00188_TUHSD_FSA_HSA_COBRA_RFP_Financial_Workbook_2026(6007494.1).xlsx

XLSX spreadsheet 67 KB Posted Oct 14, 2026

Attached to: Employee Benefits- Life/STD/FSA/HSA/COBRA
Solicitation number: 27-011CH-32RFP
Issued by: Maricopa County, Tucson City, Arizona

About this file

Written by GovTribe AI · Oct 29, 2026

This is a financial workbook supporting an Employee Benefits request for proposal issued by Tempe Union High School District in Arizona. The RFP seeks proposals for Life Insurance, Short-Term Disability (STD), Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), and COBRA administration services. Proposals must be submitted through the Procurement Portal at https://procurement.opengov.com/portal/tuhsd no later than 2:00 pm on Thursday, November 19, 2026. The workbook provides financial data and cost analysis frameworks to support bidders in developing their proposals and pricing structures for the requested employee benefits programs.

The financial workbook contains detailed pricing terms, benefit structure information, and cost modeling data relevant to the district's employee population and benefit needs. Bidders are expected to use this workbook to calculate and present their proposed costs for administering the various benefit programs. The document serves as a standardized tool to ensure consistent pricing submissions and comparable proposals for the evaluation committee's review. No specific set-asides, incumbency information, or contract term details are evident from the workbook itself, though these elements would typically be addressed in the accompanying RFP documentation.

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Other files

File	Type	Posted
Employee_Benefits-_Life_STD_FSA_HSA_COBRA_(Addendum_#1_Revision).pdf	PDF	Oct 29, 2026
Employee_Benefits-_Life_STD_FSA_HSA_COBRA.pdf	PDF	Oct 20, 2026
B6__Flex_Document(6009515.1).pdf	PDF	Oct 14, 2026
Attachment_B5__FSA_Utilization(6008907.1).docx	DOCX document	Oct 14, 2026
B4__STD_Experience(6009514.1).xlsx	XLSX spreadsheet	Oct 14, 2026
B3__STD_Booklet(6009513.1).pdf	PDF	Oct 14, 2026
B2__Life_Experience(6009512.1).xlsx	XLSX spreadsheet	Oct 14, 2026
B1__Life_Certificate(6009511.1).pdf	PDF	Oct 14, 2026
2026_Life-STD-FSA-COBRA_RFP.xlsx	XLSX spreadsheet	Oct 14, 2026
00188_TUHSD_Life,_AD&D,_and_Disability_RFP_Financial_Workbook_2026(6007601.1).xlsx	XLSX spreadsheet	Oct 14, 2026
RFP,_TUHSD_00188,_Life,_STD,_COBRA,_FSA,_HSA_RFP_Background_and_SOW_2027(6007309.2).pdf	PDF	Oct 14, 2026

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Instructions

FSA/HRA/HSA/COBRA/RETIREE BILLING RFP — Financial Workbook

Instructions

Exhibit Instructions to Vendors

1. Do not delete or alter pre-labeled rows.

2. Electronic copies of these exhibits must be returned in Excel. Do not provide in a PDF format.

3. Do not extract individual worksheets (exhibits) and submit as separate Excel workbooks in the electronic copy.

4. Cells shaded light orange are expected inputs. Please review these carefully for a response.

You may additionally include your normal underwriting pricing worksheets and caveats. However, we will use your responses on the required exhibits and questionnaire as your proposal response when they differ from any supplemental underwriting materials you provide.

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

General Information

FSA/HSA/COBRA RFP — Financial Workbook

General Information

Instructions to HBA

1. Prepare template and make sure it is peer reviewed before sending externally.

2. Check to make sure client information, policy year, and items in purple font are updated and correct before sending to carriers.

3. Do not extract individual worksheets (exhibits) and submit as separate Excel workbooks in the electronic copy.

4. Documentation required for emails sent externally to carriers. Need to save e-mail and template workbook to iManage.

Plan Information	Client Information
Client and Project Name	Tempe Union High School District - RFP 27-011CH-32
Policy Year	July 1, 2027–June 30, 2028
Policy Effective Date	July 1, 2027
Number of Eligibles	1000
Number of Employees/Participants	800
Peer Review Role	Name	Date
Doer	Khin Han	9/24/26
Checker
Reviewer

	Plan Year	Effective Date	Policy End Date
Year 1	07/1/2027 - 06/30/2028	7/1/27	6/30/28
Year 2	07/1/2028 - 06/30/2029	7/1/28	6/30/29
Year 3	07/1/2029 - 06/30/2030	7/1/29	6/30/30
Year 4	07/1/2030 - 06/30/2031	7/1/30	6/30/31
Year 5	07/1/2031 - 06/30/2032	7/1/31	6/30/32

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

1|FSA Admin Fee

Tempe Union High School District - RFP 27-011CH-32

FSA Administration Services Fees

Effective July 1, 2027

Offeror Name

Authorized Name

Authorized Signature

Date

Contact Email and Phone Number

If bidding, this form must be completed in its entirety. Please do not alter, add or delete rows. Failure to complete this exhibit as requested may results in rejection of your offer.

Multi-year rate guarantees, including rate caps, will be given a higher weight in scoring.

Health FSA Enrollment Assumptions: 244

Dependent Care Enrollment Assumptions: 18

Participants in both FSA and DCAP: 14

FSA Administration Services	Requested	07/1/2027 - 06/30/2028	07/1/2028 - 06/30/2029	07/1/2029 - 06/30/2030	07/1/2030 - 06/30/2031	07/1/2031 - 06/30/2032
Set-Up Fees
First-Year Fees	None	$ - 0
System Interface	None	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Renewal Fees	None		$ - 0	$ - 0	$ - 0	$ - 0
Monthly Fees
Health FSA Administration Fees (PPPM)		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Limited Purpose FSA Administration Fees (PPPM)		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Dependent Care Administration Fees (PPPM)		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Monthly Debit Card Fee	None	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total Monthly Fee		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
If both FSA and HSA are awarded, is there a discount to the FSA fee? If yes, what is the fee (PPPM)?		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Adjusted Total Monthly Fee (after multi-product discount)		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Minimum Monthly Fee		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Other Fees
Claims Processing/Payment	Included
Electronic Enrollment File	Included
Direct Deposit	Included
Employer Web Services - Enrollment	Included
Employer Web Services - Payment Lookup	Included
Hard Copy Enrollment/Communications Materials	Included
Attendance at Enrollment Meetings	Included
Creation of a Flex Plan Document/SPD	Included
Amendments to the Flex Plan Document/SPD	Included
Nondiscrimination Testing
Health FSA: Eligibility Test	Included
Health FSA: Benefits Test	Included
DCAP: Eligibility Test	Included
DCAP: Contributions and Benefits Test	Included
DCAP: +5% Owners Concentration Test	Included
DCAP: 55% Average Benefits Test	Included
Postage Costs	Included
Debit Card Mailing Costs	Included
Employee Statement Mailings
a. Confirmation of Enrollment	Included
b. Year End Statement of Account Balance	Included
c. Quarterly Statement of Account Balance	Included
d. Communication Materials	Included
Other
Other

Comments:

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

2|HSA Admin Fee

Tempe Union High School District - RFP 27-011CH-32

HSA Administration Services Fees

Effective July 1, 2027

Offeror Name

Authorized Name

Authorized Signature

Date

Contact Email and Phone Number

If bidding, this form must be completed in its entirety. Please do not alter, add or delete rows. Failure to complete this exhibit as requested may results in rejection of your offer.

Multi-year rate guarantees, including rate caps, will be given a higher weight in scoring.

HSA Administration Services	07/1/2027 - 06/30/2028	07/1/2028 - 06/30/2029	07/1/2029 - 06/30/2030	07/1/2030 - 06/30/2031	07/1/2031 - 06/30/2032
Set-Up Fees
First-Year Fees	$ - 0
Renewal Fees		$ - 0	$ - 0	$ - 0	$ - 0
System Interface	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total Base Set-Up Fees	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Monthly Fees
HSA Administration Fee (PPPM)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Other Monthly Fees	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total Monthly Fees	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
If both FSA and HSA are awarded, is there a discount to the HSA fee? If yes, what is the fee (PPPM)?	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Adjusted Total Monthly Fee (after multi-product discount)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Other Fees
Account Closure Fee	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Other Fees (Specify)	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

Comments:

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

3|COBRA Admin Fee

Tempe Union High School District - RFP 27-011CH-32

COBRA Administration Services Fees

Effective July 1, 2027

Offeror Name

Authorized Name

Authorized Signature

Date

Contact Email and Phone Number

If bidding, this form must be completed in its entirety. Please do not alter, add or delete rows. Failure to complete this exhibit as requested may results in rejection of your offer.

Multi-year rate guarantees, including rate caps, will be given a higher weight in scoring.

Annual Number of New Hires Assumption: 133
Annual Number of Qualifying Events Assumption: 38
COBRA Administration Services	Requested	07/1/2027 - 06/30/2028	07/1/2028 - 06/30/2029	07/1/2029 - 06/30/2030	07/1/2030 - 06/30/2031	07/1/2031 - 06/30/2032
Set-Up Fees
First-Year Fees	None	$ - 0
Renewal Fees	None		$ - 0	$ - 0	$ - 0	$ - 0
System Interface	None	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Periodic Fees
Qualifying Event Notice		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Initial COBRA Notice		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Open Enrollment Notices		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Collect Monthly Premiums	Included	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Premium Remittance to Carriers	Included	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Billing Statements	Included	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Monthly Reporting to Client	Included	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Other Fees (Specify)		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Will you retain the 2% administration charge?	Yes
Comments:

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

4|Credits and Allowances

Tempe Union High School District - RFP 27-011CH-32

Credits and Allowances

Effective July 1, 2027

Offeror Name
Authorized Name
Authorized Signature
Date
Contact Email and Phone Number
Provide the amount of proposed credits and allowances in the indicated area.
Confirm that at the Client's discretion, the credits and allowances may be maintained as a single fund to encompass the initiatives which include but are not limited to the following:
Credits and Allowances	Vendor Response
Implementation Allowance
Procurement Allowance
Implementation Audit Allowance
Ongoing Audit Allowance
Compliance Check Allowance
Training Allowance
Communication Allowance
Other Fees (Specify)

Comments:

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

5|Performance Guarantees Tempe Union High School District - RFP 27-011CH-32

Performance Guarantees

Effective July 1, 2027

Authorized Signature

Authorized Name

Offeror Name

Date

Contact Email and Phone Number

For the following categories, provide the performance standard you are willing to offer, the financial penalty (maximum dollar amount or % of administrative fees) you will agree to pay if the standard is not met.

		Performance Guarantee	Frequency	Agree to comply with Performance Guarantee?
(Y \| N)	Dollars at Risk (% or $)
		1. Contractor attendance at Client meetings	Quarterly
		Attendance by Contractor representatives when requested at meetings scheduled by the Client during the contract period and implementation phase.
		2. Contractor call (or e-mail) return timeliness	Quarterly
		The Client or designated consultant’s calls (or e-mails) to Contractor are returned within 24 business hours.
		3. Processing monthly eligibility updates	Monthly
		All updates to eligibility or enrollment records will be made within three business days after the information is received by the Contractor.
		4. Telephone call availability & answering speed	Monthly
		90% of all calls are answered within 30 seconds (based on Client specific results).
		5. Telephone call on-hold (in-queue) time	Monthly
		An average of less than 2 minute(s) on hold before a human being answers.
		6. Telephone Abandonment Rate	Monthly
		An abandonment rate of less than 3% is maintained during standard business hours (based on Client specific results).
		7. Claims Processing Accuracy	Quarterly
		Process 98% of clean claims within an average of twelve (12) calendar days. This standard will be measured quarterly .
		8. Claims Processing Turnaround Time	Quarterly
		At least 99% of claims dollars submitted for payment will be accurately processed and paid. Financial accuracy will be based on Contractor’s self-reported numbers using Client specific claims and as verified through any claims audit conducted by the Client and/or their selected auditor.
		7. Account Management	Quarterly
		a. Arrange and conduct meetings with the Client regarding outstanding issues at pre-determined, mutually agreeable time intervals.
		b. Address and identify resolution of all Client administrative, plan management, and miscellaneous issues/problems within one week of notification of such issue.
		c. Contractor shall conduct an annual account management satisfaction survey/score card.
		d. Account Management Scorecard (to be determined jointly by the Client and Contractor).
		e. Account Team Scorecard (to be determined jointly by the Client and Contractor).
		8. Timeliness of Reports	Annually
		Provide accounting and statistical reports to the Client on a quarterly cadence and upon request by the Client within 10 days of the end of quarter or request for report.
		9. Implementation	Annually
		a. A contract draft will be provided within 60 business days following receipt of employer approval of contract language and all completed application materials and binder check.
		b. Enrollment materials for all eligible participants under the Plan will be delivered in accordance with the agreed upon Implementation Schedule/Calendar.
		c. Policy and certificate delivery to participants will occur prior to the effective date of coverage.
		c. Implementation is completed 60 days prior to open enrollment and the implementation manager shall continue to support the Client for 45 days after the implementation effective date of July 1.
		d. Successful implementation as defined by key milestones. Measurable milestones are included in your proposal.
		10. Communication Materials	Annually
		a. Mail a welcome packet to new participants within five (5) business days of receiving the Client's enrollment file.
		b. Submit copies of all Plan Participant communication materials and promotional materials to the Client for review and approval prior to distribution.

Comments:

This Request For Proposal form is the sole property of Segal and is not intended to be reproduced for any purpose other than review by the Plan Sponsor contracted with Segal to prepare a procurement analysis. This file cannot be copied or reproduced in any method without the written consent by Segal.

8|Ratings

Tempe Union High School District - RFP 27-011CH-32

Ratings

Independent Rating Agency
Ratings	AM Best	Standard & Poor's	Moody's	Other
Rating
Rating Date

Unauthorized replication or use of this financial workbook is prohibited.

This file cannot be copied or reproduced in any method without the written consent by Segal.

Master

CITY OF PHOENIX - RFP HR 23-003

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File details come from the government source that posted it. Updated Oct 29, 2026.