network?

D.COST AND PERFORMANCE GUARANTEES

DHMO / 10/1/2017 – 9/30/2019
(Initial term of contract-
2 plan years) / 10/1/2019 – 9/30/2021
(1st of 3 options to renew)
Employee Only
Employee + One
Employee + Family
PPO
Employee Only
Employee + One
Employee + Family
Question / Response
  1. Confirm premium rates are to be presented per the employee and retiree counts provided in Attachment 5 – Census of the RFP.

  1. Confirm and list optional services that will incur additional cost should be specified.

  1. Confirm rates proposed are guaranteed for at least two (2) years.

  1. Confirm proposals areto besubmitted net of commissions

  1. Please indicate the tolerable loss ratio assumed in the guaranteed premiums above and indicate the tolerable loss ratio to be used for renewals. Please indicate any variances by product.

  1. Disclose any underwriting assumptions and limitations that were used to establish your proposed rates per product

4.Indicate the Performance Standards and Financial Penalties your Company will include in your contract with the County.

Category / Target / Financial Penalties
Plan implementation / Plans loaded andtested; stafftrained; andIDcards issued andreceivedbeforeOctober1, 2017
Network Turnover / 5% or less annual turnover
Claim Processing Turnaround Time / minimum of 90% clean claims in 14 calendars days and100% all claims in 30 days
Claim Processing Accuracy / at least 95%ofthetotal numberof correct claims divided bythetotal claims processed
Accurate and Timely Reporting / Quarterlyand Annual reportingdue bythe15th ofthemonth and reports to beerror free.
Customer Average Speed of Answer / minimum of 85% calls answered in less than
20 seconds
Customer Call Abandonment Rate / 3%orless
Customer Return Call ResponseRate / minimum of95%in 48 hours
Customer WebInquiryResponseTime / minimum of95%in48 hours
Other (Please list)

As an officer of the company, I certify that the information contained in our proposal is accurate, and our company will be bound by the contents of our proposal.

______

Signature

______Date______

Printed Name/Title

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