Somewhere, Some State, Some Zip Code

SAMPLE RFP

123 Main St.

Somewhere, Some State, Some Zip Code

SAMPLE RFP

PROPOSAL FORMAT AND CONTENT

Proposals must be concise and in outline format. Pertinent supplemental information should be referenced and included as attachments. All Proposals must be organized and tabbed to allow for easy reference.

1. The Proposal shall include a Letter of Transmittal that provides an introduction to the Company and includes an expression of the Company’s ability and desire to meet the requirements of the RFP. The Letter of Transmittal should be under the signature of a Company officer.
2. The Proposal shall include an Executive Summary that briefly describes the Company’s approach to meeting the District’s requirements as outlined in the RFP, indicates any major requirements than cannot be met, and highlights the major features of the Proposal. The reader should be able to determine generally how well the Proposal meets the Company’s requirements by reading the Executive Summary.
3. The Proposal shall include a Summary of Compensation that describes the Company’s manner of compensation and discloses any and all fees and commissions, payable by either the Company or individual carriers.
4. The Company shall complete Attachment 1, “Bid Form Questionnaire.”
5. The Company shall complete Attachment 2, “Company Identification Form.”
6. The Company shall complete Attachment 3, “References and Experience,” thereby providing the Company a listing of all similar companies for which the company currently provides applicable services. The references should include at least one contract currently in force with a company similar in size and population.

Attachment 1: Vision Insurance Bid Form Questionnaire

Please complete the attached questionnaire.

Corporate Information

1. Please provide the name, telephone number (office and cell), email, and office location of the individual to be contacted with any questions.

1. Please provide the following about your organization: name; locations; assets; ratings by A.M. Best, Moody’s, and Standard and Poor’s (if appropriate); a brief history of your company; a description of business activities; and financial results for the last three years.

1. What major changes have occurred within your organization within the last year, three years and five years? Are there any anticipated changes expected in the next year? (Please include any pending joint ventures, planned divestitures, mergers, etc.)

1. Summarize legal action taken against your organization in the past three years, including number of suits, causes of action, outcomes and the amount of any monetary settlement or judgment.

1. Who is the underwriter of your vision plan?

1. Who is the administrator of your vision plan?

1. What year did you begin offering a Company Paid/Voluntary Group Vision Plan?

1. What is your total Company Paid/Voluntary Group Vision in-force annual premium volume?

1. What is your total number of Company Paid/Voluntary Group Vision accounts?

1. How many corporate group accounts do you currently have with approx. xxxx eligible employees? Please provide a sampling of these accounts.

1. How many employees are covered by your insured vision plans?

1. How many total members does your company cover? What percentage of your total membership is in full-service plans versus discount plans?

1. Do you have other similar companies in your portfolio of clients? If yes, how many?

1. What is your client persistency percentage? What is your member retention percentage?

1. Is your vision plan COBRA eligible?

1. What is your company’s vision care philosophy?

1. Why should the District select your organization as our vision plan provider?

1. What amount of general business and professional liability coverage do you currently have in force and which carrier do you use for these coverages?

1. Describe your different service models based on client size.

Financial

1. Are there any minimum participation requirements for insured business?

1. Please provide your underwriting methodology.

1. What current trend factors are you using to project claims in your vision care renewals?

1. How far in advance of the plan anniversary will you provide firm renewal rates?

1. Confirm that all future renewal rate adjustments will be communicated in writing at least 60 days in advance of the effective date.

1. Indicate how renewal rates would be determined after the initial guarantee period.

1. Please indicate the point at which a change in participation would affect premium rates.

Contract / Licensing

1. What are the Company’s responsibilities for the program?

1. Does your company have existing relationships with third party administrators/brokers? If yes, please explain.

1. What if any agreements must be signed by the Company? Please provide a sample.

1. In the event that the Company would wish to terminate the program, what is your cancellation policy? Written notice? How many days? Is there a cancellation charge?

1. Will you assign the Company a dedicated Account Manager? Where will this individual be located?

Marketing & Enrollment (Implementation)

1. Based on your experience with other groups similar in size, please provide a detailed plan and time line for implementing your vision insurance plan. Be sure to include your underwriting and approval process for enrolling employees and specifically state what tasks are required of the Company.

1. Please provide a sample of all forms and communications that are typically used in the administration of your program. Include samples of solicitation forms, communication material and internet/intranet communications.

1. Is there a charge for client customization of marketing materials such as wording changes or logos?

1. Who will be responsible for printing, mailing, and any other related marketing costs?

1. Vendor will provide a web address to the Company for employees to use the vendor’s online enrollment for the initial open enrollment. Vendor will provide FTP website or some other secure website to process on going enrollments, terms, changes. Preference will be given to those vendors with online enrollment options.

1. Do you provide a welcome packet? Is it distributed at the workplace by the employer or do you direct mail the packet to participant’s home address? Please attach a sample of your welcome packet. Does your welcome packet include a membership ID card?

1. Are you able to provide individual ID cards for each covered family member? Are these cards automatically included in the welcome packet or do employees have to request additional cards? Is there a charge for replacement ID cards?

1. Is an ID card required for service?

1. Will you offer ongoing assistance in promoting the program after implementation? What types of communication materials are available after the initial enrollment period? Are you willing to “train the trainers” with both written materials and educational meetings? Are you willing to participate in employee group meetings and onsite benefit fairs? If yes, please describe the level of support that you can provide.

1. Please describe how your implementation processes ensures efficiency and quality

1. Describe how you would assist an employer group conduct enrollment meetings.

1. What results are measured to evaluate your implementation performance?

Internet Access

1. Are you willing to set up a website or special link on our Intranet?

1. Please explain what is available on your website to plan members. Plan Details? Doctor Network with Locator? Medical Information? Out of Network Claim Form?

1. Please provide a guest ID and password for the Company to review your website capabilities.

1. Do you have an administrative website available for clients and/or the District? If yes, please describe capabilities. Reporting? Eligibility? Billing? Payments?

Payroll & Information Technology

1. When are billing invoices issued and when is associated payment due?

1. What is your standard grace period?

1. Do you utilize direct billing and/or EFT for premium collection from the Company? Is there a fee for this service?

1. Do you have e-billing capability?

1. Describe your record keeping and account reconciliation capabilities.

1. Where is your system and system support for the Company located?

1. Where is your backup (secondary) processing center?

1. How do you ensure client confidentiality consistent with current HIPPA requirements?

1. Describe in detail your back-up and disaster recovery system which assures against loss of data. Have you ever tested or actually implemented these plans?

1. Describe your general confidentiality and security procedures.

1. Describe your procedures and controls around systems security and user identification.

Customer Service / Call Center

1. Where are the call centers located for sales, service and claims that will service the Company’s employees?

1. Describe your customer service department. Include hours of operation in CST, number of Customer Service Representatives (CSRs) average length of experience, training and average number of members for which each CSR is responsible.

1. Are the CSRs dedicated to Vision Insurance?

1. Do you have a 24-hour IVR for members? For providers?

1. Do member reach a live representative or an interactive voice response unit when calling member services?

1. Is an automatic call distributor used to queue and route incoming calls?

1. What customer service performance indicators do you use to assess your service? How often are they used? Against what benchmarks is this done? Please provide a sample of your performance standards for customer service during the last 12 months.

1. Is a toll free number available for customer service and claims? Toll free fax?

1. Does the member services area use a dedicated on-line call-tracking and documentation system to log inquiries by type and ensure the timeliness of follow-up activities? Please describe.

1. Do member services representatives have access to claims status on-line?

1. When claimants call with claim questions, does a claims processor or a special service unit handle the request?

1. Can the person who receives the call take corrective action during the call?

1. What are the performance standard for abandonment rate and average speed to answer calls?

1. What information is available to both the client and covered members via your web site?

Claims (Eligibility)

1. Is the claims department separate from Customer Service? If yes, please describe the claims department. Include hours of operation, number of staff, average length of experience, training and average number of members each staff member serves.

1. Does the provider confirm eligibility prior to service? If yes, what methods does the provider use to do so? (Call-center, online, 24-hour IVR?)

1. Please explain the procedures for processing a claim.

1. Are you planning to make any system changes in the next year?

1. What reports are available to clients?

1. Provide a list of standard reporting package.

1. Are members able to access claim payment information online?

1. Does your system check for duplicate charges based on provider, procedures, amount of charge and date of service?

1. Describe your system of edits for identification of fraudulent claims.

1. Describe process/frequency for eligibility files.

1. What percentage of claims is automatically adjudicated?

1. What percentage of claims is typically from in-network providers?

1. Can a client have on-line access to your eligibility and claims systems? Please describe.

1. What is your average claim turnaround time in days (receive date to check date) for claims submitted by providers? Claims submitted by members?

1. Describe your internal quality assurance processes for claims administration.

1. Does you claims system have the following capabilities (Yes/No):

a)Access provider specific data, including contractual and financial agreements.

b)Employee and dependent information, including individual provider.

c)To maintain historical eligibility information and a positive record of the subscribers eligibility status?

d)Provide a claim file to a third party FSA administrator.

1. What is your financial accuracy?

1. What percent of claim forms are submitted by vision providers? By members?

1. Under what circumstances would a member be required to submit a claim form?

1. Confirm your company will work with a third-party administrator for managing electronic eligibility files.

1. Can you accept eligibility information electronically and/or by magnetic tape?

1. Pleas indicate if your standard reports include the following items and if so, at what frequency?

a)Funds summary

b)Claim detail

c)Premium, claim & enrollment data by the plan, by month

d)Utilization by plan

e)In-Network provider utilization vs. out-of-network

Customer Satisfaction Surveys

1. What is your performance standard for participant satisfaction survey results?

1. Does your company participate in the JD Powers Vision Study? If yes, what were your results in the most recent survey?

Management Reports for Our Client

1. Describe your Client reporting capabilities in detail. Provide examples of all of your standard reports.

1. Can you provide a monthly loss run? List information that would be included in this report.

1. Are you able to customize reports if the Company’s requests?

Vision Providers

1. What is your membership criteria for providers?

1. Do you require Optometrist providers to be DPA certified? TPA certified?

1. Please describe your provider credentialing and re-credentialing process.

1. What is your provider retention rate and/or network turnover?

1. What % of your providers have on-site dispensing capability?

1. Are salespeople/providers operating on a commission basis as they interact with employees? If yes, please detail how the employees purchasing decisions affects the salesperson’s commission.

1. What is the total number of STATE provider locations in the vision network you are proposing? Include specific information for CITY and surrounding counties. Do you have any providers that are available nationally?

1. Does your network have a mail order component for contact lenses?

1. How do you select providers for participation in your network? Please be as specific as possible.

1. What is the typical duration of provider contracts?

1. Are there specific plans to expand the network to locations you are currently unable to cover? If yes, where and when?

1. Please complete the table below regarding your doctor network for CITY, STATE and the surrounding area:

Network Counts / Number
All points of access (all doctors at all offices)
All doctors, counted once
All offices, counted once
All Optometrists, counted once
All Ophthalmologists, counted once

1. What level of innetwork utilization do you project for your vision plan?

1. Can an employee request that a doctor be added to your network, and what is the timeframe? How is an employee notified of the outcome?

1. Describe your relationship with optical laboratories. Which laboratories do you own? Which laboratories do you contract with?

1. Are plan members required to utilize specific optical laboratories? If yes, please detail.

1. Are independent/private practitioners required to utilize specific optical laboratories? If yes, please describe.

1. Do you contract with regional and/or national chain optical stores? If so, how do you guarantee there will be no disruption in service if one or more chains close or no longer accept your vision insurance plan?

1. Please list major chain stores included in your network.

1. What are the quality standards for eyewear and optical laboratories?

1. What processes/procedures do you have in place to communicate and service doctors?

1. Using GeoAccess reporting (based on driving distance), identify the percentage/number of employees that have access to two (2) providers within a ten (10) mile radius. Please attach the complete Geo report for employees with and without desired access.

1. Are members required to follow a pre-authorization process? Please describe the procedure employees and dependents must follow to access your network.

1. Can a member receive an exam from one provider and materials (frames, lens or contacts) from another provider?

1. At what frequency, and under what conditions, can an employee change providers?

1. Do you have a policy of quality audits of provider offices?

1. How frequently do audits occur?

1. What office or practice criteria are measured?

1. What is the standard required amount of malpractice coverage (individual and aggregate)?

1. Are members required to follow a pre-authorization process? If so, please describe.

1. What is your ongoing quality assurance and quality improvement process?

1. What information about network providers will you provide a caller upon request?

1. Explain the grievance and resolution process.

Vision Plan Design

1. Please describe the coverage available under your proposed plan. Include any exclusions to that coverage.

1. What types of frames are available under your plan? Are members limited to a certain selection?

1. What services do you include in a comprehensive eye exam?

1. Please describe your pricing formula for frames and indicate how many frames are fully covered under your plan.

1. Do you guarantee a certain stock of frames available at the allowance proposed? If yes, what is your guarantee and how do you enforce it?

1. What is the frame discount available if a member exceeds the frame allowance?

1. What type of coverage do you offer for contact lenses? How many boxes are covered? Is the contacts allowance only applicable to materials?

1. Do you offer a material discount over the contact lens allowance?

1. How does your plan cover the contact lens fit and follow-up?

1. What type of coverage do you provide for eyeglass lenses?

1. Do you cover replacements for damaged/lost glasses or contacts?

1. Do you provide discounted mail order contacts? How does your discount % compare to sites available to the general public?

1. Do you cover prescription sunglasses?

1. Please describe the discounts that are available through your program. For example, do you discount an additional set of glasses, non-prescription sunglasses, lens options, frame upgrades, Lasik, etc.?

1. Other than the discounts listed above, are there any other value-added services associated with your program? If yes, please list and describe in detail.

1. If the specifications included in this proposal do not permit you to fully explain your product or capabilities please provide additional information that will allow the Company to make an informed carrier decision.

Pricing