10-RFP 09 Attachment 1.xlsx

XLSX spreadsheet 69 KB Posted Jul 12, 2026

Attached to: Employee Dental Benefits
Solicitation number: RFP26-69
Issued by: Los Alamos County, New Mexico

About this file

Written by GovTribe AI · Jul 15, 2026

Summary

This is a Request for Proposal (RFP) attachment containing detailed specifications and questionnaires for dental insurance benefit coverage services issued by Los Alamos County, New Mexico. The RFP seeks qualified vendors to provide comprehensive dental insurance benefits, including Administrative Services Only (ASO) options, claims administration, provider network coverage, and customer service effective January 1, 2027. Vendors must respond to detailed specifications across multiple sections addressing plan design, network accessibility, and operational capabilities. The document does not specify a response deadline, site visit requirements, or bidder's conference details within the provided attachment, though these details are likely contained in the main RFP document. The contract term requires guaranteed self-funded fees for a minimum of two years from the effective date, with four or more years of guaranteed fees preferred. The County requires 120-day advance notice of renewal rates and reserves the right to terminate coverage with no more than 30-day notice and without penalties.

Pricing must be submitted on a mandatory Cost Proposal Response Form and must be proposed net of any premium tax and commissions, as Los Alamos County is exempt from New Mexico insurance premium tax. The current ASO fee history shows increases from $4.63 PEPM in 2020-2023 to $5.66 PEPM in 2026. Vendors must be licensed in New Mexico or willing to obtain licensure and must maintain provider networks in Los Alamos, Espanola, Santa Fe, Taos, Albuquerque, and Rio Rancho. The County requires detailed network accessibility data, procedure code analysis with hard copy and Excel file submissions, and provider disruption analysis. Vendors must comply with all HIPAA and EDI requirements, provide quarterly claims reporting with online access capabilities, maintain designated customer service representatives, and agree to audits by the County or its representatives without additional fees.

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Other files

File	Type	Posted
8-RFP 08 Cost Proposal Worksheet.pdf	PDF	Jul 12, 2026
3-RFP 04 Request for Preference Form.pdf	PDF	Jul 12, 2026
1-RFP 01 Sample Services Agreement.pdf	PDF	Jul 12, 2026
11-RFP 00 Request For Proposal.pdf	PDF	Jul 12, 2026
6-RFP 07 Agreement Deviations and Exceptions Form.pdf	PDF	Jul 12, 2026
4-RFP 05 Verification of Authorized Offeror Form.pdf	PDF	Jul 12, 2026
9-RFP 08 Cost Proposal Worksheet.docx	DOCX document	Jul 12, 2026
2-RFP 03 Certification Debarment Suspension Form.pdf	PDF	Jul 12, 2026
7-RFP 02 Campaign Contribution Form.pdf	PDF	Jul 12, 2026
5-RFP 06 Request for Client Information Form.pdf	PDF	Jul 12, 2026

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A-Specifications

SECTION A - SPECIFICATIONS

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

VENDORS MUST COMPLETE THIS SECTION.

If you are unable to agree to any of the stipulations noted below, you must provide an explanation for your inability to comply. Your inability to meet any of the specifications, may or may not lead to a deduction in point value attributed to your proposal or a disqualification of your response.

	Please indicate whether you agree or disagree with each of these statement and provide detail where requested.
		Agree	Disagree
1	The effective date of 1/1/2027 for coverage is acknowledged and accepted.
2	Self-funded fees must be guaranteed for a minimum of two (2) years from the effective date, with 4 or more years of guaranteed fees preferred. If you are offering a guarantee or fee cap for subsequent years, indicate this on the mandatory Cost Proposal Response Form.
3	Renewal rates must be submitted 120 days prior to the renewal date.
4	The vendor will be responsible for producing the Plan Document / Summary Plan Description. The County of Los Alamos and the consultant reserve the right to review / revise the SPD prior to final printing.
5	Vendor agrees to provide an Summary Plan Description/document draft within 30 days of the effective date.
6	Vendor must provide a designated customer service representative for this group
7	Vendor agrees to waive the “actively at work” provision for the currently enrolled. The master contract will reflect the elimination of the actively at work restriction or deferred effective date for all initially enrolled active or inactive employees and dependents. This will include only initial eligibles (those eligible on the effective date of the contract) including COBRA continuees.
8	Vendor is in and will maintain compliance with all HIPAA Privacy and Electronic Data Interface (EDI) requirements along with security regulations.
9	Vendor has reviewed and accept the Plan’s eligibility provisions outlined in the RFP.
10	The contract must require no more than a 30-day notice of termination by the County. Your contract cannot prohibit the group from terminating coverage at any time. There must be no penalties for late notification or for termination off anniversary.
11	Claims reporting must be provided to the County and its benefits consultant on a quarterly basis and prior to each renewal. Additional reports will be provided on an ad-hoc basis, if required by County.

· If you are unable to provide claims experience on a quarterly basis, please describe frequency and format of claims reports. If you are unable to provide any reporting, please explain the reason.

12	The County and its consultant must be able to access reports online.
13	Vendor must be licensed in New Mexico, or willing to obtain a license in New Mexico.
14	Vendor currently has a provider network in Los Alamos, Espanola, Santa Fe, Taos, Albuquerque or Rio Rancho New Mexico and the surrounding areas.
15	Vendor may be required to attend Open Enrollment meetings.
16	Vendor has specifically listed all deviations from the RFP and coverage requirements on the Submission of County’s Standard Sample Service Agreement with Deviations or Exceptions Noted or Statement of No Deviations or Exceptions. NOTE: Deviations MUST be listed; you cannot simply make a “general” reference to section(s) of the proposal.
17	You completed all questionnaires and exhibits in full and in the format requested (e.g., Word or Excel – not PDF).
18	By New Mexico State statute(s), insurance premium tax does not apply to public entity employers including, but not limited to, cities, counties, school districts, etc. Confirm your understanding that the County is NOT subject to premium tax or commissions, and that your financial rates are proposed NET of any premium tax and commissions.
19	Vendor agrees to audits conducted by the County or their chosen auditor. Vendor agrees to make available all provider records to the County or its representatives (e.g. County auditiors, actuary, etc.)

B-Dental Plan Questio

Section B - DENTAL PLAN QUESTIONNAIRE

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

CARRIERS: PLEASE COMPLETE THE FOLLOWING. DO NOT ALTER THE FORMAT OR REQUESTED DATA IN ANY WAY.

1	Indicate any minimum requirement for employee and dependent participation.
2	Describe any pre-authorization requirements and the process.
3	Describe any pre-authorization requirements and the process.
4	Do you have an extension of benefits when an employee initiates treatment while covered and completes it after termination of coverage?
	· For Major Restoration?	Yes		No
	• If yes, …	# of Months		Until work is completed
	· For Orthodontia?	Yes		No
	• If yes …	# of Months		Until work is completed
5	Are Out of Network claims paid according to Usual and Customary levels (U&C)?	Yes		No
	• If yes, what percentile of U&C is utilized?		%
6	If Out of Network claims are paid according to U&C, does the County have the option to dictate what percentile claims will be paid at?	Yes		No
7	Describe pre-certification requirements if using non-participating dentists.
8	Do you offer any type of additional program that would allow members to receive discounts on any services provided by non-participating dentists?	Yes		No
	• If yes, explain how this program works.
9	How are claims for emergency services paid if using non-participating dentists?
10	Do you own your provider network, or do you subcontract?		Own		Subcontract
	• If you subcontract, please identify network.
11	What was your provider retention rate and/or network turnover for the following years?
	2024
	2023
12	Are you willing to add providers specifically requested by the client?	Yes		No
13	How many providers have been added to your network in 2025?
	• How many terminated?
	• How many chose to terminate participation?
14	How do you monitor provider compliance with policies and protocols?
15	What is the standard percentile used as a basis to determine R&C?
16	How often are Dental R&C allowances revised?
17	How often are network provider allowances revised?
18	Do you have different provider network arrangements (e.g., “Preferred” vs. “Participating”)?	Yes		No
	• If yes, describe.
	• If you do have different network provider arrangements, please answer the following:
	Are network discounts available WITH plan design differentials?
	"Preferred" Provider	Yes		No
	"Participating" Provider	Yes		No
	Are network discounts available WITHOUT plan design differentials?
	"Preferred" Provider	Yes		No
	"Participating" Provider	Yes		No
	How are “Preferred” dentists paid? (check all that apply)		Discounted fee for service
			Fee schedule
			Other (describe)

How are “Participating” dentists paid? (check all that apply)	Discounted fee for service
	Fee schedule
	Other (describe)

19	Do the network dentists have a contractual agreement not to “balance bill” the patient?	Yes	No
20	For services covered but not eligible for reimbursement because member deductible is not satisfied, are network discounts applied to all portions of the claim being paid by the member?	Yes	No
21	Briefly describe your national network, including major locations, number of providers, and any upcoming plans for expansion of the network.
22	Briefly describe how claims incurred outside of the U.S. are processed.
	• Is any type of pre-authorization required for non-emergency services occurring outside of the U.S.?	Yes	No
23	With regard to network directories, please respond to the following items.
	• Are your directories available online?	Yes	No
	• How are members, and plan sponsors notified of changes in your network?

C-Vendor Info

SECTION C - VENDOR INFORMATION

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

VENDORS MUST COMPLETE AND PROVIDE RESPONSES IN THE COLUMN AT THE RIGHT. IF NOT APPLICABLE, INDICATE "N/A"

1	Provide a brief description of your organization, to include, at a minimum: parent company and location; quoting organization and location, if different; and subcontractors/partners, if any.
	For each organization noted, provide:
	Where is your corporate headquarters located?
	Number of employees
	How many New Mexico employers with greater than 500 employees are administered by your organization?
2	What is the average size of New Mexico employers that you cover?
3	What is the average length of the contract you've held with New Mexico employers?
4	What Claim and Member Service center(s) will be responsible for this account? Provide the following:
	Location of office
	Size of office
	Days and hours of operation
	Will you provide a toll-free number?
5	Indicate all foreign languages offered by your Member Services center(s)
6	What is the normal lead-time required to implement a group?
6	Please outline details regarding your transition/implementation process.
7	Do you require a deposit?
	If so, how much do you require?
	Can the deposit requirement be waived?
	What are the requirements for waiving the deposit?
8	Do you offer Performance Guarantees. If so, please describe.
9.	When are premiums due under your policy?
	What is the grace period?
	If premium is paid after the grace period, is a penalty and/or interest charge assessed?
	If yes, explain in detail.
	Are there any options available with respect to the grace period?
	If so, explain the option(s) and any charge that is made for them.
10	Describe all Support/Educational tools that are availble for the County HR department as well as employees (add extra lines as needed)
9	Which of the following tasks can members and plan sponsor representatives perform online? (check all that apply)	Members	Plan Sponsors
	Billing (Plan Administrators only)	N/A
	• ID Card request
	• Claim inquiry
	• Other
	• Other

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D-ASO Responses

SECTION D - ADMINISTRATIVE SERVICES ONLY (ASO) RESPONSES

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

CARRIERS: PLEASE COMPLETE THE FOLLOWING. DO NOT ALTER THE FORMAT OR REQUESTED DATA IN ANY WAY.

If you are unable to agree to any of the stipulations noted below, you must provide an explanation for your inability to comply. Your inability to meet a minimum requirement, may or may not lead to a deduction in point value attributed to your proposal or a disqualification of your bid.

CURRENT AND PROPOSED PLAN DESIGN

Calendar Year Deductible	$50/$150
Diagnostic and Preventive	100% paid by Plan
Restorative	80% paid by Plan
Basic	80% paid by Plan
Major	50% paid by Plan
Orthodontic	50% paid by Plan
Maximums
§ Annual	$1,500
§ Lifetime for ORTHODONTICS	$1,500
Predetermination of Benefits	Yes

DENTAL ASO FEE HISTORY PEPM

2020-2023	2024	2025	2026
$4.63	$4.95	$5.29	$5.66

1.	The vendor agrees that the claims and accompanying eligibility data produced in connection with all the claim payment activities on behalf of the client is and will be the property of the client. And, that the client retains the right to request the full and complete data in electronic format with proper notice and at no additional cost.	Agree	Disagree
2.	For any non-incumbent vendor, the existing administrator will pay run-out claims. Your pricing should assume no run-in claims payment.	Agree	Disagree
3.	You must provide access to all files on request (e.g., a claims audit) and not to assess any fee for such access.	Agree	Disagree

A. FIRM / ORGANIZATION
4.	Show the number of employer groups you currently service at the client-assigned claims office in each of the size categories below:
	▪ 150 - 500 EEs
	▪ 500 – 1,000 EEs
	▪ 1,000 + EEs
5.	What is your average annual employee turnover?
6.	Are you able to provide data that benchmarks the client’s experience against the following :
	· Your book of business	Yes	No
	· National norms	Yes	No
	· Similar sized clients	Yes	No

B. CLAIMS ADMINISTRATION SERVICES
7.	Provide a brief list of services that are not covered but for which discounts are available to members, if any, along with the average discount percentage for each category listed.
8.	For services covered but not eligible for reimbursement, are network discounts are applied to any portion of the claim being paid by the member.	Yes	No
9.	Concisely identify and comment on any major claim / eligibility / reporting system changes or upgrades planned in the next 12 to 24 months along with the intended outcome.
10.	You agree to reimburse services provided outside of the U.S.	Yes	No
11.	Do you coordinate benefits?	Yes	No
	▪ If yes, do you outsource this service?	Yes	No
	▪ Does your claim system readily identify potential Coordination of Benefits (COB) opportunities prior to claim payment?	Yes	No
	▪ Do you (1) pend and pursue or, (2) pay and pursue these types of claims?	Pend and Pursue	Pay and Pursue
12.	What is the standard percentile used as a basis to determine Usual, Customary, and Reasonable (UCR)?
	▪ How often is UCR updated?
13.	Audits:
	▪ What is the frequency of your internal audits?
	▪ What is the frequency of your external audits?
14.	At termination, after the runout, how will you handle the following:
	▪ Claims in house, but not processed?
	▪ Claims submitted after the runout period?
15.	What mediums do you accept for plan enrollment? Do you accept electronic interfaces with Tyler Technologies?	Yes	No
16.	When are premiums due under your policy?
	What is the grace period?
	If premium is paid after the grace period, is a penalty and/or interest charge assessed?
	If yes, explain in detail.
	Are there any options available with respect to the grace period?
	If so, explain the option(s) and any charge that is made for them.
17.	Confirm you utilize a claims quality assurance or review process.	Confirmed	Not confirmed
	▪ Do you have reviews conducted by an outside agency?	Yes	No
18.	Describe your reporting capabilities and provide sample reports sent to self funded plans. How often are the reports sent? Provide a list of all standard reports available to Self Funded Plans:
	REPORTS (List below. Add lines if needed):	Frequency	Indicate any cost for report	Indicate any limitation on availability due to size of client

19.	What is the lag time on when reports are provided?
20.	On average, how many clients do you service from each of your Claims and/or Member Service site(s)?
21.	Does the same person handle both claims processing and customer service functions?		Yes		No
22.	How many trained claim examiners do you employ?
	What is their average length of experience?
	What is the volume of claims paid per day per examiner?
23.	Describe your security, backup and disaster recovery procedures.
24.	Does your claim adjudication system have edits for identification of fraudulent claims? (If proprietary, describe the staffing and client response capabilities of your IT staff.)	Yes		No
	Is your system leased/owned?	Own		Lease
	When was the system last updated?
25.	What was your average turnaround time for paid claims for the last two years?
	2024
	2023
26.	Indicate your claims error rate for the last two years:
	2024
	2023
27.	Confirm that if you fail to meet timely payment requirements for in-network providers, neither the members nor the Plan will be liable.	Confirmed		Not confirmed
	▪ Do you have reviews conducted by an outside agency?	Yes		No

E-Network Accessibility

SECTION E - NETWORK ACCESSIBILITY

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

ALL VENDORS MUST COMPLETE ALL TABLES IN THIS SECTION.

Please complete the following charts by noting the number of providers in your network in each cell below.

Dental PPO – Preferred Provider Network*
Metropolitan Area	# of Generalists	% NOT accepting new patients	# of Endodontists	# of Periodontists	# of Orthodontists	# of All Other Specialists	Total
Bernalillo County (871)
Los Alamos County (875)
Rio Arriba County (875)
Sandoval County (871)
Santa Fe County (875)
Taos County (875)

Dental PPO – Preferred Provider Network*
Metropolitan Area	# of Generalists	% NOT accepting new patients	# of Endodontists	# of Periodontists	# of Orthodontists	# of All Other Specialists	Total
Bernalillo County (871)
Los Alamos County (875)
Rio Arriba County (875)
Sandoval County (871)
Santa Fe County (875)
Taos County (875)

*Copy and complete multiple charts if you have differing provider networks (e.g., Preferred and “Participating”). Indicate if one network is a sub-set of another. If one network quoted, complete only one version of the chart.

F-Procedure Code Analysis

SECTION F - DENTAL PROCEDURE CODE ANALYSIS

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

Network Data Request - Dental

Procedure Code Analysis

For each location listed, provide the average network discounted allowable fee for the procedure codes provided; include plan liability as well as member share. Also indicate your maximum allowance at the percentiles of Reasonable & Customary charges indicated. As a percentage of ALL procedure code allowable charges, what percentage of total do the codes listed typically represent based on your overall book of business?

NOTE: If network arrangement is based on % of billed, indicate actual average allowance in dollar terms based on 2025 plan experience. Indicate the percentage discount in the comments of the exhibit below each location as applicable.

Your proposal response MUST include hard copy and an Excel file version. Do not alter order of codes, or insert columns or rows.

Failure to comply may result in elimination of your proposal from consideration!

Note: ACTUARIAL OR OFFICER ATTESTATION IS REQUIRED BELOW. *

Note: To the extent there are differences in the average/maximum allowable by location within the Zip Codes identified, please identify those locations and provided requested data using the blank sections. Add sections as needed.

Responding Company Name:

ZIP 875 - Los Alamos, NM

ZIP 870/871 - Albuquerque, NM area

ADA Code

Description

Expected % of total Procedures

Expected % of total allowable charges

80th Percentile R&C

90th Percentile R&C

In-Network Contracted Rate

80th Percentile R&C

90th Percentile R&C

In-Network Contracted Rate

80th Percentile R&C

90th Percentile R&C

In-Network Contracted Rate

80th Percentile R&C

90th Percentile R&C

In-Network Contracted Rate

80th Percentile R&C

90th Percentile R&C

In-Network Contracted Rate

80th Percentile R&C

90th Percentile R&C

In-Network Contracted Rate

120

periodic oral evaluation

140

limited oral evaluation

150

comprehensive oral evaluation

210

intraoral - complete series

220

intraoral - periapical first film

230

intraoral - periapical each additional film

272

bitewings - two films

274

bitewings - four films

330

panoramic film

1110

prophylaxis - adult

1120

prophylaxis - child

1203

topical application of fluoride - child

1204

topical application of fluoride - adult

1351

sealant

2140

amalgam - one surface

2150

amalgam - two surfaces

2160

amalgam - three surfaces

2330

resin-based composite - one surface (anterior)

2331

resin-based composite - two surfaces (anterior)

2391

resin-based composite - one surface (posterior)

2392

resin-based composite - two surfaces (posterior)

2752

crown - porcelain fused to noble metal

2950

core buildup

4910

periodontal maintenance

7140

extraction, erupted tooth or exposed root

7240

Extraction, complete bony impaction

* As an actuary (ASA or FSA) or officer of the company,

I hereby attest that the information included in this

workbook is accurate and complete.

Sign Date

Print Name Title

Comments Section (okay to insert rows below; DO NOT INSERT COLUMNS):

G-Disruption Analysis

SECTION G - DISRUPTION ANALYSIS

Los Alamos County

RFP 26-69 Dental Insurance Benefits for Los Alamos County Employees

Proposed Effective Date: January 1, 2027

ALL VENDORS MUST COMPLETE ALL TABLES IN THIS SECTION

NETWORK COMPARISON OF MOST HIGHLY UTILIZED DENTAL PROVIDERS

Please complete by checking each dentist below who is currently in your network and who you expect to remain in your network in 2027.

For those not in your network, please indicate at the bottom of the page, what steps you will take to add them to your network, along with time frames and guarantees.

Note: It is our assumption that any additional providers will be contracted at reimbursement rates comparable to those reflected by existing arrangements.

Responding Company Name:

Provider Last Name Provider First Name Address1 Address2 City State Zip Code Is Dentist Currently In Network (Y/N) Will DDS be in Network in 2027 (Y/N)

File details come from the government source that posted it. Updated Jul 15, 2026.