10-Exhibit 2 - Medical Costs Services.xls
XLS spreadsheet 81 KB Posted
- Attached to
- Re-Issue Group Medical Insurance Services
- Solicitation number
- RFP 35-26-NH
- Issued by
- Bernalillo County, New Mexico
About this file
This file contains cost exhibit instructions and worksheets issued by Bernalillo County, New Mexico for a Request for Proposals to provide Administrative Services Organization (ASO) medical claims administration services for the County's self-insured medical plan, with an effective date of July 1, 2026. Vendors must submit completed cost exhibits in Excel format without altering the worksheet structure, order, or format. The instructions require vendors to quote all ASO fees on a per-employee-per-month (PEPM) basis and complete Exhibit 2A (ASO Fees) and Exhibit 2B (ASO Services Components). Vendors must indicate whether ASO fees differ for sole carrier versus slice carrier arrangements and provide a detailed breakdown of Core Administrative Services fees by component, including claims administration, disease management, medical/utilization/case management, network access, onsite clinic integration, and carve-out pharmacy benefit management fees if applicable. The instructions also require vendors to specify any impact to ASO fees and data interface fees should the County carve out stop loss coverage to a third party; however, individual and aggregate stop loss rate quotes are not being requested at this time.
Vendors must guarantee quoted fees for a minimum of two years with no increase permitted between Year 1 and Year 2. All fees must be quoted net of commission. Exhibit 2B requires vendors to identify which services are included in the total core ASO fee and which services carry additional costs. Services subject to this analysis include account management, customer/member services, banking fees, information technology, plan documents, compliance services, PPACA appeals processes, medical management, catastrophic case management, disease management, wellness services, prescription drug administration, provider network access, and online tools. Vendors must also complete supplemental worksheets for disease management (Exhibit 2C) and wellness services (Exhibit 2D) if those services are offered.
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Text version
EXH 2 INSTRUCTIONS
| Bernalillo County |
| Instructions for Proposed Cost Exhibits - ASO MEDICAL |
| Proposed Effective Date: July 1, 2026 |
| VENDOR INSTRUCTIONS |
| This workbook contains multiple worksheets. Vendors are expected to complete all worksheets applicable to the plans / coverages being quoted. |
| DO NOT ALTER THESE WORKSHEETS IN ANY WAY (e.g. CHANGE ORDER, INSERT COLUMNS OR ROWS). YOU MUST COMPLETE IN THE FORMAT PROVIDED (i.e., EXCEL). |
| SELF-INSURED MEDICAL PLAN ADMINISTRATION |
| Quote ALL ASO fees on a per employee per month (PEPM) basis. Vendors offering ASO services must complete the following worksheets found in this file: Exhibit 2A - ASO Fees and Exhibit 2B - ASO Services Components. You must indicate as instructed on Exhibit 2A if ASO fees differ for SOLE carrier versus SLICE carrier arrangement. |
| Fees must be quoted net of commission. |
| STOP LOSS |
| Requests for Individual and Aggregate Stop Loss rates will be issued closer to the July 1, 2026 effective date. Stop Loss quotes are NOT being requested at this time. |
| On Exhibit 2A, you must indicate any impact to ASO fees, and provide any data interface fees, should the County decide to carve out Stop Loss to a third party. |
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Exh 2A ASO Fees
| BERNALILLO COUNTY | |||||
| PROPOSED COST EXHIBITS: SELF-INSURED MEDICAL PLAN ASO FEES | |||||
| EFFECTIVE DATE: JULY 1, 2026 | |||||
| 1) | Quotes fees separately for SOLE carrier and SLICE carrier arrangements, if applicable. Quote fee for self-insured, ASO claims administration assuming all services are bundled with your organization. You must provide a break-out of how much of the Core Administrative Services fee is charged for Claim Administration, Disease Management, Medical Management, and Provider Network Access. Express fee in dollar amount on a PEPM BASIS. | ||||
| 2) | Fee Guarantees. Fees must be guaranteed for a minimum of two years. Fees for Years 1 & 2 must be the same (i.e., there cannot be a fee increase in Year 2). | ||||
| 3) | Do not change the order of worksheet in any way. You must complete in EXCEL. You may add rows if needed. Failure to comply may result in elimination of your proposal from consideration. | ||||
| VENDOR NAME | |||||
| CONFIRM THE FOLLOWING: | |||||
| Fee guaranteed period (must be a minimum of 2 years). | |||||
| SOLE CARRIER FEES | SLICE CARRIER FEES | ||||
| BREAK-OUT OF CORE ADMINISTRATIVE SERVICES FEE FOR BUNDLED SERVICES. PROVIDE ON COMPOSITE BASIS. | EPO | PPO | EPO | PPO | |
| CLAIMS ADMIN FEE | |||||
| DISEASE MANAGEMENT FEE | |||||
| MEDICAL / UTILIZATION / CASE MANAGEMENT FEE | |||||
| NETWORK ACCESS FEE | |||||
| ONSITE CLINIC INTEGRATION FEE | |||||
| CARVE-OUT PBM FEE (IF APPLICABLE) | |||||
| TOTAL CORE ASO FEE | |||||
| EPO | PPO | EPO | PPO | ||
| EFFECT ON QUOTED ASO FEE IF STOP LOSS IS CARVED OUT: | |||||
| COST TO INTERFACE WITH CARVE-OUT STOP LOSS VENDOR: |
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Exh 2B ASO Service Components
| BERNALILLO COUNTY | ||||
| PROPOSED COST EXHIBITS: SELF-INSURED ASO SERVICES | ||||
| EFFECTIVE DATE: JULY 1, 2026 | ||||
| Only vendors offering ASO medical claims administrative services should complete this worksheet. | ||||
| 1) | Indicate below if each of the services listed are included in your Core administrative service fee. If not, indicate additional cost for service. | |||
| 2) | Do not alter the worksheet in any way (e.g., change order, insert columns or rows). Failure to comply may result in elimination of your proposal from consideration. | |||
| VENDOR NAME | ||||
| SET UP FEE, IF APPLICABLE. | ||||
| ADMINISTRATION FEES (PEPM) | EPO Plan | PPO Plan | ||
| 1 | TOTAL CORE ASO FEE: | |||
| Indicate if the following are included in Total Core ASO fee, or show additional cost: | INCLUDED, OR NOTE ADDITIONAL COST: | INCLUDED, OR NOTE ADDITIONAL COST: | COMMENTS | |
| 2 | Account Management | |||
| 3 | Customer / Member Services | |||
| 4 | Banking Fees / Financial Services | |||
| 5 | Information Technology | |||
| 6 | SPDs / Plan Documents | |||
| 7 | PPACA Required Summary of Benefits and Coverage (SBC) | |||
| 8 | Claim Forms | |||
| 9 | Check Stock | |||
| 10 | EOBs | |||
| 11 | Reports | |||
| 12 | HIPAA certificates | |||
| 13 | ID Cards | |||
| 14 | Postage | |||
| 15 | Printing | |||
| 16 | Preparation of information required for federal disclosure forms | |||
| 17 | Submission of Annual Gag Clause Attestation | |||
| 18 | Submission of Annual RxDC Reporting | |||
| 19 | Toll Free number for Member and Provider services | |||
| 20 | Compliance Services | |||
| 21 | Corporate Profit/Surplus | |||
| 22 | Communications Costs | |||
| 23 | Meeting Attendance | |||
| 24 | Commissions | NET | NET | |
| 25 | PPACA Appeals Process (Internal & External) | |||
| 26 | Medical Management / Utilization Management | |||
| 27 | Catastrophic Case Management | |||
| 28 | Disease Management (YOU MUST COMPLETE DM WORKSHEET EXHIBIT 2C) | |||
| 29 | Wellness Services (YOU MUST COMPLETE WELLNESS WORKSHEET EXHIBIT 2D) | |||
| 30 | Prescription Drug administration | |||
| 31 | Provider Network Access Fee | |||
| 32 | Online tools for Employers and Members | |||
| 33 | Other (Define) |
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