11-RFP 09 Attachment 1 Sections A-E.xlsx
XLSX spreadsheet 64 KB Posted
- Solicitation number
- RFP26-70
- Issued by
- Los Alamos County, New Mexico
About this file
This is a Request for Proposal (RFP) attachment document for Long-Term Disability Benefits insurance services for Los Alamos County, New Mexico, with a proposed effective date of January 1, 2027. The RFP solicits proposals from licensed and qualified carriers to provide fully insured, contributory long-term disability coverage for eligible county employees. The document comprises five sections: a Minimum Requirements Questionnaire, a General Questionnaire, an LTD-specific Questionnaire, an LTD Contract Comparison template, and a Rates section. Offerors must complete all sections to be considered responsive. Key requirements include a two-year rate guarantee with potential for a third year guarantee and rate caps for years four through seven, waiver of the "actively at work" provision for currently enrolled participants, provision of a Certificate of Coverage, no-loss/no-gain coverage basis for existing enrollees, and quarterly claims experience reporting. The County requires 120-day termination notice and prohibits penalties for late notification or off-anniversary termination.
Offerors must provide fully insured, fully pooled, non-participating coverage on a net basis with no commissions or premium taxes included in quoted rates. The RFP mandates specific claims management and disability validation procedures, including dedicated claims examiners and detailed reporting of open and closed claims with specified data elements. Offerors must confirm they will not require evidence of insurability for currently enrolled employees and must accept premium remittance on a self-reported basis. The proposal must include industry-standard Survivor Income benefits and may optionally quote the current LTD plan design. Additional requirements address cost containment features, rehabilitation programs, return-to-work incentives, and employee assistance programs, with detailed specifications on benefit calculations, elimination periods, benefit durations, and offsets for other income sources.
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A-Min Requirement Quest
| Attachment 1 - Section A - MINIMUM REQUIREMENTS QUESTIONNAIRE |
| Los Alamos County |
| RFP Long-Term Disability Benefits for Los Alamos County |
| Proposed Effective Date: January 1, 2027 |
OFFERORS MUST COMPLETE THIS SECTION.
| The following are minimum requirements. Please complete the following chart by responding in the right-hand column. If you disagree with any of the criteria, your proposal may be considered non-responsive; please indicate in your cover letter why you are not willing to agree to the requirement. | |||
| Agree | Disagree | ||
| 1 | The effective date of 1/1/2027 for coverage is acknowledged and accepted. | ||
| 2 | For fully insured programs, rates must be guaranteed for a minimum of two (2) years from the effective date. Thereafter, rates may be adjusted no more than once per year. The County is interested in obtaining a rate guarantee for a third year term and rate caps for years 4 - 7. Your completed Cost Proposal Response must indicate any guarantees or caps you are prepared to offer and their terms on RFP Cost Proposal Response. | ||
| 3 | The rates / fees shall not include commissions. No additional fees, compensation, or overrides are to be paid. | ||
| 4 | Renewal rates must be submitted 180 days prior to the renewal date. | ||
| 5 | Offeror agrees to provide a Certificate of Coverage draft by the effective date. | ||
| 6 | The offeror will be responsible for producing the Certificate of Coverage or Benefit Booklet. The County and Aon Consulting, Inc. reserve the right to review / revise the Certificate prior to final printing. | ||
| 7 | Insured coverage must be provided on a no-loss / no-gain basis for all eligible participants so the current group does not suffer a loss of benefit solely due to the transfer of coverages to your firm. | ||
| 8 | You must agree to waive the “actively at work” provision for the currently enrolled. The final agreement 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 those initially eligible. Those currently enrolled insureds who are either on Long-Term Disability benefits, or are in the elimination period, will remain the liability of the current carrier. | ||
| 9 | You have reviewed and accept the Plan’s eligibility provisions outlined in the RFP. | ||
| 10 | Your proposal must provide to the County at least a 120-day notice of termination. Your proposal 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 experience 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. | ||
| 12 | Confirm that you will not require evidence of insurability during the initial enrollment of existing enrollees in the LTD plan. | ||
| 13 | 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. | ||
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B-General Questionnaire
| Attachment 1 - Section B - GENERAL QUESTIONNAIRE |
| Los Alamos County |
| RFP Long-Term Disability Benefits for Los Alamos County |
| Proposed Effective Date: January 1, 2027 |
OFFERORS 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: | |
| Date formed | |
| Where is your corporate headquarters located? | |
| Number of employees | |
| How many New Mexico employers with greater than 500 employees are administered by your organization? | |
| Have you recently been acquired or been involved with any merger/acquisition? If yes, describe. | |
| Provide company’s organization chart, including County service team and locations of service team. | |
| 2 | Do you carry an Errors & Omissions policy? |
| What are the policy limits and deductible? | |
| 3 | Do you carry a comprehensive general liability policy? |
| What are the policy limits and deductible? | |
| 4 | Does your company carry a fidelity bond? |
| What are the policy limits and deductible? | |
| What are the combined aggregate funds held for all Countys? | |
| 5 | What is the average size of New Mexico employers that you cover? |
| 6 | What customer service office 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? | |
| 7 | What is the normal lead-time required to implement a group? |
| 8 | Please outline details regarding your transition/implementation process. |
| 9 | 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? | |
| 10 | What mediums do you accept for plan enrollment? |
| 11 | Is evidence of insurability a requirement under ANY part or parts of the plan proposed by your company? |
| If yes, specify. | |
| 12 | 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. |
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C-LTD Questionnaire
| Attachment 1 - Section C - Long-Term DISABILITY QUESTIONNAIRE |
| Los Alamos County |
| RFP Long-Term Disability Benefits for Los Alamos County |
| Proposed Effective Date: January 1, 2027 |
All offerors must complete the LTD Contract Comparison Spreadsheet and the questionnaire to be considered. Do not alter any of the contents contained in the current carrier's column.
| 1 | Confirm you included detailed plan summaries for all quoted plans. |
| 2 | Confirm that the pre-existing condition clause does not apply to those who are currently enrolled, and actively-at-work on the proposed policy effective date, and have satisfied any previous pre-existing condition requirements of the prior policy. If no, which condition(s) is/are not met. |
| 3 | Do you agree to accept premium remittance on a self-reported basis? |
| 4 | Provide a sample premium remittance form or data requirements. |
| 5 | Will you require a periodic census report? |
| - If so, frequency of report? | |
| - What information is required? | |
| 6 | Briefly describe your claim management process, and the types of personnel involved (e.g. nurse case managers, others). |
| - Describe the qualifications and experience of such personnel. | |
| - Are all registered nurses? | |
| - With whom does this personnel have contact (employee, employer, physician, etc.)? | |
| 7 | What determines whether your physician will review the attending physician's statement? |
| 8 | What is your appeals process for denied claims? Please provide details. |
| 9 | On average, what percentage or number of disability claims or cases are referred to a physician for consultation and review? |
| 10 | Could your proposal be designed to insist upon a third physician's opinion when the claimant's and your company's physicians disagree on the status of a claimant? |
| 11 | Once approved for disability benefits, how frequently is validation of continued disability required? |
| 12 | What is the process used to validate continued disability once approved? |
| 13 | What part does your company play in assisting LTD claimants to obtain Social Security disability benefit awards? |
| - Do you pay out the unreduced benefit and then collect retroactively if Social Security disability is approved? | |
| - Do you pay the net benefit and then pay an additional amount if Social Security is ultimately denied? | |
| 14 | Describe your process and success rate in obtaining refunds of overpayments due to subsequent Social Security awards when full LTD benefits have previously been paid without Social Security offsets. (This would be applicable to claimants who previously worked for an employer participating in Social Security.) |
| 15 | Will you assign a dedicated claims examiner and/or disability management team to this County’s account? |
| - Identify this individual and/or each team member; briefly describe his/her background and experience. | |
| 16 | Do you have the capability to withhold, on behalf of the County, from benefit amounts for: |
| - FICA taxes? | |
| - State taxes? | |
| - Employee benefit contributions? | |
| 17 | Does your proposal contain language to support and administer a plan with provisions outlined in IRS ruling 2004-55? |
| 18 | Please indicate the percentage of premium that would be retained for incurred but unreported claims. |
| 19 | Explain how you establish the reserve for claimants during the elimination period. |
| 20 | What credibility would you assign to the County’s experience? |
| 21 | If not full credibility, please describe the development of the credibility factor. |
| 22 | Does your company review the claims and vary reserves from the tabular calculation based on known claim circumstances? |
| - If so, how often? | |
| 23 | Would a claim stabilization reserve be mandatory? |
| - If so, based on your premium bid, what maximum percent of annual premium would be established for such fluctuations? | |
| 24 | Is the entire reserve established in the first rating period, if possible, or over a longer period? |
| 25 | How would the reserve be handled upon termination? |
| 26 | What percentage of interest is paid to or credited to the policyholder for the following reserves: |
| - Incurred but not reported? | |
| - Disabled life reserve for open claims? | |
| - Claim stabilization reserve? | |
| 28 | How will the expected claims be estimated? |
| 29 | Identify the terms and conditions of at termination of an agreement (i.e. County liability, responsibility for incurred claims, etc.). |
| 30 | When would you prepare and present a final experience accounting? |
| 31 | Confirm that your proposal for fully insured Long-Term disability coverage is presented on a fully insured, fully pooled, non-participating basis |
| 32 | Confirm that you will provide claims activity / experience and open and closed claims reports on a quarterly basis. |
| 33 | Confirm your ability to provide detailed open and closed claims reports with, at a minimum, the following information: |
| · Name, Gender, DOB | |
| · Employer division | |
| · Occupation or job classification | |
| · Date of disability | |
| · Cause of disability/diagnosis/injury type | |
| · Basic monthly salary at disability | |
| · Monthly benefit | |
| · Reserve amount | |
| · Date claim closed/benefits terminated |
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D-LTD Contract Comparison
| Attachment 1 - Section D - LONG-TERM DISABILITY CONTRACT COMPARISON |
| Los Alamos County |
| RFP Long-Term Disability Benefits for Los Alamos County |
| Proposed Effective Date: January 1, 2027 |
CARRIERS: PLEASE COMPLETE THE FOLLOWING DESCRIPTION OF BENEFITS USING EXCEL. DO NOT ALTER THE FORMAT OR REQUESTED DATA IN ANY WAY.
PROPOSAL SUMMARY - Long-Term DISABILITY INSURANCE
| 1 | What is the definition of own occupation? |
| Does the elimination period count toward the “own occ” period? | |
| 2 | Definition of any occupation |
| 3 | Is Earnings Loss AND Occupation Loss required to satisfy elimination period or begin benefit payments? |
| 4 | Definition of partial disability |
| 5 | Does your standard LTD policy contain a requirement that total disability must precede partial disability? |
| Can you provide a residual definition from the 1st day of disability, based on an earnings test of 80%? | |
| If yes, what is the incremental increase to proposed rates? | |
| 6 | Using 80% earnings test, do you index pre-disability earnings so benefit is not offset by future raises? |
| 7 | Does your proposal offset benefits for the following items: |
| No-fault motor vehicle, or disability payments from auto liability? | |
| Subrogation? | |
| Third party settlements? | |
| Individual disability policies? | |
| Formal / Informal salary continuation? | |
| Salary continuance provided by ER | |
| Paid time off benefits provided by ER | |
| Sick leave benefits provide by ER | |
| Unemployment benefits | |
| Worker's comp benefits | |
| Occupational disease benefits | |
| Any similar act or law | |
| Social Security, PERA, Canada Pension, etc. | |
| Disability payments from plan or arrangement of disability coverage resulting from employment or association with any ER | |
| Disability payments from group life / accident policy | |
| Does integration include Full Family? | |
| 8 | Rehabilitation |
| Does proposal include rehab benefits? | |
| If so, are they mandatory or voluntary? | |
| Please explain in detail your rehabilitation program, including part-time work and possible reduction of benefit, for performance of non-comparable work. | |
| Do you have an in-house rehabilitation staff dedicated exclusively to LTD claimants? | |
| Is a discount applied to the rate? | |
| What percentage of rehabilitation earnings is used to offset your LTD benefit? | |
| 9 | Return To Work Incentive Program and Benefits |
| Do you have a return-to-work incentive program? | |
| Does the offset of other income apply during the 1st year? | |
| 10 | Describe how separate periods of disability from the same cause are calculated to determine the elimination period. |
| 11 | Describe how you handle the payment of benefits for a recurring disability. |
| 12 | Included Cost Containment Features, as listed below: |
| Limitation (If the limitation period is combined for any of the conditions, please indicate.) | |
| Mental / Nervous | |
| Drug / Alcohol abuse | |
| Musculoskeletal / Connective Tissue Limitations | |
| Self-reported illness or sickness | |
| Specific injury or sickness limitations | |
| Prudent person | |
| Gainful occupation | |
| Pre-Existing Conditions | |
| 13 | Does your proposal contain a childcare benefit? |
| 14 | Does your proposal contain a spouse disability benefit? |
| 15 | Does your proposal contain any Long-Term Care benefits? |
| 16 | Does your proposal provide Reasonable Accommodation/Worksite Modification benefits? |
| What is the benefit? | |
| 17 | Does your proposal include CPI indexation? |
| How does it work? | |
| 18 | Do you have a Cost of Living Adjustment (COLA)? |
| If yes, what is the impact on the rate? | |
| 19 | Is Waiver of Premium included? |
| Confirm the following: the premium must be waived after the employee satisfies the elimination period and the WOP is applicable when the employee is approved for the benefit. | |
| 20 | Does your LTD policy include a portability privilege? |
| 21 | Describe any Survivor Income Benefit |
| 22 | Describe the following standard LTD contract provisions: |
| Partial Disability Benefit Calculation | |
| Other standard LTD contract provisions: | |
| Additional Services for Work/Life | |
| Indexation | |
| Identify any additional benefits / provisions | |
| Your coverage is to reflect coverage provided on a no loss / no gain basis | |
| Confirm that you will not require EOI during the initial enrollment of existing enrollees in the LTD plan | |
| 23 | Are Benefits payable for any illness or injury? |
| 24 | Does your standard LTD contract have any of the following exclusions? |
| Armed conflict, war | |
| Intentionally self-inflicted injury | |
| Sickness, injury occurring while in military services | |
| Committing assault or felony | |
| Participation in riot | |
| Injuries suffered in fight in which EE is aggressor | |
| Loss of professional license / certification | |
| Sickness/injury due to cosmetic or reconstructive surgery, except surgery to correct deformity caused by sickness/injury | |
| 25 | Does the LTD plan include an Employee Assistance Program (EAP)? If yes, describe benefits such as # telephonic and face-to-face visits, legal and financial assistance, etc. |
| What is the additional cost of the EAP? | |
| Does the EAP plan and rates include all employees or just those who are enrolled in the LTD plan? | |
| If the EAP plan only includes LTD enrolled employees, what is the additional charge to add the non-enrolled LTD employees? | |
| 26 | Does your proposal require the claimant to apply for Social Security disability benefits to receive benefits from you? |
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E-Rates
| Attachment 1 - Section E - RATES |
| Los Alamos County |
| RFP Long-Term Disability Benefits for Los Alamos County |
| Proposed Effective Date: January 1, 2027 |
| CARRIERS: PLEASE COMPLETE THIS CHART FOR THE PLANS AND RATES YOU ARE QUOTING: |
| IF NECESSARY, COPY AND COMPLETE THIS SPREADSHEET FOR ANY ALTERNATIVE PLANS YOU ARE QUOTING. |
| Benefits | |
| Quote an LTD contract that includes fully-insured industry-standard Survivor Income benefits, and does not include any Life / AD&D benefits. Please complete RFP Cost Proposal Response. | |
| As an option only, quote the Plan Design outlined in Current LTD Policy attached to RFP solicitation, or a proposal that offers similar features. This option is not required; quote only if you are able to offer such a proposal. Please complete RFP Cost Proposal Response. | |
| Funding | |
| Quote on a fully insured basis . Illustrate your rates in RFP Cost Proposal Response | |
| LONG-TERM DISABILITY BENEFITS | OFFEROR RESPONSE |
| BENEFITS | Provide a brief description of the features listed: |
| Benefit Percentage | |
| Minimum Monthly Benefit | |
| Maximum Monthly Benefit | |
| Elimination Period | |
| Duration of Temporary Recovery During Elim Period | |
| Definition of Total Disability (include Own Occ, and Income loss requirements) | |
| Benefit Duration (include schedule of Age Related Benefit Reductions, if applicable). | |
| Pre-existing Condition | |
| Life and AD&D benefit, if included | |
| Survivor Income Benefit, if included |
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