15-D4 - City of Burleson - Dental RFP Questionnaire.xlsx

XLSX spreadsheet 907 KB Posted

Attached to
RFP 2026-015 Dental & Vision Insurance Benefits
Solicitation number
RFP 2026-015
Issued by
Johnson County, Texas

About this file

This is a Request for Proposal (RFP) questionnaire prepared by Lockton Companies, LLC for the City of Burleson, Texas, seeking dental insurance coverage for eligible full-time employees, retirees, and dependents with an effective date of January 1, 2027. The City requests quotes matching current plan designs as well as alternative enhanced designs, with proposals due in Excel format as specified in the questionnaire template. Bidders must provide both self-funded and fully insured quote options, clearly define any deviations from requested plan designs, and submit completed questionnaires along with standard proposal materials. The RFP requires a detailed implementation timeline assuming a business award date of June 1, 2026, and mandates that vendors commit to having ID cards in employees' hands and all benefits accurately loaded and tested by the January 1, 2027 effective date.

The current dental programs are self-funded and administered by UHC under a National PPO 30 Base Plan and PPO Buy-Up Plan, with enrollment of 268 employees on the Base Plan and 150 on the Buy-Up Plan for self-funded options, and 132 and 60 employees respectively for fully insured options. Vendors must provide administrative fees on a net commission basis with no modifications to commission levels, quote a five-year rate guarantee, and submit performance guarantees covering implementation, claims processing, member services, and other operational metrics with specified dollar or percentage amounts at risk. The questionnaire requires vendors to demonstrate relevant experience administering dental plans for public entities, detail claims processing locations and capacity, provide network accessibility data for general dentists, specialists, and orthodontists, and outline customer service capabilities including dedicated account management, web-based reporting, and integration with the City's BenAdmin system.

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Front Cover

Request for Proposal - Dental

City of Burleson

Prepared by:
Lockton Companies, LLC
Date:
Effective 1/1/2027
2100 Ross Avenue, Suite 1200
Dallas, TX 75201
(214) 969-6100 phone
www.lockton.com

Introduction Introduction

Background
The City of Burleson has requested Lockton Companies to complete an evaluation of its Dental programs
Current Program
The current dental programs for Burleson are self funded. We are requesting a self funded and fully insured quote. The currently plans are administered by UHC.
Proposal Guidelines
For all proposals:
•Quote matching the requested plan designs and clearly define all deviations.
•Quote alternative enhanced plan design as requested in the 'Plan Design' tab.
•Please provide the following information:
—Applicable administrative fee for all options quoted.
—Network GeoAccess for all locations using criteria specified in proposal.
—Benefit summaries for all plans quoted.
—Standard proposal material.
—Completed Questionnaire in an Excel format
—All Financial proposals with any caveats or exclusions
Commission Level
NET
Please do not modify the template’s layout or formatting—any supplemental details can be added in the “Additional Information” area tab.
Service
Rates
Rate Validation/Check
Network Accessibility
Claims Service
New Client/Prospect
Renewal Review
Other
Flat fee
Capitated fee (per employee per month)
Flat percentage of premium
Graded percentage of premium
Member-based sliding schedule
Net of commission
Other

Bidder Information

Vendor Name
Vendor Contact Name
Vendor Contact Email
Vendor Contact Phone Number
Vendor Fax

Plan Design

Requested Dental Plan DesignQuote CurrentQuote Alternate 1Quote Alternate 2
Note -Please quote the plans as they are currently and provide an alternate option for adding adult ortho on the high plan and no ortho on the low plan. Also, add an option to not apply the preventive care to the annual maximum.
PLAN DESIGNS THAT THE VENDOR SHOULD USE TO PROVIDE QUOTES TO
MATCH CURRENT:PLAN DESIGNS THAT THE VENDOR SHOULD USE TO PROVIDE QUOTES FOR MATCHING PLAN DESIGN:PLAN DESIGNS THAT THE VENDOR SHOULD USE TO PROVIDE QUOTES FOR ALTERNATIVE DESIGN:PLAN DESIGNS THAT THE VENDOR SHOULD USE TO PROVIDE QUOTES FOR ALTERNATIVE DESIGN:
Current: National PPO 30 Plan
(Base Plan)Current: PPO
(Buy-Up Plan)Proposed Base Plan
Proposed Buy-Up Plan
Proposed Base Plan
Proposed Buy-Up Plan
Proposed Base Plan
Proposed Buy-Up Plan
UHC DentalUHC DentalCarrier NameCarrier NameCarrier NameCarrier NameCarrier NameCarrier Name
General Plan InformationIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkIn-NetworkOut-of-Network
Annual Deductible$50/$150$50/$150$50/$150$50/$150$50/$150$50/$150$50/$150$50/$150
Annual Plan Maximum$2,000 / $500 for treatment of TMJ$3,000$2,000 / $500 for treatment of TMJ$3,000$2,000 / $500 for treatment of TMJ$3,000$2,000 / $500 for treatment of TMJ$3,000
Preventative applies to annual Max?YesYesYesYesYesYesNoNo
Lifetime Orthodontia Plan Maximum$1,500 (child only)$2,500 (child only)$1,500 (child only)$2,500 (child only)Not Covered$2,500 (child + adult)$1,500 (child only)$2,500 (child + adult)
Annual Max Rollover OptionDoes not applyDoes not applyDoes not applyDoes not apply(PROVIDE COST AS OPTIONAL - PROVIDE DETAILS ON HOW IT WORKS)(PROVIDE COST AS OPTIONAL - PROVIDE DETAILS ON HOW IT WORKS)(PROVIDE COST AS OPTIONAL - PROVIDE DETAILS ON HOW IT WORKS)(PROVIDE COST AS OPTIONAL - PROVIDE DETAILS ON HOW IT WORKS)
OON Reimbursement Level90th Percentile of R&C90th Percentile of R&C90th Percentile of R&C90th Percentile of R&C90th Percentile of R&C90th Percentile of R&C90th Percentile of R&C90th Percentile of R&C
Preventive Services
Preventive Coinsurance100%100%100%100%100%100%100%100%
Oral Exams
Bitewing X-Rays
Complete series or Panoramic X-Rays
Cleaning and Scaling
Fluoride Treatments
Sealants
Basic Services
Basic Coinsurance80% after plan deductible80% after plan deductible80% after plan deductible80% after plan deductible80% after plan deductible80% after plan deductible80% after plan deductible80% after plan deductible
Restorative: Fillings
Simple Extractions
Amalgam and Resin-Based Fillings
General Anesthesia or IV Sedation
Major Services
Major Coinsurance50% after plan deductible
there is a 6-month waiting period for partial or complete dentures50% after plan deductible
there is a 6-month waiting period for partial or complete dentures50% after plan deductible50% after plan deductible50% after plan deductible50% after plan deductible50% after plan deductible50% after plan deductible
Oral Surgery
Periodontic Treatment
Endodontic Treatment
Inlays and Onlays
Crowns, Bridges and Dentures
Complex Extractions
Dentures and Denture Repair
Implants
Orthodontia Services
Orthodontia Coinsurance (Only children covered currently)50%50%50%50%Not Covered50%50%50%
Rate Guarantee
Years5 Years5 Years5 Years
Please do not modify the template’s layout or formatting—any supplemental details can be added in the “Additional Information” tab.
Any changes to input plan design should be highlighted.

&P

Rates & Contributions

Current Dental Plan is voluntary and self-funded
UHC DentalUHC DentalPROPOSEDPROPOSEDPROPOSEDPROPOSEDPROPOSEDPROPOSED
PPO Base Plan
(National PPO 30)PPO
Buy-Up PlanProposed Plan
(Match Current PPO 30)Proposed Plan
(Match Current Buy-Up)Proposed Plan
(PPO Base Plan)Proposed Plan
(PPO Buy-Up Plan)Proposed Plan
(PPO Base Plan)Proposed Plan

(PPO Buy-Up Plan)

To be completed by bidderTo be completed by bidderTo be completed by bidderTo be completed by bidderTo be completed by bidderTo be completed by bidder
CurrentCurrentPROPOSED CURRENTPROPOSED CURRENTPROPOSED ALTERNATE 1PROPOSED ALTERNATE 1PROPOSED ALTERNATE 2PROPOSED ALTERNATE 2
Monthly Admin FeeMonthly Admin FeeMonthly Admin FeeMonthly Admin FeeMonthly Admin FeeMonthly Admin FeeMonthly Admin FeeMonthly Admin Fee
PPO Base Plan (National PPO 30)Buy-Up PlanBase PlanBuy-Up PlanBase PlanBuy-Up PlanBase PlanBuy-Up Plan
Employee Only$4.15$4.15
Employee + Spouse
Employee + Child(ren)
Employee + Family
Headcounts268150268150268150268150
Total Cost Per Month$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00
Total Annual Cost$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00
PROVIDE A FULLY INSURED QUOTE AS AN OPTION
UHC DentalUHC DentalPROPOSEDPROPOSEDPROPOSEDPROPOSEDPROPOSEDPROPOSED
PPO Base Plan
(National PPO 30)PPO
Buy-Up PlanProposed Plan
(Match Current PPO 30)Proposed Plan
(Match Current Buy-Up)Proposed Plan
(PPO Base Plan)Proposed Plan
(PPO Buy-Up Plan)Proposed Plan
(PPO Base Plan)Proposed Plan

(PPO Buy-Up Plan)

To be completed by bidderTo be completed by bidderTo be completed by bidderTo be completed by bidderTo be completed by bidderTo be completed by bidder
PROPOSED CURRENTPROPOSED CURRENTPROPOSED ALTERNATE 1PROPOSED ALTERNATE 1PROPOSED ALTERNATE 2PROPOSED ALTERNATE 2
Enrollment CountsEnrollment CountsMonthly Fully Insured RatesMonthly Fully Insured RatesMonthly Fully Insured RatesMonthly Fully Insured RatesMonthly Fully Insured RatesMonthly Fully Insured Rates
PPO Base Plan (National PPO 30)Buy-Up PlanBase PlanBuy-Up PlanBase PlanBuy-Up PlanBase PlanBuy-Up Plan
Employee Only13260
Employee + Spouse
Employee + Child(ren)
Employee + Family13690
Total Cost Per MonthN/A
Total Annual CostN/A
Please do not modify the template’s layout or formatting—any supplemental details can be added in the “Additional Information” tab.

Questionnaire

Dental Questionnaire
Please do not modify the template’s layout or formatting—any supplemental details can be added in the “Additional Information” tab.
Organization[Insert Carrier Name]Additional Information
vIdentify and describe your relevant experience with administering dental services similar to this plan in both size and design.
vHow long has your organization been providing dental services?
vDescribe your experience working with public entity clients.
Fees, Renewals and Guarantees
vDescribe your process for implementation of the benefit plan including:
vTimeline required by your company.
vID card design and welcome package options including time needed for approval by the City.
vClaim form design and approval from the City.
vParticipant material production, review, approval, and distribution process.
vImplementation and open enrollment communication strategy.
vAssuming a business award date of June 1 for an effective coverage date of January 1, please include a copy of your detailed transition plan/timeline that includes completion dates for each specific task. List any start-up fees.
vPlease provide an implementation guarantee that includes having ID cards in employees hands and loading/testing of all benefits accurately on or before the effective date of the new plan. Include 'drop dead' dates for receiving all information and the fees you will place at risk for non-performance.
vWhat type of cost and performance guarantees are you willing to provide for the following areas, along with the amount you will be putting at risk:
vImplementation
vDelivery of Cards
vDelivery of Contract/SPD
vAccount Management
vClaims Processing
vCustomer Service
vReporting
vAre your fees (rates) guaranteed for five years?
vDo you provide introductory letters to member homes?
vIf so, please provide a copy of your standard new member communications materials.
vAre you willing to work with the incumbent vendor to transfer data electronically through out the implementation phase?
vCan you integrate data with the City's BenAdmin system, BenTek ?
vDescribe capabilities for billing structures by plan/tiers, divisions, employee classifications, what are the requirements or limits?
vAre you willing to set up and host a "Net Meeting" or a "Web Cast" in order to accommodate open enrollment?
vAre you willing to set up and host a "Net Meeting" or a "Web Cast" in order to accommodate educational seminars throughout the year?
vAre you committed to attending up to 3 days of OE meetings IN PERSON in for the client?
vPlease indicate if you will allow enrolled members to change or drop coverage during an annual open enrollment period.
vWhat is the minimum amount of time you believe is necessary to implement the City plans in an efficient and effective manner?
vDo you offer an integrated program (one system, one member, service number, etc.)?
vWhat specific information, not already provided in this RFP, do you need in order to be able to implement properly?
vAre you willing to guarantee your overall network savings percentage?
vDo you agree to provide the renewal no later than 120 days prior to the renewal date?
vDo you agree to 30-day cancellation notification provision by the City for any reason and a 120-day cancellation notification provision by the vendor for any reason other than non-payment?
vWhat is your trend for a group of this size?
Customer Service
vDescribe your standards and procedures for maintaining contact with the employer and employee. Provide timing of these contacts.
vDoes your organization have service offices in DFW Metroplex area? If not, from which location will you service the City account?
vWill you guarantee that all incoming calls from the City will be returned the same day/next day they are placed? If not, provide a standard return call time and include this in PG's.
vDo you provide dedicated customer service teams to handle member questions/issues or do service center call agents handle claim issues?
vThe vendor will provide a description of their resources for effective and timely customer service. This will include current customer service staffing levels, dedicated staff commitments, customer service representative (CSR) training (initial and ongoing), systems for CSR call reporting and tracking, CSR performance management and other related activities.
vSpecify the documentation procedures for inquiries to the customer service department.
vWhat percentage of inquiries are documented?
vAre inquiries updated immediately?
vPlease answer the following regarding your customer service reporting capabilities.
vWill you provide client-specific reports?
vWill you provide issue-specific reports?
vHow frequently will customer service reports be provided to the City?
vDo you provide paper dental ID Cards to members?
vDo you provide an account manager?
vWhat is the current number of clients serviced by the account manager/account executive that would be assigned to the City?
vWhat was the turnover rates of your account managers for the last three years, respectively?
vWill you provide support to the City to manage client eligibility and other administrative tasks? Can the City update in real time on-line?
vHow will you help the City monitor plan performance?
vHow frequently do you provide status updates to your clients? What information is documented and provided at these meeting?
vDo you provide the following at no additional cost?
vEnrollment kits, posters, brochures
vMonthly employee articles
vMonthly payroll stuffers
vWallet cards
vOngoing employee orientations
vParticipate in health fairs and/or organizational events
vMonthly HR e-mailer
vMember access to a Web site for educational tools
vMember access to a robust website and mobile friendly app for digital ID cards, claims data and benefit coverages
vCan your Web site be customized by client?
vHow often will your account manager review the quality and effectiveness of the program with the client?
Claims Processing
vPlease provide the location(s) where the City claims would be paid.
vHow long have you been processing claims in this location(s)?
vHow many employees are located in this claims office(s)?
vIn this claims office(s), how many covered employees do you process claims for?
vIn this claims office(s), specify the number of accounts you process claims for by employee.
vIn this claims office(s), how many covered employees are included in the largest account for which your serve as claims administrator?
vIn this claims office(s), what is the average size account?
vWill you allow the City to choose an auditing firm, to perform an operational and claims audit, without incurring cost from you?
vDo you have the capability to feed the client's Flexible Spending Account (FSA) vendor claims data to be used for substantiation of claims under the FSA program?
vIs it available for this client?
vIf so, is there an additional cost for this service?
vWhat claims reporting will be provided to monitor claims dollars paid in-network, dollars paid by participant tier, total savings attributable to network discounts, dollars not covered, etc? Provide samples of claims reports considered ‘Standard’ and those considered ‘Custom’ (additional cost).

v Can claims be processed and reported out by employee classification in Active, Retiree, COBRA and plan tier?

vPlease describe the billing options for bill payment that are available to this client.
vPlease provide a detailed list of the standard exclusions and limitations included within your standard contract.
vHave you waived the actively at work/non-confinement clause? Please explain.
vHave you waived all limitations for preexisting conditions, missing teeth, etc. subject to plan provisions (no loss-no gain)?
vPlease provide your limitations/language regarding experimental/investigational procedures.
vWhat is the average weighted discount (based on book of business utilization) in each of the areas the City has locations?

v Do you currently rent or own your dental network?

vWhat actions are you prepared to take to reduce or eliminate inadequacies in your current network service area? Please describe your process for reviewing nominations of non-participating dentists into your network and the percentage of successful additions occurring in the zip codes relevant to the City.
Additional Health Management Programs
vWhat incentive-based benefit plan designs and communication tools do you have to encourage semi-annual preventive care and ongoing dental health? (if you are quoting these, please outline on the Plan Design tab and notate any additional cost on the Rates & Contributions tab)

v Describe how recent improvements in your administrative systems and billing capabilities will enhance the internal administration at the City.

v What resources will you provide to ensure effective and timely communication of the new program?

vDo you have the ability to price only desired services (i.e., a la carte) versus your full array of services?
vDoes your contract include a "missing tooth" exclusion? If so, please describe.
vWhat provisions do you include in your provider contracts that will ensure dentists do not balance bill patients for amounts in excess of your reimbursement level? How often, and in what way, do you contact providers to educate them on contract provisions and administration?
vDescribe what reporting is available to the City .
vCan the City generate these reports? Is this reporting capability available on-line at no additional charge?
vDo you offer ad hoc or special-request reporting? Are these also available on-line? Are there additional fees for the standard reporting package and/or ad hoc reports? If so, explain costs.
vWhat standard reports are available and how frequently (monthly, quarterly, annually)? Are there additional costs associated with any of these reports?
vDoes your reporting indicate the following:
vTotal Identified Members
vTotal Participating Members
vTotal Members who declined participation
vAre customized reports available through your organization's web site?
Please do not modify the template’s layout or formatting—any supplemental details can be added in the “Additional Information” tab.

&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P

Performance Guarantees

Dental Performance Guarantees
Please summarize your proposed performance guarantees for the City below including the minimum standard, how that standard is measured and the dollar or percentage you are willing to place at risk.
ServiceDefinitionMinimum StandardHow is the Minimum Standard Measured?% at Risk (include what amount of risk is based on, i.e., Base Admin. Fee)
Implementation
Account Implementation
ID Cards
Claim Readiness
Call Readiness
Account Management
Overall Account Management
Claim Administration
Claim Turnaround Time
Claim Processing Accuracy
Claim Financial Accuracy
Total Claim Accuracy
External Audits
Member Services
Inquiry Resolution
Abandoned Calls
Average Speed to Answer
Eligibility Processing
Member Satisfaction
Other Performance Guarantee(s)
Other
Other
Other
Performance Guarantee Questions
When are the PGs measured?
When are PGs paid out?
Are you willing to offer a separate implementation guarantee agreement?
Are the guarantees combined with other coverage?

Overall Total At Risk $ %

&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P

Network Providers

Network Provider Comparison
Please indicate if the below providers are in your network
TAX IDPractice NameProvider First NameProvider Last NameAddressAddress 2CityStateZipLicense NumberNPITotal Cost# Of Services# of Unique ClaimantsSpec. CodeINDICATE Y for In Network or N for Out of Network
1
2TO BE ADDED BY LOCKTON WHEN WE RECEIVE THE DATA FROM UHC
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

Geo Access

General Dentists
Employee GroupCount with AccessAverage DistanceCount w/out AccessAverage Distance
Urban (10mi)
Suburban (15mi)
Rural (20 mi)
Specialists
Employee GroupCount with AccessAverage DistanceCount w/out AccessAverage Distance
Urban (10mi)
Suburban (15mi)
Rural (20 mi)
Orthodontists
Employee GroupCount with AccessAverage DistanceCount w/out AccessAverage Distance
Urban (10mi)
Suburban (15mi)
Rural (20 mi)

Additional Info

Back Cover

OUR MISSION
To be the worldwide value and service leader in insurance brokerage, risk management, employee benefits, and retirement services
OUR GOAL
To be the best place to do business and to work

lockton.com

© 2023 Lockton, Inc. All rights reserved.

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