008-24 Medical Plans - Self Insured and Fully Insured (Posted Copy).pdf

DeNerika.Johnson, Acting Director | DeNerika.Johnson@pgcps.org 13300 Old Marlboro Pike | Upper Marlboro, MD 20772 | 301-952 6560

RFP 008-24 Self Insured and Fully Insured Medical Plans

RFP PUR-007-24

SELF-INSURED AND FULLY INSURED MEDICAL PLANS

ISSUED BY:

The Department of Purchasing and Supply

Services

Attention: Donna Parks, Johnna Smarr, and

Diane Forde

RFP NUMBER:

RFP PUR-008-24

RELEASE DATE:

DECEMBER 19, 2023

PRE-PROPOSAL MEETING:

QUESTIONS DUE DATE:

JANUARY 8, 2024

JANUARY 12, 2024

PROPOSAL DUE DATE:

JANUARY 26, 2024, at 11:00 a.m.

DIRECT ALL INQUIRIES TO PROCUREMENT: DONNA.PARKS@PGCPS.ORG

JOHNNA.SMARR@PGCPS.ORG

DIANE.FORDE@PGCPS.ORG

To All Prospective Offerors:

Prince George’s County Public Schools (PGCPS) is soliciting proposals from qualified vendors to provide self-funded Three-Tiered Network Medical Plan coverage and/or fully insured Staff Model Health Maintenance

Organization (HMO) coverage. In addition, PGCPS is seeking proposals for a new fully insured plan as outlined in the Technical Questionnaire included with this RFP. A detailed description of the current PGCPS Three tiered network “Triple Option” Plan and Staff Model HMO plan are outlined later in this RFP. Note, the new plan may or may not be awarded depending on a determination made by PGCPS after proposals are reviewed.

A virtual pre-proposal conference will be held on January 8, 2024 via Zoom. Zoom information will be provided at a later date.

In order to participate in the pre-proposal conference, you must complete Attachment B - Letter of Interest and submit no later than 2:00 p.m., January 5, 2024, to all procurement contacts listed above. While attendance at the pre-proposal meeting is not mandatory, the information presented is informative. All interested Offerors are encouraged to attend.

Solicitation Documents may be obtained by:

● Download the solicitation by accessing the Prince George’s County Public School Board’s website at the following link: https://offices.pgcps.org/purchasing/bids.aspx

● Download the solicitation by accessing eMaryland Marketplace link:

https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage mailto:.stewart@pgcps.org mailto:DONNA.PARKS@PGCPS.ORG mailto:JOHNNA.SMARR@PGCPS.ORG mailto:DIANE.FORDE@PGCPS.ORG https://offices.pgcps.org/purchasing/bids.aspx https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage

Please respond according to the instructions provided in the RFP. Offerors are cautioned not to make changes to any of the terms and conditions or specifications in this solicitation, doing so may render an Offeror’s Proposal unacceptable and subject to rejection. In addition, offerors should not make any changes to the formatting of the

Excel Technical and Financial Questionnaires.

The Department of Purchasing & Supply Services is not responsible for information obtained from sources outside the Prince George’s County Purchasing Office, including downloads from the County website. Offerors are directly responsible for obtaining updates, changes or addendums either from the updated web page or by contacting the

Purchasing Office for instructions. If the Offeror has questions, they must be in writing and directed to the procurement contacts specified. Failure to adhere to this requirement may subject the Offeror to immediate disqualification.

TABLE OF CONTENTS

Contents

1. PART I: INTRODUCTION AND BACKGROUND:

2. PURPOSE

3. SUMMARY OF SERVICES

4. NON-EXCLUSIVE

5. OFFERORS IN LEGAL PROCEEDINGS WITH PGCPS

6. PERIOD OF PERFORMANCE

7. OPTION TO EXTEND SERVICE

8. CONTRACT TYPE

9. CONTINUITY OF SERVICES

10. BONDING

11. POINT OF CONTACTS

PART II: INSTRUCTIONS TO OFFERORS

1. OFFEROR KNOWLEDGE OF TERMS AND CONDITIONS

2. PROPOSAL SCHEDULE

3. PROPOSAL SUBMISSION REQUIREMENTS

4. PROPOSAL MARKINGS

5. PROPOSAL SUBMISSION LAYOUT

6. BIDDER DELIVERY AND ENVELOPE PACKAGING

PART III: SCOPE OF WORK

1. INTRODUCTION

2. BACKGROUND

3. SCOPE OF WORK – ADD SCOPE OF WORK

PART IV: PROPOSAL EVALUATION AND AWARD

1. EVALUATION COMMITTEE

2. EVALUATION PROCESS

3. EVALUATION CRITERIA

4. PROPOSAL AWARD

PART V: GENERAL TERMS AND CONDITIONS

1. PARTNERSHIPS

2. CORPORATIONS

3. SAMPLES

4. PROPOSAL PREPARATION FEES

5. RIGHT TO PROTEST

6. APPEAL OF CONTRACT AWARD DECISION:

7. COMMENCEMENT OF SERVICES

8. ADDENDA

9. STATEMENT OF CONFIDENTIALITY

10. TERM OF AGREEMENT

11. PRE-PROPOSAL MEETING

12. PAYMENT TERMS

13. MINORITY BUSINESS ENTERPRISE PROGRAM

14. LOCAL MBE INITIATIVE

15. MINORITY BUSINESS ENTERPRISE PROHIBITIONS

16. E- COMMERCE

17. CYBER LIABILITY INSURANCE

18. LIQUIDATED DAMAGES

19. FINGERPRINT CRIMINAL HISTORY BACKGROUND CHECKS, CHILD PROTECTIVE

SERVICE CLEARANCES, AND SAFE SCHOOLS TRAINING REQUIREMENTS

20. EDUCATIONAL/MEDICAL/PSYCHOLOGICAL RECORDS

21. PROTECTION OF STUDENT RECORDS

22. LEGAL COMPLIANCE

23. EPA COMPLIANCE

24. STATE OF MARYLAND CERTIFICATE OF GOOD STANDING

25. PERSONAL IDENTIFIABLE INFORMATION (PII)

26. OFFEROR PERFORMANCE EVALUATION

PART VI: SPECIAL TERMS AND CONDITIONS

1. REQUEST FOR PROPOSAL

2. GENERAL REQUIREMENTS

3. PRICES

4. ITEM DELIVERY

5. GUARANTEE AND WARRANTIES

6. ANNULMENTS AND RESERVATIONS

7. TERMINATION OF CONTRACT

8. GOVERNING LAW & VENUE

9. CONTRACT TERMS AND CONDITIONS

10. CHANGES IN TERMS OR DELIVERY

APPENDIX A – PROPOSAL AND ADDENDA ACKNOWLEDGEMENT

APPENDIX B – PAST PERFORMANCE AND REFERENCES

APPENDIX C - NON-COLLUSION CERTIFICATE

APPENDIX D - DEBARMENT AFFIDAVIT

APPENDIX E - ANTI-BRIBERY AFFIDAVIT

APPENDIX F - CERTIFICATE OF INSURANCE COVERAGE

APPENDIX G - FINANCIAL PROPOSAL TERMS

APPENDIX H - MBE FORM

APPENDIX I – STATE OF MARYLAND TAX CERTIFICATION

APPENDIX J – CERTIFICATION OF COMPLIANCE

APPENDIX K – VENDOR CONFLICT OF INTEREST DISCLOSURE FORM

ATTACHMENT A – COST PROPOSAL FORM

ATTACHMENT B – LETTER OF INTEREST FOR PRE-PROPOSAL CONFERENCE

ATTACHMENT C – LETTER OF INTENT TO APPLY

Exhibit 1 – Medical Technical Questionnaire

Exhibit 2 – Medical Financial Questionnaire

Exhibit 3a – Medical Repricing Files Dataset 1 of 3

Exhibit 3b – Medical Repricing Files Dataset 2 of 3

Exhibit 3c – Medical Repricing Files Dataset 3 of 3

Exhibit 4 – Staff Model HMO Enrollment by Tier

Exhibit 5 – Staff Model HMO Paid Claims and High Cost Claims

Exhibit 6 – Triple Option SPD – 2023

Exhibit 7 – OOA Comp Plan SPD – 2023

Exhibit 8 - Self Funded Historical Monthly Experience

Exhibit 9 - Kaiser Permanente Staff Model HMO EOC

Exhibit 10 – Group Structure

Exhibit 11 - Administrative Services Agreement Enhanced Fiduciary

Exhibit 12 – PGCPS Census

PART I: INTRODUCTION AND BACKGROUND

1. INTRODUCTION AND BACKGROUND:

The Board of Education of Prince George’s County (The Board) serves the needs of public education in Prince George’s County, covering approximately 1,789 square miles, with a residential population of more than 904,430. Prince George's County Public Schools (PGCPS), one of the nation's 20th largest school districts, has 208 schools and centers, has approximately 131,657 students and nearly 22,000 employees and an annual operating budget of $2.3 billion.

The school system serves a diverse student population from urban, suburban and rural communities located in the Washington, DC suburbs. PGCPS is nationally recognized for college and career-readiness programs that provide students with unique learning opportunities, including dual enrollment and language immersion. The Central administration headquarters is located at 14201 School Lane, Upper Marlboro, Maryland.

2. PURPOSE

The Board of Education of Prince George’s County (The Board) is issuing this Request for Proposal (RFP) Self-Insured and Fully Insured Medical Plans to provide a self-funded Three-Tiered Network Medical Plan coverage and/or fully insured Staff Model Health Maintenance Organization (HMO) coverage services to eligible Prince George’s County Public Schools (PGCPS) employees, retirees and their eligible dependents, and COBRA recipients.

3. SUMMARY OF SERVICES

This Request for Proposal (RFP) is soliciting proposals seeking one or more vendor(s) to provide Self- Insured and Fully Insured Medical Plans as defined in Part III, Scope of Work. Services that are to be provided include Non-Emergency Care and Emergency Care as defined in Part III, Scope of Work.

4. NON-EXCLUSIVE

The intent of this contract is to provide the Board with an expedited means of procuring supplies and/or services at the lowest cost. This contract is for the convenience of the Board and is considered to be a "Non-Exclusive" use contract. The Board does not guarantee any usage. The Board will not be held to purchase any particular Brand, in any groups, prices or discount ranges, but reserves the right to purchase any item/service listed in the Cost Proposal.

5. OFFERORS IN LEGAL PROCEEDINGS WITH PGCPS

PGCPS recognizes the significant costs and imposition on the time of personnel associated with legal proceedings. Accordingly, PGCPS has adopted a process stating that:

“One factor, among others, that are to be considered when awarding a contract or purchase order is the existence of a pending legal dispute – whether in court or an alternative dispute forum – with any Vendor or Offeror which has submitted a Proposal. Before including consideration of the legal dispute as a factor, the Procurement Officer shall seek the advice of the Office of General Counsel regarding the legal dispute and shall obtain the concurrence of the Superintendent of Schools or his designee.”

6. PERIOD OF PERFORMANCE

The term of this Contract will begin on January 1, 2025, with the understanding that certain contract implementation matters will begin the date the Notice of Award is signed by both the Offeror and The BOARD (the “Effective Date”) and shall continue for a period of five (5) years (“Initial Term”). In its sole discretion, The Board shall have the unilateral right to renew the Contract for two (2) additional one-year option periods successive (each a “Renewal Term”) at the prices established at contract award. “Term” means the Initial Term and any Renewal Term(s).

7. OPTION TO EXTEND SERVICE

The Board may require continued performance of any services within the limits and at the rates specified in the contract. The option to extend provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 12 months.

8. CONTRACT TYPE

The contract resulting from this solicitation shall be Fixed Rate requirements. Vendors are encouraged to partner with local Offerors or firms if they don’t meet all the required expertise or MBE requirements.

Subcontractor and or teaming partner information shall be included in response.

9. CONTINUITY OF SERVICES

The Vendor recognizes that the services under this contract are vital to PGCPS and must be continued without interruption and that, upon contract expiration, a successor, either the PGCPS or another vendor, may continue them. The Vendor agrees to exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.

10. BONDING (Not Applicable) The Offeror may be required to submit a Bid and or a Performance Bond as indicated below.

A. BID BOND (Not Required If applicable, the bid bond will be in the amount of five percent (5%) as determined by the BOARD and specified in the RFP, to ensure the satisfactory completion of the work for which a contract or purchase order is awarded that may exceed $100K. (COMAR 21.06.07.10). The bond must be made in favor of the BOARD OF EDUCATION OF PRINCE GEORGE’S COUNTY, UPPER

MARLBORO, MARYLAND 20772-9983.

B. PERFORMANCE AND LABOR BOND (Not Required) The awarded vendor(s) will be required to submit a performance and/or labor bond, Cashier’s or Certified Check in the amount of one hundred percent (100%) of the project cost as determined by the BOARD and specified herein to ensure all phases of the project are satisfactory complete for which a contract or purchase order is awarded that exceeds 100K. (COMAR 21.06.07.10).

When applicable, the Board reserves the right to request performance and labor bond for amount over or under $100K. The bond, cashier or certified check must be made in favor of the BOARD OF EDUCATION OF PRINCE GEORGE’S COUNTY and mailed to 13300 Marlboro Pike, Upper Marlboro, Maryland 20772-9983 prior to the start of performance.

11. POINT OF CONTACTS

The Offeror’s performance will be under the direction of the Procurement Department ensuring the Offeror's compliance with the requirements of this contract to include managing the daily activities of the contract, providing guidance to the contract, and coordination. The Offeror shall be accountable to the end users on all matters relating to the scope of work.

PROCUREMENT CONTACTS TECHNICAL CONTACT

Donna Parks, Supervisor of Purchasing Services Nick Venturini, Director Benefit Services Johnna Smarr, Procurement Specialist (Do Not Contact) Diane Forde, Records Keeping Clerk

Donna.Parks@pgcps.org Johnna.Smarr@pgcps.org Diane.Forde@pgcps.org

Your questions or concerns are important to PGCPS. To ensure that your questions and/or concerns are received and addressed properly, please ensure that you forward all email inquiries to all Procurement contacts listed above.

mailto:.stewart@pgcps.org mailto:Donna.Parks@pgcps.org mailto:Johnna.Smarr@pgcps.org mailto:Diane.Forde@pgcps.org

PART II: INSTRUCTIONS TO OFFERORS

1. OFFEROR KNOWLEDGE OF TERMS AND CONDITIONS

Before submitting Proposals, Offerors are expected to fully inform themselves as to the conditions, requirements, and specifications before submitting a Proposal. Offeror shall acquaint themselves with all State and Federal governing laws, ordinances, etc. and otherwise familiarize themselves with all matters, which may affect the Proposal. The act of submitting a Proposal shall be considered as meaning that the Offeror has so familiarize themselves; therefore, there shall be no misunderstanding or lack of information. Offerors, or their authorized representatives, are expected to fully inform themselves as to the conditions, requirements, and specifications before submitting Proposals. Failure to do so will be at the Offeror's own risk and Offeror cannot secure relief on the plea of error. Neither law nor regulations make allowance for errors of omission or commission on the part of Offerors.

All correspondence concerning the Proposal and contract, including Notice of Award, copy of the Contract, and Purchase Order, will be provided electronically.

2. PROPOSAL SCHEDULE

Due to the constant need of the Solicitation, milestones are listed with target dates. Please adhere to the schedule unless notified by way of an Addendum.

Event

Event Due Date or Occurrence Date

Issuance of RFP December 19, 2023

Letter of Intent to Attend Pre-Proposal

Conference and Letter of Intent to Apply

Due no later than 10:00 a.m. January 5, Encrypted Link Sent to Vendors Commencing December 21, 2023

Pre-Proposal Conference January 8, 2024 @ 11:00 a.m.

Questions Due

Due no later than 2:00 pm. January 12, Posting of Addendum January 18, 2024 (approximate date)

Proposal Due Date January 26, 2024 @ 10:00 am

Proposal Evaluation March 2024

Oral Interviews (if held) March 2024

Award Issuance May-June 2024

Benefits Open Enrollment October 2024

Exhibits 1 - 12 will be available for pickup via electronic portal, Zendto. Zendto is an encrypted secure site. Only those Respondents who submit Attachment C -- Letter of Intent to Apply will receive notice via email from Zendto.

All interested respondents will also be required to utilize the Zendto link to submit their proposals electronically.

NOTE: PGCPS Offices will be closed December 25, 2023 – January 2, 2024. However, emails will be monitored for forwarding Zendto technical files during this period.

3. PROPOSAL SUBMISSION REQUIREMENTS

In order to be eligible, Proposals must be received via electronic portal, Zendto, no later than January 26, 2024 @ 10:00 a.m. Only proposals that are submitted via the encrypted electronic portal, Zendto by the date as specified will be utilized during the evaluation process. Proposals that are not submitted via this portal may be ruled non-responsive. The Proposal shall consist of the required documentation for each volume as identified. Offerors shall retain one (1) original copy of the Proposal for their files. PGCPS may request the original notarized documents that were posted electronically before final award execution.

NOTE: Only those Respondents who submitted their Letter of Intent to Apply will receive a notice via email from Zendto. Approximately ten (10) days prior to the deadline for the submission of all proposals, potential Offerors who completed Attachment C -- Notice of Intent to Apply will receive a notice via email from Zendto to submit their proposal. The notice will contain a link generated by Zendto. Zendto is an encrypted, secure site. All interested Respondents shall utilize the link provided to submit their proposals electronically. All proposal submissions via Zendto are automatically encrypted and are date/time stamped. Therefore, please upload your documents no later than the deadline date and time indicated in the RFP or subsequent addenda.

All Respondents who upload their proposal documents onto the Zendto portal will receive an automated response advising the school system has “picked up” the documents when they are retrieved by the PGCPS Purchasing Office.

It is the Respondent’s responsibility to submit their proposals on time via the electronic portal.

It is also the Respondent’s responsibility to ensure the proposal has been uploaded properly on Zendto. Therefore, it is recommended that Respondents become familiar with this portal, as well as the submission process prior to the due date and time of this solicitation.

PGCPS reserves the right to request Respondents to provide proof of uploaded proposals via Zendto. Respondents that fail to provide adequate proof of submission of their proposal via Zendto may be declared non-responsive and will not be included in the evaluation process.

The electronic Proposal shall show the full business address, telephone number, email and fax number of the Offeror and be signed by the person or persons legally authorized to sign contracts and commit the company.

4. PROPOSAL MARKINGS

All Proposals shall be submitted without redactions. All sections of the Proposal that are considered Confidential or Proprietary shall be clearly marked within the Proposal. The Offerors’ shall provide justification for any and all confidential or proprietary information. Justification must be on a separate word document and submitted with the Technical Proposal.

5. PROPOSAL SUBMISSION LAYOUT

The completed bid documents(s) should be without interlineations, alterations, or erasures. The bid should present all information in a concise manner, neatly arranged, legible, and in terms understandable for evaluation. All information requested is to be addressed directly and completely. It is more desirable to give additional information than less when the answer could be misinterpreted. The submission layout will include four (4) parts:

GENERAL FORMAT- FOUR-PART SUBMISSION

Volume I - Technical Proposal

Volume II – Minority Business Enterprise (MBE)

Volume III – Cost Proposal

Volume IV – Appendices

Note: Each Volume should include a cover sheet detailing the Volume number and Title, RFP number and Title and the name of the Offeror.

6. BIDDER DELIVERY AND ENVELOPE PACKAGING

The bidder shall upload their Proposal electronically through Zendto and package their bid in two separate Zendto envelopes as noted below.

A. VOLUME I – TECHNICAL PROPOSAL (Envelope One)

The Technical Proposal shall be submitted electronically via Zendto secured portal by the deadline date indicated in this RFP in PDF format. Note: The Technical excel Questionnaire (Exhibit 1) shall be submitted in the Excel file provided in this RFP (not in PDF format). Certain other reports shall also be submitted electronically as outlined in the Technical Questionnaire.

Offerors shall not include any pricing in their technical proposal. Offeror shall include a table of contents and all pages in the technical proposal must be numbered, consecutively from beginning to end and separated by tabs as described below:

1) TAB A – TRANSMITTAL LETTER

Offeror shall include a brief transmittal letter prepared on the Offerors’ letterhead, and signed by an individual who is authorized to commit the Offeror to the services and requirements in the RFP and Proposal. This transmittal letter shall include:

a) The name, title, address, telephone number, and electronic mail address of the person authorized to bind the Offeror to the contract and the person who will receive all official notices concerning this RFP.

b) The Offerors’ Federal Tax Identification Number or Social Security Number.

c) The Offerors’ PGCPS iSupplier ID Number must be listed. To obtain an iSupplier ID number, you must register with PGCPS at https://www.pgcps.org/offices/purchasing/isupplier

d) A brief statement of the Offerors’ understanding of the work to be done, the commitment to perform the work, and a statement of why the firm believes it is best qualified to perform the work specified in RFP.

e) A statement that the Proposal is a firm and irrevocable offer for a period of one hundred twenty (120) days following the closing date for receipt of initial Proposals or the closing date for receipt of a best and final offer, if applicable.

2) TAB B – LEGAL CLAIMS

Offeror shall identify any claims during the past three (3) years and provide information on any pending litigation, lawsuits etc. The failure to provide accurate information may be determined to be a material breach of any future agreement or contract with The Board. If applicable, the Offeror must state no claims exist.

3) TAB C – EXPERIENCE AND CAPABILITIES

Offeror shall prepare and present a Technical Proposal in such a way as to provide a straightforward description of response to experience and qualifications, product quality, demonstrated capacity to perform, past performance and references to satisfy the requirements of the RFP.

4) TAB D - TECHNICAL RESPONSE TO RFP SCOPE OF WORK

Technical Questionnaire (Exhibit 1) is included with this solicitation. Note, the Technical Questionnaire has separate tabs allowing vendors to respond to specific questions and information requests. Vendors should respond to the questions and requirements outlined in the Technical Questionnaire (Exhibit 1) in its entirety. Each tab represents a separate form.

All sections must be separated by tabs when submitting the responses to the Questionnaire.

The form / tabs must be completed in the format provided.

A list of each attachment that each offeror is required to complete is listed at the bottom of TF-1a for offerors proposing Self-funded ASO services (or bidding on the new alternative EPO style plan option) and at the bottom of TF-1b for offerors submitting proposals for fully insured Staff Model HMO services.

https://www.pgcps.org/offices/purchasing/isupplier

Note: Please do not modify any tab within the Technical Proposal Bid Forms document.

Modifying any tab or layout may eliminate your company from consideration.

Do not:

- Add Cells

- Delete Cells

- Renumber questions or Add Questions

- Delete Questions - If you cannot respond to a question please just note - "No

Response Available" or "N/A".

Responses to questions should be brief and concise. "Yes" or "No" responses are encouraged when appropriate. The maximum number of characters for a response is 700.

The primary requirement is that you accurately answer the questions posed.

Form Description

a. TF-1a

Self-Funded Medical Questionnaire (and EPO fully insured option, if applicable)

(Including Attachments A-S requested under the

ATTACHMENTS section of this Form)

b. TF-1b

Staff Model HMO Questionnaire (Including Attachments A – N requested under the ATTACHMENTS section of this Form)

c. TF-2a

Network Access Summary - 1st Tier Network – Self Funded

Administration

d. TF-2b

Network Access Summary - 2nd Tier Network – Self Funded

Administration

e. TF-2c Network Access Summary - Staff Model HMO

f. TF-3a

Top Facilities - All Networks – DO NOT NEED

TO PRINT

g. TF-3b

Top Facilities - All Networks – DO NOT NEED

TO PRINT Deviation to Plan Design - Self-funded Triple Option

Plan and

h. TF-4 Care Management Programs – All 3 Proposal Options

i. TF-5a Performance Guarantees – Self-Insured Administration

j. TF-5b Performance Guarantees – Staff Model HMO

k. TF-6 Proposed Low Premium Alternative Plan Design

l. TF-7a

Deviation to Plan Design - Self-funded Triple Option Plan and

Out of Area Plan

m. TF-7b Deviation to Plan Design - Staff Model HMO

n. TF-8a References - Self-funded Triple Option Plan

o. TF-8b References - Staff Model HMO

p. TF-9 All Other Deviations to Specifications

q. TF-10 Key Differentiators

Copy and pasting large-preformatted responses from marketing materials that, while answering the question, also provide extensive information not related to the particular question, may be negatively scored.

Specific instructions on how to complete each section is included within the Technical

Questionnaire.

Electronic File shall include a cover sheet detailing the RFP number, as well as the name of the Offer and labeled “Volume I, Technical Proposal.

B. VOLUME II - MINORITY BUSINESS ENTERPRISE (MBE) (Envelope One)

Offerors shall submit MBE information electronically in Zendto under the Technical Proposal folder in a separate file, titled as such. A MBE goal of 15% has been established for the contract representing a percentage of the total Contract dollar value, including all renewal option terms.

Minority Businesses included in the Proposal package at time of opening, cannot be changed without prior approval of the Director of Purchasing and Supply Services.

By submitting a response to this RFP, the Offeror acknowledges the overall MBE participation goal and commits to achieving the overall goal by utilizing certified minority business enterprises, or will include a full or partial waiver of the overall goal with the Proposal.

1) Offerors shall describe how they intend to meet the MBE goals or justify why the goal cannot be met.

C. VOLUME III – COST PROPOSAL (Envelope Two)

The Offerors cost proposal shall include all labor, delivery, materials, tools, and equipment to perform work.

All pricing shall remain fixed for the full contract term, including renewals thereto unless an escalation or adjustment is included herein. Offerors should not include any portion of their Technical Proposal in its Cost Proposal.

1) Offerors shall complete “Appendix G Financial Proposal Form”, Exhibit 2 Medical Financial Questionnaire, Exhibits 3a, 3b, and 3c Medical Repricing Files Please submit under a separate sealed cover as described in Part II, Section 3.

Note: The financial proposal form is designed to capture fixed fees for the Three Tiered “Triple Option” Plan and fully insured premiums for the Staff Model HMO, as well as any implementation, technology, discretionary, communications, and/or wellness allowances proposed.

With respect to the request for a new EPO style plan, please fill out tab PF-2c in Exhibit 2, Medical Financial Questionnaire with your financial proposal, matching as closely as possible with the “Target” rates outlined on tab PF-2c, designing a plan design of your choice to meet the specified premium rates.

Financial Submission Documentation shall include the following:

1. Appendix G - Financial Proposal Form

2. Exhibit 2 – Medical Financial Questionnaire

Complete Columns B through L in both of these files (Claims Data provided in both files – the file had to be split into two (2) parts and both must be completed)

2) Offerors shall provide the Cost Proposal in Excel format using Exhibit 2 – Medical Financial Questionnaire. Do not amend, alter, or leave blank any items on the Financial Questionnaire or include additional clarifying or contingent language on or attached to the Questionnaire.

Items or costs required to provide the services and deliverables as proposed, but not identified will be the sole responsibility of the Offeror.

3) The Offeror shall demonstrate its financial stability. The Offeror shall include a fiscal integrity/ financial statement for the last two calendar years. If the Offeror has not had its financial statements audited by an independent accounting firm, the Offeror must submit such un-audited financial statements.

D. VOLUME IV - Appendices and Exhibits (Envelope Two) Offerors shall submit the Appendices electronically in eMMA under the Technical Proposal folder in a separate file, titled as such. The Offeror shall sign, date, and notarize where applicable all appendices identified. Appendices shall be packaged together as one file and delivered under Volume IV.

o Appendix A – Proposal and Addendum Acknowledgement o Appendix B – Past Performance and References

Form Description

PF-1a ASO Questionnaire

PF-1b Staff Model HMO Questionnaire

PF-1c Fully Insured NEW EPO Style Plan Questionnaire

PF-2a Administrative Fees ASO

PF-2b Fully Insured Staff Model HMO Plan Premium Rates

PF-2c Fully Insured NEW EPO Style Plan Premium Rates

PF-3 Additional Fees – ASO

PF-4 Summary of Repricing Analysis – ASO Proposal Only

PF-5a

1c_Medical Repricing Files_Dataset 1 of 3 - Price Form

5a –

Additional file to be completed as part of Price Proposal

PF-5b

1c_Medical Repricing Files_Dataset 2 of 3- Price Bid

Form 5b –

Additional file to be completed as part of Price Proposal

PF-5c

1c_Medical Repricing Files_Dataset 3 of 3 - Price Form

5c –

Additional file to be completed as part of Price Proposal o Appendix C – Non-Collusion Certificate o Appendix D – Debarment Affidavit o Appendix E – Anti-Bribery Affidavit o Appendix F – Certificate of Insurance Coverage o Appendix G – Financial Proposal Form o Appendix H – MBE Form o Appendix I – Certificate State of Maryland Tax Certification o Appendix J – Certification of Compliance o Appendix K – Vendor Conflict of Interest Disclosure Form

Failure to provide any of the requested information or documents in this solicitation may render the Proposal non-responsive.

PART III: SCOPE OF WORK

1. INTRODUCTION

This Request for Proposals (RFP) is soliciting proposals seeking one or more vendor(s) to provide a self-funded Three-Tiered Network Medical Plan coverage and/or fully insured Staff Model Health Maintenance Organization (HMO) coverage services to eligible Prince George’s County Public Schools (PGCPS) employees, retirees and their eligible dependents, and COBRA recipients. A detailed description of the current PGCPS Three-tiered network “Triple Option” Plan and Staff Model HMO plan is noted in the Excel Based Medical Technical Questionnaire included with this RFP.

NON-EMERGENCY CARE

When seeing a provider in the MD, DC or northern VA area, the member has access to three levels of benefits at the time the seek service:

• Tier 1 – For providers who are in the Bidder’s Core Network1

• Tier 2 – For providers who are in the Bidder’s Non-Core Network

• Tier 3 – For providers who do not participate in the Bidders Core or Non-Core Network (this includes providers who participate in an “Indemnity Network”)

When seeing a provider outside the MD, DC or northern VA area (the Core Network) the member has access to two levels of benefits:

• Tier 2 – For providers who are in the Bidder’s Core or Non-Core Network

• Tier 3 – For providers who do not participate in the Bidders Core or Non-Core Network (this includes providers who participate in an “Indemnity Network”)

EMERGENCY CARE

For all emergency care services, benefits will be paid at the Tier 1 level (regardless of the geography or network status of the provider)

NETWORK DEFINITIONS

• Core Network Providers – Providers who are in the Bidder’s standard network (e.g., the CareFirst

BlueChoice Network); this may be a regional or national network

• Non-Core Network Providers – Providers who participate in a network for the Bidder other than the Core Network (e.g., the CareFirst BluePreferred Network or the BCBS National Network); this may be a regional or national network.

• If a member sees a doctor who is in multiple networks for the Bidder, benefits should be paid at the highest tier available for that provider, et. if the doctor is in both the Tier 1 and Tier 2 networks, the claim will be paid at the Tier 1 level.

PGCPS also offers a closed Out of Area (OOA) plan for members who reside outside the regional network’s service area. The OOA plan is an indemnity plan with slightly different in and out of network benefits as outlined in the evidence of coverage documentation.

1 The State of Maryland, District of Columbia, and the Cities of Alexandria and Fairfax, the Town of Vienna, the County of Arlington and the areas of Fairfax and Prince William Counties in Virginia east of Route 123.

Bidders are encouraged to match the current benefit design in their proposal submissions.

In addition, PGCPS is requesting an additional low-cost option plan which will have the fully insured premiums noted in PF-2c tab of the Medical Financial Questionnaire in the document named “1b_PGCPS_Medical Price Proposal Bid Forms 1-4.xlsx”. This a purely exploratory alternative plan request and there are not guarantees of an award.

The current self-funded health offering also includes prescription drug coverage through CVS Health – both Commercial and Employer Group Waiver Plan (EGWP). The prescription drug coverage is not part of this RFP. Note that there is a separate concurrent RFP for the prescription drug coverage for both Commercial and EGWP plans.

2. BACKGROUND

The Board of Education of Prince George’s County (The Board) serves the needs of public education in Prince George’s County, covering approximately 1,789 square miles, with a residential population of more than 904,430. Prince George's County Public Schools (PGCPS), is one of the nation's 20th largest school districts, has 208 schools and centers, has more than 136,500 students and nearly 22,000 employees and an annual operating budget of $2.3 billion.

The school system serves a diverse student population from urban, suburban and rural communities located in the Washington, DC suburbs. PGCPS is nationally recognized for college and career-readiness programs that provide students with unique learning opportunities, including dual enrollment and language immersion. The Central administration headquarters is located at 14201 School Lane, Upper Marlboro, Maryland.

PGCPS has engaged the services of Bolton Partners and Girling Benefits Consulting to assist the school district with this solicitation.

Note: All questions should be referred to PGCPS Contacts as listed in Part I, item 11 Point of Contact.

3. SCOPE OF WORK

The Offeror shall perform the following specific tasks for Prince George's PGCPS Public Schools

(PGCPS):

Claims Administration

1) Offeror will adjudicate claims in an accurate and timely manner based on the Triple Option Plan

(or comparable health plan as proposed) and OOA plan designs in place, see Exhibits 6 and 7.

Bidders are encouraged to match the current benefit design in their proposal submission.

2) Provide EOB statements for services (electronically and/or hard copy) mailed and/or emailed directly to the address on file for the member;

3) Verify claim charges are for eligible employees and dependents including a process for rectifying, managing, and monitoring disabled dependents;

4) Audit technology to detect fraud, validate claims, prevent and predict claim denials, and improve claim turnaround.

5) Offeror will need to offer a benefit rewards program. The eligible activities to be tracked would need to be flexible and identified by PGCPS, and these trackable activities could change annually.

The incentive would be monetary incentive based (cash or gift card), and not tied to a benefit copay reduction/premium reduction/etc. Any paid rewards need to be billed back to PGCPS, and not included in any fully-insured premium calculations.

6) Comply with PGCPS’s right to select independent auditors for eligibility or claim audits within 18 months after the contract period end date with 90-day advanced notice. Net overpayments discovered during any audit must be refunded to Prince George's County Public Schools (PGCPS) regardless of whether the administrator can recoup payments from the employees and providers.

Financial and Banking Arrangements

1) Offeror will not retain any percent of discounts or savings as fees.

2) Offeror will bill allow PGCPS to create self-bills for administrative fees based on the PGCPS internal enrollment counts. Bidder will audit these bills based on its enrollment counts.

3) Maintain current, complete, and confidential records for each covered (or previously covered) person in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

4) Provide claim fiduciary services for the Parties and provide an external appeals procedure in compliance with the Affordable Care Act.

5) Offeror will not have any minimum enrollment guidelines.

6) Offeror will not propose tiered enrollment fees based on enrollment.

Member Services

1) Provide members online services including:

i. Benefit plan information

ii. Email availability

iii. Claims status and history

iv. Financial information, such as deductible and out-of-pocket maximum status

v. Ability for participants to upload or store personal health information

vi. Medical provider locator

vii. Download forms (claims)

2) Eligibility and Enrollment Processes:

i. Offeror(s) will monitor dependent eligibility for age limitation and disabled status

Cost Containment Program

1) Offeror to provide the following services:

i. Retrospective review

ii. Concurrent review

iii. Utilization management

iv. Cost containment

v. Case management

Network Management

1) Provide adequate availability of provider networks meeting minimum access standards specified in the RFP (provider panels open to all new members).

2) Continue provider recruitment efforts (including recruitment of heavily utilized medical surgical provider and mental health who are not currently in network).

3) Offeror will abide by all rules of the Consolidated Appropriations Act of 2021 including the following:

i. Provide machine readable files

ii. Provide cost transparency tools

Account Management

1) Offeror will provide a designated Account Management Team that will include the following:

i. Senior Account Executive – responsible for overall account

ii. Account Manager – day to day contact for all issues

iii. Claim Manager

iv. Customer Service Manager

v. Communication Manager

vi. Billing Manager

vii. Enrollment Manager

viii. Population Health/ Disease Management Manager

ix. Implementation Manage

Benefit Plan Communications

1) Attend enrollment meetings for the PGCPS

2) Develop Evidence of Coverage (EOC) Documents

3) Develop a Summary of Benefits and Coverages (SBC) for the program(s) proposed.

Reporting

1) Send disease management and wellness data to PGCPS and track all participation in the wellness and disease management programs

2) Provide ad hoc reports within 48 hours of data request

3) Provide an on-line reporting system to PGCPS which will provide access to historical summaries of claims, enrollment, fees and large claimant details broken down into various subsets including group status (i.e. active vs retiree), plan enrollment, member status, etc.

4) Provide designated representative to run standard and ad hoc reports

5) Provide reporting to a designated data warehouse vendor.

Disease Management and Wellness Programs

1) Identify employees, non-Medicare retirees and spouses to be enrolled in a Disease Management

Program, based on industry standard metrics.

2) Offer disease management programs for all the conditions below

i. Diabetes

ii. Asthma

iii. Congestive heart failure (CHF)

iv. Hypertension

v. Coronary artery disease (CAD)

vi. Chronic obstructive pulmonary disease (COPD)

vii. Hyperlipidemia

viii. Depression

3) Offeror will make active outreach efforts to all member identified as moderate or high acuity.

4) Provide annual wellness budget for disease management and wellness programs and completely fund such program.

5) Provide 24-hour nurse advisory service seven days a week with respect to specific health questions, utilizing:

i. Phone

ii. Web chat

iii. Email availability

6) Online Health Risk Assessments and Analysis to include health advising and online coaching programs to members.

Client Implementation

1) The Offeror shall provide a designated implementation manager to coordinate implementation of the medical plans for all parties. The implementation manager shall prepare a detailed implementation schedule reflecting key milestones and required time frames in order to implement this program by the effective date of January 1, 2025.

2) The Offeror shall assign an account manager to PGCPS. The assigned account manager for the Offeror should also be part of the implementation team. The Bidder shall meet (in person or via conference call) with PGCPS key personnel at least weekly during the implementation phase of the Contract to review status of overall operation of the program and highlight action items detailed in implementation schedule.

4. TECHNICAL SPECIFICATIONS

PGCPS has a secure website for qualified Plan Vendors to upload and download documents.

Vendors must submit Attachment C – Letter of Intent to Apply prepared on the Contractor’s letterhead to the specified buyers to obtain access to the RFP Technical Forms (Exhibits 1 through 12). Access to the RFP Technical Forms will be provided only to those qualified vendors who submit the Letter of Intent to gain access.

The secure website will only be available during the solicitation process and closed at the end of the deadline date for submission of proposals or closed upon request by the PGCPS Purchasing Department.

NOTICE: The Technical Proposal response must not include any pricing or cost information. If any pricing or cost information amounts of any type (including pricing relating to other projects) is included in any part of the technical response, PGCPS may deem the proposal to be non-responsive and reject it.

5. MINIMUM QUALIFICATIONS

Qualified Respondents must have at least ten (10) years of experience in providing self-funded and/or fully insured medical plan benefits, including claims administration and provider network services. In addition, responding vendors must have experience providing such services to at least four (4) Public School or Public Sector clients similar in size to PGCPS.

Note: Respondents are not required to provide both the self-funded and fully-funded programs.

The Board will not consider proposal responses from agents, brokers and consultants.

PART IV: PROPOSAL EVALUATION AND AWARD

1. EVALUATION COMMITTEE

Only proposals that are submitted via eMMA will be utilized during the evaluation process. Proposals that are not submitted via this portal will be ruled non-responsive.

Evaluation of the proposals will be performed by a committee established for that purpose and will be based on the criteria set forth below. The contract resulting from this RFP will be awarded to the

Offeror(s) whose proposal(s) is/are the most advantageous to The Board, considering price and technical factors set forth herein. The Board will consider the Offeror's record and performance of any prior contracts with The Board, federal departments or agencies, or with other public bodies.

Offeror, including any of their representatives, subcontractors, affiliates and interested parties shall not contact any member of the Committee or any person involved in the evaluation of the proposals. All inquiries related to this procurement must be handled by the RFP officials identified on the cover page.

Failure to comply with this directive may, at the sole discretion of the Board result in the disqualification of an offeror from the procurement process. The Evaluation Committee will make the final determination about acceptability of proposals.

2. EVALUATION PROCESS

The committee will evaluate each technical proposal using the evaluation criteria set forth below. As part of this evaluation, the Committee, at its sole discretion, may hold discussions with all qualified Offerors.

Discussions may be conducted via teleconference or may take the form of questions to be answered by the Offerors and conducted by mail, E-mail, or facsimile transmission at the discretion of The Board.

During the evaluation process, the committee may request technical assistance from any source.

a. Following the completion of the technical evaluation of all Offerors’ technical proposals, including any discussions, the committee will rank each qualified Offerors’ technical proposal.

b. The cost proposal of each qualified proposal will be distributed to the Evaluation Committee following the completion of the technical evaluation. The cost proposals will not be distributed to the committee until the technical evaluation is completed. The Committee will determine total costs of the proposals with the support of PGCPS’s Health and Welfare consultants, in order to establish a financial ranking of the proposals from lowest to highest.

c. The Evaluation Committee may reject in whole or in part any and all proposals, waive minor irregularities, and conduct discussions with all responsible Offerors in any manner deemed necessary to serve the best interests of the Board.

d. Based on the results of the evaluation, the highest rated offeror(s) may be invited by the Director of Procurement to make oral presentations to the Committee (if required). The Committee will then conduct its final evaluation of the proposals.

e. If it is determined to be in the best interest of The Board, the Board may invite Offerors to make final revisions to their technical and/or financial proposals through submission of a Best and Final Offer.

f. Should the Committee determine in writing and at its sole discretion that only one offeror is fully qualified, or that one offeror is clearly more highly qualified than the others under consideration, a contract may be negotiated and awarded to that offeror. The Committee will make appropriate recommendations to the Board, if appropriate, prior to actual award of contract. The Committee will recommend the Offeror whose overall proposal provides the most advantageous offer to the Board considering both price and technical factors set forth in this RFP.

3. EVALUATION CRITERIA

The evaluation criteria include proposal responsiveness, demonstration of capability to perform, price factors, and responsibility. The Board reserves the right to: (1) reject in whole or in part any and all proposals and waive minor irregularities; (2) Reject any or all proposals, or portions thereof; (3) Cancel a RFP and re-solicit.

The Evaluation committee will evaluate proposals using the criteria listed below. The committee shall determine which proposals have the basic requirements of the RFP and shall have the authority to determine whether any deviation from the requirements of the RFP is substantial in nature.

The points awarded for your offers will be based on the following:

A numeric evaluation system based on 100 evaluation points will be used to score the proposals. The maximum points awarded for each category are listed below:

I. Cost Proposal 35 Points

• Fixed Costs

• Provider Discounts

• Discount/Cost Guarantees

II. Provider Networks 35 Points

• Geographic Access

• Number of providers by county

• History/Stability

• Quality

• Match of top providers used

III. Administration 15 Points

• Claims Administration

• Utilization Management

• Network Access/Referrals

• Performance Guarantees

IV. Compliance with Specifications 5 Points

• Requested Plan Design

• Compliance with RFP Instructions

• Form Submission

V. Client References 5 Points

VI. Data Reporting Capabilities 5 Points

VII. MBE Participation 5 Bonus Points

See Part III, Scope of Work for additional information.

4. PROPOSAL AWARD

The Award of this contract will not be final and complete until: (1) Offeror has an active iSupplier, (2) the

Offeror submits complete and satisfactory documentation required under the Contract and/or documentation required by the Procurement Officer; and (2) the Contract is signed by the Department following any required approvals of the Contract, including approval by the Board, if such approval is required.

5. PGCPS has engaged the services of Bolton Partners and Girling Associates to provide consultancy services for this solicitation. Consultants may receive proposals in advance of the

Evaluation Committee in preparation of technical and pricing evaluations and scoring.

PART V: GENERAL TERMS AND CONDITIONS

1. PARTNERSHIPS

Proposals by partnerships shall be signed with the partnership name by one of the members of the partnership or by an authorized representative, followed by the signature and designation of the person signing, who shall also state the names of the individuals composing the partnership.

2. CORPORATIONS

Proposals by corporations shall be signed with the name of the corporation, followed by the signature and designation of the officer having authority to sign. When requested, satisfactory evidence of authority of the officer signing on behalf of the corporation shall be furnished. Anyone signing the proposal as agent shall file satisfactory evidence of authorization to do so.

3. SAMPLES

Offerors may be required to submit samples of each product awarded with an affidavit stating that the chemical composition of the sample submitted is identical with the composition tested prior to the proposal and all remain unchanged during the period of the contract. This requirement shall be part of the specifications of the product or products requested if applicable.

If Samples are required, a properly tagged sample and descriptive data shall be submitted to the address specified no later than the date specified. The tag on the sample shall indicate the item number, the name of the company submitting the sample, and the IFB number. The Board will not be responsible for any samples not picked up within 30 days of the notification of Vendors to do so. Samples may be retained by The Board until Vendors are notified to remove them.