1-26RFP005 Solicitation.pdf

Last Update: 02/12/2025 COS RFP Template

ISSUING AGENCY – CITY OF SCOTTSDALE

FORMAL REQUEST FOR PROPOSAL

HEALTHCARE BENEFITS

RFP# – 26RFP005

CRITICAL DATES

QUESTIONS DUE: 2:00P.M. AZ LOCAL TIME, SEPTEMBER 17, 2025

PROPOSAL SUBMITTAL DUE: 2:00 P.M.AZ LOCAL TIME, SEPTEMBER 25, 2025

SUBMITTAL RECEIPT AND OPENING

The City of Scottsdale is utilizing Bonfire Interactive to provide a procurement portal that allows access to business opportunities and to submit bids and proposals electronically. If you are not registered as a City of Scottsdale Bonfire vendor visit the Bonfire portal at City of Scottsdale, AZ (bonfirehub.com) then follow the link to the Bonfire vendor registration page to register your company. Registration is easy and free. If you have any challenges with the registration process, please contact Bonfire Interactive Support at support@gobonfire.com.

SEALED SOLICITATION SUBMITTALS WILL BE ELECTRONICALLY RECEIVED until the time and date stated in the portal and in the CRITICAL DATES section of the solicitation document. It shall be the responsibility of the proposer to confirm that proposals contain all required documents and are submitted electronically through the City of Scottsdale procurement portal at: City of Scottsdale, AZ (bonfirehub.com).

LATE SUBMITTALS WILL NOT BE ACCEPTED The Purchasing office will conduct a remote/online Microsoft Teams Live Event meeting for the public opening of the solicitation. To virtually attend this meeting, visit us online by clicking the following link 26RFP005

It is strongly recommended you begin your submission upload process at least one (1) day prior to the deadline. Any technical or internet-related issues that may arise during your submission are not grounds to extend the deadline.

INFORMATION REQUESTS

Requests for any information relating to this solicitation should be directed to the purchasing staff listed below:

Lynn Gustafson Purchasing Supervisor lgustafson@scottsdaleaz.gov 480-315-5768

Bidders shall not contact any City of Scottsdale employee, officer, or director other than purchasing regarding this solicitation until after the award of a contract. Any such unauthorized contact may result in bidder being disqualified from further consideration.

https://scottsdaleaz.bonfirehub.com/portal/?tab=login mailto:support@gobonfire.com https://scottsdaleaz.bonfirehub.com/portal/?tab=login https://scottsdaleaz.bonfirehub.com/portal/?tab=login https://teams.microsoft.com/meet/2754068628216?p=Th1rWmziSzymw3Lb3O mailto:lgustafson@scottsdaleaz.gov

INSTRUCTIONS TO BIDDERS AND

GENERAL TERMS AND CONDITIONS

The Instructions to Bidders and General Terms and Conditions for formal solicitations, are listed as attachments A and B as outlined below and shall be downloaded by prospective Bidders as part of the solicitation.

Attachment A - Formal Solicitation Instructions to Bidders (current version at time of posting).

Applies to all formal Invitation for Bids (IFB) and Request for Proposals (RFP).

Attachment B - Formal Solicitation General Terms and Conditions (current version at time of posting). Applies to all formal Invitation for Bids (IFB) and Request for Proposals (RFP).

TABLE OF CONTENTS

SECTION 1 - INTRODUCTION

A. Intent B. Background

SECTION 2 – STATEMENT OF NEED

A. Specifications

SECTION 3 – SPECIAL TERMS AND CONDITIONS

SECTION 4 – EVALUATION CRITERIA

A. Evaluation Criteria

SECTION 5 – SUBMITTAL PREPARATION REQUIREMENTS

SECTION 6 – REQUIRED FORMS

A. Proposal Signature Page B. Pricing Proposal Forms Lot A-E C. Bidder General Disclosure Form D. Bidder Litigation Disclosure Form E. References F. Bidder Questionnaire-Company Information

SECTION 7 – ATTACHMENTS

A. Instructions to Respondents B. General Terms and Conditions C. Sample City Services Contract D. Sample Business Associate Agreement

SECTION 8 - EXHIBITS

A. Summary Plan Descriptions B. Experience and Census C. Medical Repricing D. Network Disruption Medical & Dental E. RX Disruption F. Detailed RX Cost Analysis

SECTION 1 - INTRODUCTION

A. INTENT

The City of Scottsdale is seeking proposals for the city's benefit programs including medical, pharmacy, dental, employee assistance program, stoploss and administration of flexible spending accounts/health savings account. The current contracts for these services will expire June 30, 2026.

The City is also seeking information pertaining to establishing an Onsite/Near-site Clinic.

B. BACKGROUND

Located in the beautiful Sonoran Desert, Scottsdale, Arizona is bordered by Phoenix to the west and the McDowell Mountains on the east. Scottsdale is annually rated among the nation’s most desirable communities to live in, visit and do business in. Scottsdale’s vibrant Old Town is considered the finest urban center in Arizona. It is home to more than 90 restaurants, 320 retail shops and more than 80 art galleries. Scottsdale’s McDowell Sonoran Preserve, in the city’s northern reaches, is the largest urban wilderness area in the United States and features more than 60 miles of trails through diverse and scenic desert terrain.

SECTION 2 – STATEMENT OF NEED

A. SPECIFICATIONS

I. Background

The RFP has various parts to quote. Please see the lots below and tell us in your response which lot or lots your firm will be quoting on. Lot A includes a section pertaining to the Onsite/Near-site Clinic the City wishes to implement in 2026. This dedicated onsite health center for advanced primary care services for employees and dependents is expected to help drive member engagement in healthcare as well as savings with total medical spend. Please provide answers to the questions pertaining to the Onsite/Near-site Clinic when responding to this solicitation.

Lot A -Medical Administration including bundling the PBM (Pharmacy Benefit Manager) Lot B -Stoploss Administration Lot C- Dental Administration Lot D - EAP Administration Lot E – Flexible Spending, Dependent Care and Health Savings Accounts

City of Scottsdale is annually rated among the nation’s most desirable communities to live, visit, and do business in.

Summary of Current Benefit Environment

City of Scottsdale provides a self-insured health plan for its employees & dependents. The plan covers approximately 2,173 employees and 4,900 total members. Currently the plan is administered by Cigna for medical administration, network access, Pharmacy Benefit Management, Stoploss and EAP program, Flexible spending accounts are administered by ASI. Health savings accounts are administered by HSA Central Bank. The RFP process will be focused on all services listed above.

In conducting this competitive process, City of Scottsdale would like to partner with a vendor that will ensure:

Network competitiveness/discounts Network flexibility - access to broad and narrow network Competitiveness of fee arrangement (including % of savings/claim fees) Integrated access to variety of health & wellness tools Service provider’s proven capabilities in all administrative areas including but not limited to client claims access, third-party file feeds, customized reporting, etc.

Account team’s experience with similar-natured clients Health Savings Account administrative services Flexible Spending and Dependent Care administrative services Conformance to all requirements as stated in this RFP Complete and timely response to the RFP

We will be considering both bundled and unbundled arrangements including but not limited to Dental, EAP, Stoploss and FSA/HSA accounts. We would like to keep the Pharmacy bundled with

COS RFP Template the medical administrator. Please keep this in mind when providing your response. Any fees associated with unbundling should be disclosed.

Included with this RFP:

Current Census

Current SBC’s and SPD

3 Years of Paid Claims experience by month broken out by Medical/RX Claims

3 Years of large claims experience over $100K

Provider Disruption File on Medical and Dental

Medical and Dental Claims Repricing File

Pharmacy Claims Repricing File

Current info and Rates:

ASO Admin $20.31 PEPM Medical, Dental ASO $2.94

RX rebate 100% pass through paid out quarterly

Stop Loss $350,000 $80.00 PEPM No ASL Contract Paid

Net Commission

RX Formulary: Standard PDL Programs include SaveOnSP

DHMO Rates

EE – $10.39

EE + SP $17.05

EE + Child(ren) $23.30

Family $27.34

Wellness $200,000 Wellness Fund, $20,000 Firefighter Pilot

Please see separate information regarding current wellness program and on-site well-being coordinator

EAP-Confide Increased to 10 visits and 12 for public safety

10 visits $3.15 PEPM This includes Confide (see description)

12 visits $3.15 (first responders only)

Confide is a behavioral health navigation service that provides additional support for employees and their families, managers and human resources.

Flexible Spending and Dependent care $2.95 per participant per month

Health Savings Account $1.25 per participant per month

Services to be Provided

The selected vendor(s) will be responsible for delivering the following:

Claims administration of appropriate benefit programs and associated benefit designs

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Matching the current plan designs consisting of OAP IN, OAP PPO and HDHP with HSA Quote any plan design or product your firm offers that could be beneficial to the City to manage costs Network management (broad network and narrow network) Member services including (CM, UM) Dedicated account management and implementation support PBM services Bundled EAP Management Dental Network and Claims management Stop Loss Accurate and timely claims processing Ability to administer consumer-based plan designs Stop loss coverage or interface with stop loss carrier Strategic guidance and services to improve overall population health Onsite Wellness Coordinator FSA/DFSA and HSA management

II. General Information (All Lots)

1. Describe the history, organization and ownership of your company

2. What is your most recent financial rating for AM Best, Moody’s, Standard & Poor’s.

3. Please provide 3 references of current clients similar in size to City of Scottsdale that includes their contact information. See COS form

III. Network Management (including Access & Disruption) Lot A

1. Please provide discount and geo-access information on an excel file including the summary of access and disruption.

2. Complete the provider disruption analysis and indicate within the attached Claims Repricing & Network Disruption file if each listed provider: “Network Participating” or “Non-Participating” (PAR or

NON-PAR).

3. Please provide a full repricing analysis based upon the attached claim file. In addition to the detail repricing and disruption, please summarize your results using the following table:

Claim Types

Number of

Records Total

Charges Network Charges

Network Discount

Network Discount

Network Allowed

In-Network

Inpatient

Outpatient

Physician

Other Medical Ancillary

Total Network

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Out-of-Network

Inpatient

Outpatient

Physician

Other Medical Ancillary

Total Network

Grand Total

4. Provide your proposed Network Discount Guarantee.

5. Discount Calculation – Are any charged/submitted amounts reduced for any of the following when calculating your achieved discount? If, so, please indicate.

- Hospital Bill Audit Savings

- Fraud Savings

- UR Savings

- UM Savings

- Prompt Pay Discount Savings

- Special Claim Negotiation Savings

- COB Savings

- Subrogation Savings

- Any other savings included in your calculation not listed here (please detail)

6. Discount Calculation – Are any charged/submitted amounts reduced for any of the following when calculating your achieved discount? If, so, please indicate.

- Claims in excess of a specific amount (i.e., Specific Stop Loss or dollar amounts)

- Claims in excess of Hospital Stop Loss Contractual Amount

- Transplant Claims

- Claim Treatments under a Disease Management program

- Claims incurred on a specific group of participants (If so, please indicate the group(s))

- Specific services or claim categories (i.e., ER treatments, MHSA services, DME, injectable drugs, maternity, etc.)

7. Please detail any other customer specific claims that would be excluded from your discount calculation not listed in #5 & #6 above.

8. For out-of-network claims, please describe your R&C fee profile. How often is it updated? What percentile is used?

9. Please indicate if the network offering(s) is available nationally, or locally based and managed

IV. Medical Administration

Instructions Please see the provided pricing document to submit pricing

1. Provide pricing for administration and all products quoted.

2. Provide all fees on a per-employee-per-month (PEPM) basis.

3. Provide stop loss quote for 24/12 contract.

4. Three-year fee guarantees/commitments are required for all services.

5. Please indicate the services that are included in your fees and those services for which there are additional costs (including fees paid outside the monthly invoicing and through claims wire).

Specific Confirmations & Financial Caveats

1. Describe any rating caveats or assumptions associated with your quoted fees.

2. Specifically identify any other additional fees (e.g., set-up, ID cards, reports, printing of SPDs, etc.).

3. Identify and detail any shared savings, discount, or re-pricing programs available to City of Scottsdale to lower the cost of non-network and out-of-area claims. Please also detail any and all fees associated with such services.

4. Describe your banking arrangement(s), including an overview of each option available.

5. Do you require an initial or ongoing minimum balance in the bank account from which claims are paid?

Yes No

Amount ($ or %) ________

6. Provide details of your Performance Guarantees and dollar figures at risk.

Amount ($) ________

7. Confirm willingness to provide any implementation or general fund credits to offset costs of change.

Amount ($) ________

8. Confirm willingness to provide wellness fund or offset cost accordingly. Currently provided by the incumbent $200,000 annually.

Amount ($) _________

9. Confirm that client will be provided a designated daily claims contact.

10. Describe the tools available to members and confirm access to online portal and mobile app.

11. Confirm ability to provide monthly high claimant reports with diagnosis and details of Case

Manager Notes/Programs. Provide sample report.

12. Confirm how you would work with a carved out stop loss vendor and any fees associated.

13. Confirm the standard reporting that will be provided and frequency they will be provided.

14. Is ADHOC reporting available and is there a fee?

15. Confirm if any performance guarantee funds to be at risk with a successful implementation process.

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Onsite/Near-site Clinic – Lot A

1. City of Scottsdale plans to implement a dedicated onsite health center for advanced primary care services for employees and dependents in 2026 which is expected to help drive member engagement in healthcare as well as savings with total medical spend. Please detail your firm’s experience integrating services with onsite health centers offered by independent providers. Include examples of how onsite resources for health promotion or mental health services could collaborate with the health center and their providers to maximize engagement across the ecosystem.

2. Are there additional fees associated with having a health center in place, particularly regarding data file feeds for zero dollar claims? If yes, what are the fees City of Scottsdale may expect?

3. Are there any additional credits and/or discounts your firm would apply and incorporate in to the overall pricing?

4. The City is conducting a feasibility study for the onsite health center and data produced from this study will be released as an amendment following the publish date of this request for proposal. The feasibility study data is supplemental information only and not required to submit your proposal.

Account Management & Administration All Lots Confirm that:

A = agree D = agree with deviations N = no A D N

1. A dedicated account management team will support the benefit staff.

2. You agree to aid during the implementation process (including but not limited to informed support at employee meetings), then be available for face-to-face meetings to discuss ongoing issues.

3. You will assist in developing SPDs and provide final copy(s) no later than 60 days after the 7/1 annual renewal.

4. You agree to the proposed performance guarantees outlined.

5. You will accept electronic reporting of eligibility.

6. Based on the eligibility data you receive, you will:

Terminate coverage according to the date indicated by City of Scottsdale

Add coverage for members who joined the plan Send out ID cards and other appropriate communication materials for members who have added coverage.

7. You will provide standard reporting on a monthly basis.

8. You are able to administer the proposed plan designs.

9. Client & Broker will be involved in review/approval of all communication materials, including certificates, booklets, etc.

10. Confirm internal account management staff’s ability to offer strategic advice, updates on trends and best practice consulting advice.

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A = agree D = agree with deviations N = no A D N

11. You have a backup system capable of supporting disaster recovery efforts. The plan is written and has been tested.

12. You will provide web access for Plan participants with ability to obtain provider information, EOB and claim information, Disease Management information etc.

13. You must electronically store information on member service calls received or initiated.

General Proposal Requirements All Lots

A = agree D = agree with deviations N = no A D N

1. Confirm that you will store, transmit, communicate and safeguard individually identifiable health information in a manner consistent with and as required by applicable federal and state law.

2. Confirm your organization has satisfied all applicable privacy, EDI transaction and security requirements of HIPAA (Department of Health and Human Services regulations).

3. Confirm you agree to provide standard Performance Guarantees

Implementation Process All Lots

1. The selected Vendor must be able to implement services by July 1, 2026. Please indicate how long you believe it will take to implement this program.

2. The Vendor will actively support and participate in the implementation communications, including resources and materials for orientation to employees, internal staff, and other involved.

3. The Vendor will confirm their ability to receive an electronic eligibility file on a weekly basis at no additional cost.

Appeals All Lots

1. The Vendor will agree to handle all levels of appeals.

Reporting All Lots A = agree D = agree with deviations N = no A D N

1. Provide a copy of your sample standard reports (premium, financial, enrollment and call center statistics etc.).

COS RFP Template

Please answer each of the following questions and make your answers as concise as possible.

Account Management All Lots except Lot B

1. From what office will the account be managed?

2. Please confirm that one individual will be ultimately responsible for all programs you are quoting on

(e.g., Medical, Prescription Drug). Please identify this individual.

3. Show the organization of the account service team proposed for City of Scottsdale in chart format, including titles. Also, include the geographical location.

4. Describe the account servicing approach and address the following:

Responsibilities of the day-to-day contact Problem resolution process Title/level with problem resolution authority Year-end plan performance analysis Monitoring account service satisfaction

5. Provide an implementation plan including key dates for July 1, 2026, effective date. Who from your organization will manage the implementation process? Detail the timeline for SBC and SPD completion.

Member Service All Lots except Lot B

For the following questions, please make your responses specific to the member service location you are proposing for City of Scottsdale.

1. Where will member services be handled? Will staff be dedicated/designated to the client? Please define dedicated/designated.

2. What are the hours of operations of member services?

3. Is there an IVR system in place?

Yes No

Claims Processing/Administration Lot A, C and E

1. Where will claim processing be handled?

2. Will claims be handled by a dedicated unit or service representative? If yes, please define dedicated.

Yes No

3. Please provide claim adjudication statistics for the proposed claim office in the table below.

How many claims are auto adjudicated.

Financial accuracy (percent of dollars paid correctly)

Overall accuracy

Turnaround time in 14 calendar days

Turnaround time in 28 calendar days

4. When was the most recent major upgrade of your claim processing system?

5. Are there any upgrades to your claim processing system planned for the next 24 months? If so, please explain.

6. Please describe how your company uses AI and if AI is used to deny pre-authorizations or claims.

COS RFP Template

Web Tools Lot A, C, D and E

1. Which of the following services are currently or will be available by 2026 through your website?

Current

Member Self-Service Can members:

a. Access provider information? Yes No

b. Access provider directories? Yes No

c. Access provider directories with driving instructions? Yes No

d. Participate in community forums? Yes No If no, does your Web site link to this type of site? Yes No

e. Access benefit plan summaries? Yes No

f. Enroll on-line? Yes No

g. Check eligibility? Yes No

h. Order replacement ID cards? Yes No

i. “Talk” to providers (i.e., “Ask-the-Physician”)? Yes No

j. File a claim? Yes No

k. Download printable versions of claim forms? Yes No

l. Check claim status? Yes No

m. Submit appeals? Yes No

n. Submit inquiries to customer service via email? Yes No

Provider Support

Can providers:

o. Verify in “real-time” the eligibility status of members? Yes No

p. Create virtual medical records for their patients? Yes No

q. Access drug and medical history for their patients? Yes No

r. Access lab values or other encounter data? Yes No

s. Submit claims? Yes No

t. Submit precertification information/extended LOS information?

Yes No

Health Management Can members:

u. Access disease management program information? Yes No

v. Access educational information? Yes No

w. Complete a health risk assessment? Yes No

x. Develop and save a health profile? Yes No

Plan Sponsor/Employer Support Can plan sponsor:

y. Check customer online? Yes No

Disease/Lifestyle Management Capabilities Lot A

Participant Outreach – Please discuss your approach to:

a. Contacting potential participants for continuation in the program and track refusal to participate and dis-enrollment from the program.

b. Assessing all participants’ adherence to prescribed medical care and developing an individualized plan of care for each participant based on national standards of care and/or evidence-based medicine in coordination with the participant’s health care provider.

c. Educating each participant regarding his/her health care condition and the needs brought about by the illness. The goal of member education is to increase the participant’s understanding of the disease and to empower him/her to be more effective in self-care of the health problem(s) so he/she:

i. Is a more effective partner in the care of the disease;

ii. Is better able to understand the appropriate use of resources needed to care for the problem(s);

iii. Is able to identify when there is a negative change in the health condition and to seek appropriate attention before crisis level is reached; and/or

iv. Is more compliant with medical recommendations.

d. Providing interventions appropriate to the participant’s level of severity and risk that may include regular phone calls to the participant, home visits, and/or educational materials mailed to the participant’s home. The frequency and type of follow-up must be appropriate for the risk/severity level of the participant.

i. Contacting participants in moderate or high-risk categories must be an interactive communication with the member. Solely leaving voice mail or sending e-mail or regular mail will not be considered appropriate.

Consumerism Capabilities Lot A and C

1. Describe activities to identify those providers (hospitals and/or physicians) that are more efficient and/or low cost.

2.

3. Describe the web-based cost estimation tools that the plan makes available.

4. Describe other plan strategies for including incentives in current or planned products for consumers to purchase health care based on value.

5. Describe the measures used for incentive programs for doctors. Examples of benefit design include tiered or narrow networks as well as differential coinsurance, deductible or maximum out-of-pocket levels that steer patients to higher performing providers; public reporting may include identification in a provider choice tool or consumer guide.

Current

z. Update eligibility online? Yes No

aa. Create reports online? Yes No

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CAA and Affordable Care Act Compliance Lot A

1. Confirm your compliance with the Affordable Care Act transparency in Coverage rule and

Consolidated Appropriations Act (CAA) and how you aid the client.

Below are provisions considered essential to this proposal. Please indicate in the space provided your willingness to accept the proposed provision. If you accept the provision with revisions, please elaborate.

Right to Audit Lot A City of Scottsdale reserves the right to audit, including but not limited to a claims audit, either directly or through its authorized agent(s), the health plan administrator’s compliance with the terms of the Agreement. City of Scottsdale further reserves the right, either directly or through its authorized agent(s), to conduct a chart audit or other appropriate review to assess the quality of any services performed by the health plan administrator or its affiliated health care providers upon reasonable advance notice to the health plan administrator. Upon providing appropriate assurances as to confidentiality and proper use of medical information, the health plan administrator agrees to provide City of Scottsdale or its authorized agent(s) with the medical records maintained by the health plan administrator as well as any data needed to perform audits or other reviews. Any audits will be completed with no additional cost to City of Scottsdale for the services provided relative to the audit.

Accept Reject Accept with revisions

Confidentiality All Lots

The health plan administrator agrees to maintain the confidentiality of all medical, financial and other patient specific data pertaining to Members, as required by state and federal law. The health plan administrator agrees that, except as otherwise provided herein, such data will not be released to individuals or entities other than the Member to which the data relate or such Member’s authorized representative, except as required by law or as may be required by order of a court having jurisdiction over the Member. The health plan administrator also agrees that City of Scottsdale has the right to use and disclose all medical, financial and other patient-specific data pertaining to members and the health plan as defined by law and upon providing appropriate assurances as to compliance with HIPAA and other privacy standards. The vendor will maintain medical records that meet ERISA’s recordkeeping standards, ensure the security and confidentiality of employee medical data, and adhere to present and future legal requirements as mutually agreed upon and contractually defined.

Member Complaints A, C, D and E

The health plan administrator agrees to act promptly in response to complaints received from Members.

The health plan administrator will maintain electronic and written records of all complaints. The records will include, but not be limited to, the date and nature of the complaint filed and the date and manner by which the health plan administrator responded. The health plan administrator shall have a grievance and appeal procedures for addressing complaints and shall make such process available when addressing complaints. City of Scottsdale shall have the right to inspect such written records, including transcripts of member telephone calls, during normal business hours by providing advance written notice to the health plan administrator.

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Compliance All Lots

The selected vendor must be prepared to assist City of Scottsdale with all state and federal compliance issues, including negotiating, in good faith, appropriate Business Associate and similar “chain-of-trust” agreements and contractual provisions (“Agreements”) in order to comply with the HHS final health care privacy and security regulations and, if necessary, any applicable state law. These Agreements may include (i) addenda to the vendor contract to provide the required Business Associate contractual provisions under the HHS privacy and security regulations and (ii) similar Business Associate agreements with any subcontractors (as approved by City of Scottsdale) of the selected vendor and other service vendors to City of Scottsdale health plans, as necessary.

Proposers must demonstrate their capability and plan for coming into timely compliance with all federal regulations governing employer-sponsored health plans that take effect during the contractual period, including:

Insolvency insurance at an amount, which is sufficient, based on relevant industry standards, to cover obligations of providers for services provided to members.

US Department of Labor (DOL) final regulations on claims [and appeals] procedures;

US Department of Health and Human Services (HHS) final regulations on electronic health data transaction and coding standards; and HHS final regulations on health care data privacy and security.

Wellness Currently the City of Scottsdale has an onsite Wellness Coordinator that is a Cigna employee. This employee works very closely with all the City’s employees and with the benefits team at the City.

Please see the job description below and reply if your company can support. If so, please describe your approach to wellness.

Health Engagement Well-Being Coordinator Job Description

The Well-Being Coordinator is designated to one Offeror and works closely with the Offeror account management team and the client’s human resources/ well-being team to execute the client’s employee health engagement and well-being goals. The primary focus of the Well-Being Coordinator is to promote whole-person health and well-being. At the client’s discretion, this position can be performed fully virtual, onsite at the client up to 4 days/ week or hybrid (working at home and coming to client’s location for events).

The Well-Being Coordinator executes the appropriate delivery and coordination of the Offerors programs and resources, customer education initiatives and vendor services while monitoring engagement and effectiveness of the program.

A core objective of this position is to facilitate well-being programs that educate and influence the client’s population to lead healthier lifestyles. This role strives to create data-driven strategies resulting in measurable outcomes.

Key Responsibilities

Client Well-Being Assessment and Strategy Development

• Conduct organizational assessments to identify strengths and opportunities.

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• Administer well-being surveys to gather employee feedback and interests.

• Present data analytics, including registration rates, utilization metrics, health assessments, and overall engagement.

• Develop and execute an adaptable, client-specific annual well-being strategy in collaboration with the account team.

• Establish and manage a communication plan utilizing diverse channels to promote well-being initiatives.

• Maintain and adhere to a well-being strategy budget.

• Provide continuous analysis and evaluation of communication, wellness strategies, biometric data, and employee engagement.

Program Implementation and Management

• Collaborate with clients, account teams, and vendors to design and execute well-being programs, including events, campaigns, and seminars.

• Monitor and analyze participation and program effectiveness.

• Distribute health and well-being educational materials.

• Support the development and facilitation of well-being committees.

• Lead and manage year-round wellness activities, such as daily fitness classes and movement challenges.

• Oversee on-site preventive health services, including staffing and scheduling for Employee Assistance Programs (EAP).

• Coordinate monthly EAP Lunch & Learn series, including scheduling, promotion, and set-up.

• Develop and distribute well-being communications, including newsletters, benefit bulletins, and targeted home mailers.

• Lead programming and execution of the annual benefits fair, including vendor coordination and logistics.

• Oversee staffing and scheduling for on-site EAP services to ensure availability and accessibility.

• Manage the FF YourCall Prevention Program, including monthly outreach and engagement tracking.

Engagement, Promotion, and Compliance

• Serve as a key liaison to the client’s HR Benefits team, ensuring integrated wellness initiatives.

• Identify and address benefit education gaps through tailored information sessions and Lunch & Learn events.

• Actively promote workplace wellness initiatives, including alignment with the Blue Zones Project Scottsdale and worksite sustainability certification.

• Attend and present at staff meetings across various departments, accommodating diverse schedules.

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• Lead health and wellness award applications, ensuring accurate documentation and data submission.

• Coordinate the distribution of parental care kits for new parents.

Offeror Responsibilities

• Attend required training and meetings.

• Process budget reimbursements and expenses promptly.

• Support open enrollment activities, including presentations and Q&A sessions.

• Collaborate with Offeror to provide clients with necessary services, data, and resources.

• Continuously enhance industry knowledge and proficiency in Cigna products and software.

Qualifications

• Bachelor’s degree in health education, human resources, health promotion, or a related field preferred.

• Minimum of 2 years of experience in health and wellness programming, corporate wellness, HR/Benefits, or event coordination.

• Ability to travel locally and remotely for client engagements and training sessions as needed.

• Strong understanding of wellness programming, benefits, and health promotion strategies.

• Exceptional organizational, project management, and analytical skills.

• Excellent communication and public speaking abilities.

• Proficiency in Microsoft Excel, Word, and PowerPoint, as well as virtual presentation platforms (e.g., WebEx).

• Proven ability to work independently in a fast-paced, matrixed environment.

• Experience in engaging, influencing, and motivating diverse populations.

Preferred Qualifications

• Master’s degree in a related field.

• Professional certifications such as CHES, Chapman WellCert, or other health and wellness credentials.

Firefighter Pilot Fund - Your Call

Your Call is a health program available to all City of Scottsdale firefighters. Through the program, a firefighter has dedicated providers through Honor Health which provide appropriate preventive physical and emotional screenings. There are dedicated care coordinators and scheduling services to assist these employees in receiving specialized care. Dedicated physicians evaluate firefighter health and order targeted screenings including metabolic, depression and anxiety, genetic, physical fitness, heart, lung and various cancer screenings. Please describe any programs you currently have or are developing that address these needs.

COS RFP Template

Pharmacy (Bundled) Lot A

Network

Confirmed (Y/N)

Comments

1. All major pharmacy chains are included in your standard network.

2. Maintain an online pharmacy directory that includes name, location, telephone number, any non-English languages spoken, hours of operation (particularly 24 hour), available vaccine services and delivery services.

3. PBM is offering this quote based on their national, broadest network.

4. PBM will provide network disruption reports to show member impact if new vendor is selected.

Pricing Confirmed (Y/N)

1. The AWP discount is based on NDC-11.

2. PBM uses one AWP data source for deriving AWP values (i.e., Medispan).

3. City of Scottsdale will not be obligated to reimburse PBM for an amount greater than such contracted rates.

4. Mail service pricing is based on the actual package size used to dispense.

5. The “lower of 3” logic will be applied to all drugs, including those with a MAC.

6. If the usual & customary (U&C) price is lower than the standard discount price, the member will always pay the “lower of” U&C price.

7. Zero balance claims will not be considered 100% discounted, rather the discount will be calculated prior to the applicable copay.

8. City of Scottsdale will receive earned rebates within 90 days of drug company payment. If different, please indicate days: _____.

9. Guarantees will be reconciled on a component level (no offsetting of overperformance in one area to subsidize underperformance in another. If proposing a different reconciliation methodology, please indicate how claims are guarantees are reconciled (component/aggregate/channel).

10. Provide a list of all clinical programs and utilization management programs included in the base admin fee (or standardly included if traditional pricing is being proposed).

11. PBM will provide formulary disruption reports to show member impact (assuming formulary indicators are provided on the claims file).

12. Confirm that all generics are reconciled in the overall generic effective rate guarantee.

13. PBM will also provide their own pricing proposal document (that includes discounts, rebates, fees, services, pricing assumptions, etc.) in addition to completing this RFP.

Specialty

COS RFP Template

1. PBM shall provide a cost-effective Specialty Pharmacy Program with either centralized distribution or multi-channel distribution that is national, convenient, consistent and flexible.

2. The Program must have developed services to meet the unique challenges of dispensing and monitoring these medications.

3. The Program must provide cost-effective care and positive patient outcomes through increased adherence, as well as provide an enhanced patient experience through the convenience of scheduled delivery, disease management programs and compliance monitoring employing a care-coordination model.

4. In care coordination, licensed clinicians (nurses, pharmacists, and physicians) provide comprehensive clinical management services. Clinical professionals support patients with education, training and mental health support (e.g., behavioral health, case management or disease management referral). The plan of care will address education, interventions, compliance, monitoring parameters, and goals and outcomes of therapy.

Non-adherence or non-compliance and the rationale must be communicated to the prescribing physician.

5. The Program must contain provisions addressing preferred specialty medications and biosimilars.

Performance Guarantees

1. If applicable, PBM will provide a list of all performance guarantees being offered. This list should include:

-Performance Standard -Measurement Frequency -Dollars at Risk

Pharmacy (Bundled) Lot A

Network

5. All major pharmacy chains are included in your standard network.

6. Maintain an online pharmacy directory that includes name, location, telephone number, any non-English languages spoken, hours of operation (particularly 24 hour), available vaccine services and delivery services.

7. PBM is offering this quote based on their national, broadest network.

8. PBM will provide network disruption reports to show member impact if new vendor is selected.

Pricing

1. The AWP discount is based on NDC-11.

2. PBM uses one AWP data source for deriving AWP values (i.e., Medispan).

COS RFP Template

3. City of Scottsdale will not be obligated to reimburse PBM for an amount greater than such contracted rates.

4. Mail service pricing is based on the actual package size used to dispense.

5. The “lower of 3” logic will be applied to all drugs, including those with a MAC.

6. If the usual & customary (U&C) price is lower than the standard discount price, the member will always pay the “lower of” U&C price.

7. Zero balance claims will not be considered 100% discounted, rather the discount will be calculated prior to the applicable copay.

8. City of Scottsdale will receive earned rebates within 90 days of drug company payment. If different, please indicate days: _____.

9. Guarantees will be reconciled on a component level (no offsetting of overperformance in one area to subsidize underperformance in another. If proposing a different reconciliation methodology, please indicate how claims are guarantees are reconciled (component/aggregate/channel).

10. Provide a list of all clinical programs and utilization management programs included in the base admin fee (or standardly included if traditional pricing is being proposed).

11. PBM will provide formulary disruption reports to show member impact (assuming formulary indicators are provided on the claims file).

12. Confirm that all generics are reconciled in the overall generic effective rate guarantee.

13. PBM will also provide their own pricing proposal document (that includes discounts, rebates, fees, services, pricing assumptions, etc.) in addition to completing this RFP.

Specialty

1. PBM shall provide a cost-effective Specialty Pharmacy Program with either centralized distribution or multi-channel distribution that is national, convenient, consistent and flexible.

2. The Program must have developed services to meet the unique challenges of dispensing and monitoring these medications.

3. The Program must provide cost-effective care and positive patient outcomes through increased adherence, as well as provide an enhanced patient experience through the convenience of scheduled delivery, disease management programs and compliance monitoring employing a care-coordination model.

4. In care coordination, licensed clinicians (nurses, pharmacists, and physicians) provide comprehensive clinical management services. Clinical professionals support patients with education, training and mental health support (e.g., behavioral health, case management or disease management referral). The plan of care will address education, interventions, compliance, monitoring parameters, and goals and outcomes of therapy.

Non-adherence or non-compliance and the rationale must be communicated to the prescribing physician.

5. The Program must contain provisions addressing preferred specialty medications and biosimilars.

COS RFP Template

Performance Guarantees

1. If applicable, PBM will provide a list of all performance guarantees being offered. This list should include:

-Performance Standard -Measurement Frequency -Dollars at Risk

AMP Cap & Biosimilars

1. AMP Cap: Complete the following table

2. Please provide your NDC level AMP Cap list used for the proposed pricing. (Provide in excel)

3. Biosimilar Strategy: Complete the following table.

*Duplicate and complete above table as applicable for new products (i.e., Stelara)

4. Provide your NDC level biosimilar list of your preferred formulary products. (Provide in excel)

5. Are the Low WAC biosimilars co-preferred with originator products or are originator products excluded from formulary? List differentiation between strategies as applicable (i.e., if strategy differs between Humira and Stelara, please outline differences in strategy).

• Co-preferred

• Excluded

6. Provide your estimated shift percentage from Humira to the biosimilars in the formulary proposed for the customer. (Value in%)

Stoploss Lot B

1. Do you laser at renewal?

2. Do you provide advanced funding if you are not bundled with the carrier? Please describe

3. Describe in detail what steps would be needed to file a stop loss claim for reimbursement.

4. What date to you lock in the renewal?

AMP

Cap

Are Discount Guarantees

Underwritten to adjust for

AMP Cap Strategy?

Are AMP Cap claims included in Discount Guarantees?

Are Rebate Guarantees

Underwritten to adjust for

AMP Cap Strategy?

Are AMP Cap claims included in Rebate Guarantees?

Will a Rebate

Credit be Applied?

Current Yes/No Yes/No Yes/No Yes/No Yes/No Renewal Yes/No Yes/No Yes/No Yes/No Yes/No

Biosimilar Are Discount Guarantees

Underwritten to adjust for Biosimilar Strategy?

Are Biosimilar claims included in Discount

Guarantees?

Are Rebate Guarantees

Underwritten to adjust for Biosimilar Strategy?

Are Biosimilar claims included in Rebates

Guarantees?

Will a Rebate Credit be applied?

Current Yes/No Yes/No Yes/No Yes/No Yes/No Renewal Yes/No Yes/No Yes/No Yes/No Yes/No

5. What carriers do you have preferred contracts with?

Employee Assistance Program

1. What types of reporting will the City be able to access?

2. Please describe your program in detail on everything that is included in the EAP program. Should include work life balance programs.

3. Provide a list of training sessions or customized workshops that are available and any separate cost.

4. Do you include critical incident response resources and on-site support?

5. Currently the City has 2 onsite EAP Cigna counselors onsite. The city does pay an hourly rate for the onsite counselors. Please describe if you can do this with your EAP program. The city was involved with hiring the counselors to make sure they were a good fit for the employees.

6. Currently the City has a navigation program for Mental Health through Cigna called Confide.

Please describe any programs you have that can help members locate resources.

7. Do you provide a substance abuse program through the EAP? Currently the city is using SAP through Cigna.

8. What is the typical wait time for members to get an appointment whether in-person or digital?

Health Savings Accounts

1. What is the minimum monthly administration fee?

2. How often are participant account statements made available? (Monthly, Quarterly, etc.)

3. What method are participant account statements delivered? (Paper, electronic, etc.)

4. Are you integrated with any health carriers?

5. Are customized enrollment/communication materials provided?

6. Do you provide web access for participants? Mobile App?

7. Do employers have web access for reporting?

8. How many debit cards are included?

9. What is the fee for additional debit cards?

10. Do you provide investment options for participants?

11. What is the minimum balance needed to participate?

12. What is the fee for investment options?

COS RFP Template

13. Please provide a list of accountholder fees. (i.e. NSF, Stop Payments, Transfer/Close Accounts, etc.)

Flexible Spending and Dependent Care Accounts

1. Do you have a mobile application that can be used to submit claims by taking a picture of the receipt

2. Please describe how the City would have to fund the account and provide all of your options

3. Describe your substantiation process

4. Do you provide the plan document and explain what testing is included in the quote. If not included, please list services with associated cost.

5. Please provide copies of the reporting options.

6. How many debit cards are included?

7. What is the fee for additional debit cards?

8. Can your system be integrated with any carriers?

SECTION 3 - SPECIAL TERMS AND CONDITIONS

1. ACCEPTANCE / AGREEMENT

Contractor shall act under the authority and approval of the Contract Administrator for the City, further named herein, to provide the services required by this Contract.

If for any reason the Offeror should fail to accept in writing, any conduct by Offeror which recognizes the existence of a Contract/Agreement pertaining to the subject matter hereof shall constitute acceptance by Offeror of the Contract/Agreement and all of its terms and conditions.

Any terms proposed in Offeror's acceptance of City's Contract which adds to, varies from or conflicts with the terms herein are hereby rejected by the City. Any such proposed terms shall be void and the terms herein shall constitute the complete and exclusive statement of the terms and conditions of the Contract/Agreement between the parties.

2. ADDITIONAL LOCATIONS

The City of Scottsdale reserves the right to add or subtract to this Contract as the need arises.

Any additions or subtractions to the Contract shall be done via a written amendment and be a MINIMUM of thirty (30) days prior to the changes taking effect.

3. CITY ASSURANCE

The Contract Administrator shall report to the Contractor in writing, via email, or other written documentation, all deficiencies in the quality of performance of the maintenance service. All communication, written or verbal, between the City of Scottsdale and the Contractor shall be in English.

All deficiencies in the performance of the Contractor’s service shall be corrected promptly by the Contractor as directed by the Contract Administrator.

The Contract Administrator may monitor and review the performance of the Contractor and employees. The outcomes of this oversight may have a direct bearing on the opportunity to negotiate a renewal of the Contract, when applicable.

4. CITY OBSERVED HOLIDAYS

City holiday time frame to be 6:00 P.M. the eve of the holiday until 6:00 A.M. on the day after the holiday.

City Holidays Include: New Year’s Day, Martin Luther King Day, President’s Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving Day (plus Day after Thanksgiving), Christmas Day.

a. New Year’s Day January 1st (or Friday before or Monday after)

b. Martin Luther King Day 3rd Monday in January

c. President’s Day 3rd Monday in February

d. Memorial Day Last Monday in May

e. Juneteenth June 19th

COS RFP Template

f. Independence Day July 4th (or Friday before or Monday after)

g. Labor Day 1st Monday in September

h. Veteran’s Day November 11 (or Friday before or Monday after)

i. Thanksgiving Day 4th Thursday in November

j. Day after Thanksgiving 4th Friday in November

k. Christmas Day December 25th (or Friday before or Monday after)

5. COMPLETENESS AND ACCURACY

The Consultant will be responsible for the completeness and accuracy of work prepared by the Consultant and will correct, at its expense, all errors or omissions which may be disclosed.