2-RFP Exhibit C - Forms to Complete.docx

Town of Paradise Valley - RFP-25-030-HR Forms to Complete

RFP Questionnaires:

- Service (all lines)

- Medical

- Third Party Administration

- Pharmacy Benefit Manager

- Medical Network

- Stop Loss

- Dental

- Vision

- Life/AD&D

- Short-Term Disability

Please complete the Service tab as well each coverage tab applicable to your offer.

Medical Rate Page

Self-Funded Rate Pages:

- Third Party Administration

- Pharmacy Benefit Manager

- Medical Network

- Stop Loss

Dental Rate Page

Vision Rate Page

Life/AD&D Rate Page

Voluntary Life/AD&D Rate Page

Short-Term Disability Rate Page

References Form

Vendor Information Form image4.emf

Rate Sheet - PBM.docx

RATES FOR PHARMACY BENEFIT MANAGER

Vendor Name

RFP#

Rates

{PBM Name}

{PBM Name}

Per employee per month fee

Per script fee

Rebates

{enter data}

Questions & Answers

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2-5?

image1.png image5.emf

Rate Sheet - Provider Network.docx

RATES FOR MEDICAL PROVIDER NETWORK

Vendor Name

RFP#

Rates

{Network Name}

{Network Name}

{Network Name}

Network Access PEPM Fee

Out of State Network Fee

Out of Network Negotiation Fee (e.g., PEPM or % of negotiated savings)

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2-5?

image6.emf

Rate Sheet - Stop Loss.docx

RATES FOR STOP LOSS INSURANCE

Vendor Name

RFP#

Specific Rates

{Specific Ded & Coverages}

{Specific Ded & Coverages}

{Specific Ded & Coverages}

{Specific Ded & Coverages}

Employee Only

Employee + Spouse

Employee + Child(ren)

Family

Composite Rate

Aggregate Rates

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

Composite Rate

Monthly Accommodation

Attachment Factors

{Aggregate Corridor xx%}

{Aggregate Corridor xx%}

{Aggregate Corridor xx%}

{Aggregate Corridor xx%}

Employee Only

Employee + Spouse

Employee + Child(ren)

Family

Composite Rate

Please also confirm the following for your quote (if the response differs by plan, please be specific):

Which coverages were included for specific/aggregate (i.e., Medical, Rx)?

Confirm the contract type quoted (i.e., 12/15, 12/18, 12/24).

Was Monthly Accommodation included?

Was Terminal Liability Option included?

Confirm the Aggregate corridor quoted (i.e., 110% or 125%).

What is the maximum annual specific reimbursement?

What is the maximum annual aggregate reimbursement?

Confirm the assumed provider network.

Confirm the assumed third-party administrator.

image7.emf

Rate Sheet - Dental.docx

RATES FOR GROUP DENTAL INSURANCE

Vendor Name

RFP#

Active EE Rates

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

Employee Only

EE + Spouse

EE + Child(ren)

Family

If 2 tier rates were requested, please indicate N/A for the EE + Spouse and EE + Child(ren) tiers.

If 3 tier rates were requested, please indicate the EE + One rate on the EE + Spouse tier.

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2?

Are the quoted rates priced on a stand-alone or packaged basis?

Confirm the minimum participation required.

What crown replacement frequency was quoted (i.e. every 5 years)?

Any Waiting Period for timely entrants?

Are Composite filings covered on all teeth or front teeth only?

Are Implants covered and is the frequency same as Crowns (i.e. every 5 years)?

Please state the quoted out of network UCR (i.e. 90th UCR or Max Allowable Charge).

Please confirm the number of routine cleanings included per year and specify if a time limitation applies between cleanings.

Confirm which category Endo/Perio were quoted in (i.e. Basic or Major)?

image8.emf

Rate Sheet - Vision.docx

RATES FOR GROUP VISION INSURANCE

Vendor Name

RFP#

Active EE Rates

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

Employee Only

EE + Spouse

EE + Child(ren)

Family

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2?

Are the quoted rates priced on a stand-alone or packaged basis?

Confirm the minimum participation for the quoted rates.

Is the contact lens fitting a separate copay or included in the allowance?

Are youth polycarbonate lenses covered in full?

How are Standard Progressives covered?

image9.emf

Rate Sheet - Life.docx

RATES FOR EMPLOYER PAID LIFE & ADD INSURANCE

Vendor Name

RFP#

Basic Life/AD&D Plan

{Class 1}

{Class 2}

{Class 3}

Class Definition (if applicable)

Life benefit

ADD benefit

Dep benefit SP/CH (if requested)

Guarantee Issue

Life rate per $1,000

ADD rate per $1,000

Dep rate per unit/family (if requested)

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2?

Is pricing bundled with Voluntary Life or any other programs?

Confirm your quote includes coverage for the Retirees. (If Retiree coverage was not requested in this RFP, enter N/A below)

Does your quoted plan include a Waiver of Premium benefit?

Does your quoted Life/ADD plan provide an EAP with face-to-face visits? If yes, explain.

Do you agree to maintain the current age reduction schedule? If not, please provide reduction schedule.

image10.emf

Rate Sheet - Vol Life.docx

RATES FOR VOLUNTARY LIFE & ADD INSURANCE

Vendor Name

RFP#

Age Bracket

EE Life Rate per $1,000

SP Life Rate per $1,000

Child Rate

24 & under

Flat Monthly Premium

25-29

Per Family

30-34

35-39

40-44

OR

45-49

Life Rate per $1,000

50-54

55-59

AD&D Rate per $1,000

60-64

65-69

70-74

75-79

80 & over

AD&D Rate

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2?

Is pricing bundled with Employer Paid Life or any other programs?

Confirm the minimum participation for the quoted rates.

Do you confirm you will grandfather all current volume amounts? A one-time open enrollment shall be offered for all staff as of the effective date of this contract.

Does this also apply to Spouses and Children?

For virgin coverage, please confirm if life amounts increasing due to future annual salary increases will not require evidence of insurability.

Do you agree to maintain the current age reduction schedule? If not, please provide reduction schedule.

image11.emf

Rate Sheet - STD.docx

RATES FOR SHORT TERM DISABILITY INSURANCE

Vendor Name

RFP#

Age Bracket

Rate per $10*

Composite Rate

24 & under

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70 & over

*Please note, a composite rate, if possible, is preferred in lieu of age banding (applies if voluntary).

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2?

Is pricing bundled with Employer Paid Life or any other programs?

If STD is Voluntary, confirm the minimum participation for the quoted rates.

If STD is Voluntary, do you agree to a one-time open enrollment under the voluntary plan? If so, please indicate the maximum coverage available to employee participants?

image12.emf

Reference_Form.docx

TOWN OF PARADISE VALLEY

HUMAN RESOURCES DEPARTMENT

REFERENCES

Provide the following information for three clients for whom the Vendor has successfully provided similar services to as set forth in Section 2.2(B)(2) whom the Town may contact:

1.

Organization:

Contact Name:

Phone:

E-mail:

Project Name:

Project Cost:

Project Description:

2.

Organization:

Contact Name:

Phone:

E-mail:

Project Name:

Project Cost:

Project Description:

3.

Organization:

Contact Name:

Phone:

E-mail:

Project Name:

Project Cost:

Project Description:

image13.emf

Vendor_form.docx

PART IV. VENDOR INFORMATION FORM

By submitting a Proposal, the submitting Vendor certifies that it has reviewed the administrative information and draft of the Professional Services Agreement’s terms and conditions and, if awarded the Agreement, agrees to be bound thereto.

VENDOR SUBMITTING PROPOSAL FEDERAL TAX ID NUMBER

PRINTED NAME AND TITLE AUTHORIZED SIGNATURE

ADDRESS TELEPHONE FAX #

CITY STATE ZIP DATE

WEB SITE: E-MAIL ADDRESS:

ARIZONA CORPORATION COMMISSION FILE NO. _______________________________

SMALL, MINORITY, DISADVANTAGED AND WOMEN-OWNED BUSINESS ENTERPRISES (check appropriate item(s)):

Small Business Enterprise (SBE)

Minority Business Enterprise (MBE)

Disadvantaged Business Enterprise (DBE)

Women-Owned Business Enterprise (WBE)

Has the Vendor been certified by any jurisdiction in Arizona as a minority or woman-owned business enterprise?

If yes, please provide details and documentation of the certification.

The Proposer hereby acknowledges that the proposal, including pricing, is based on the addenda that were issued and posted to Bonfire at https://paradisevalleyaz.bonfirehub.com by the Town prior to the opening of this proposal, as follows (Itemize Addenda, if Any):

Addendum No(s). ___, ___, ___, ___, ___, ___, ___, ___, ___, ___

NOTE: Please do not return a copy of the solicitation/addenda(s) with your proposal.

Proposers are to indicate below any exceptions they have taken to the Terms, Conditions, or Specifications/Scope of Work and return redlined Sample Agreement in Bonfire.

image1.emf

2026 RFP Questionnaire (to be completed by carrier) - Town of PV.xls Service (All Vendors Required)

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis

Service & Administration Insert Carrier Name

Does your firm support on-line, real-time eligibility administration? Will the District, or their authorized administrator, be able to make changes in the system? If so, how long after a change is made does it take effect (immediately, next day, 2 business days, etc)?

Does your firm have the ability to accept 834 eligibility file feeds from a BenAdmin platform?

Does your firm have the capability to provide communication pieces in Spanish and other languages? Please specify.

It is the intent of the District that no employee suffers a loss of coverage by virtue of a change in vendors other than by plan design. Indicate your agreement to this stipulation.

Confirm your commitment to have a company representative who is familiar with the District’s policies, will attend annual open enrollment meetings along with benefit fairs that the District may have throughout the year and is available for servicing throughout the year. If primary contact is unavailable, please confirm a back-up would be available in their place.

Confirm that if you are provided any individually identifiable health information (IIHI) by the Client in order to price this proposal, you are prohibited from using the IIHI for any purpose other than as required by law and further, agree to promptly destroy such IIHI if you are NOT the successful proposer. Also confirm that you agree to maintain compliance with HIPAA EDI, Privacy and Security for the duration of the contract period.

Advise if your firm offers consolidated billing for all coverages offered in your quotation and for any other awarded lines of coverage and specify if any additional cost applies for this service.

Please confirm if you have any other clients (municipality or otherwise) in Maricopa County.

Please confirm that your firm is able to provide renewal pricing each year 180 days prior to the renewal date.

Company Ratings

Standard & Poors

A.M. Best

Moody's

Please list three (3) current Arizona municipalities that your company currently provides similar services:

Reference #1

Reference #2

Reference #3

TPA Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Third Party Administrator (TPA)

Insert Carrier Name

Will you provide monthly reporting on paid claims, claim reserves, and paid premium?

What networks do you work with?

What services do you subcontract and what services are provided in-house?

Do you review claims for billing irregularities by a provider and what actions do you take? What actions do you take to inform the stop loss carrier and client?

Do you handle medical and case management internally or do you outsource these services?

Does your firm offer a wellness program with mobile member site or app? If so, describe the program details and provide any associated costs.

What specific CM programs are included in this proposal?

How do you determine allowable charges for out-of-network claims?

Does your claims system have the capability to automatically match claims with utilization management information (both in and out-of-network) for all plans?

Describe your procedures used to administer the coordination of benefits (COB) provision?

Do you have an internal process or use a subcontracted vendor to identify and recover overpayments?

Are you able to process claims for contracted providers/facilities that are outside of the standard provider network?

What transition issues should the client consider when moving services from an existing vendor to your services?

Do you anticipate making changes or enhancements to your claim systems within the next 12 months.

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Medical Network Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Medical Provider Network

Pricing Insert Carrier Name

How often are providers recredentialed?

How often is the directory updated? Can a member search for providers via a mobile app?

How can members nominate a provider for contracting?

How many providers leave the network quarterly/annually?

What claims savings or overall discount are you willing to guarantee that the client will achieve?

Are there any providers listed in your hospital provider list and non-hospital provider list where the discount arrangement is less than 5%?

What types of providers are typically not under a contract with your network (anesthesiologists, radiologists, pathologists, emergency room physicians, etc.)?

What network is available for those employees residing or traveling outside of Arizona (or the service area for narrow networks)?

What vendor is used for out of network claims savings/recovery?

Is Referenced Based Pricing (RBP) used for any of the providers/facilities?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Network (Indicate Name of Network)

Number of unique providers for each quoted network by city or county below: PCP OBGYN Pediatrics Urgent Care Hospital Total

Pardise Valley # # # # # #

Scottsdale # # # # # #

Phoenix # # # # # #

Maricopa County # # # # # #

Provide a Geo Access Report based on the client census and following critera and indicate the applicable percentages below:

2 PCP, 1 OBGYN, 1 Pediatrician within 5 miles xx % xx % xx %

2 PCP, 1 OBGYN, 1 Pediatrician within 8 miles xx % xx % xx %

Provide a response to the following:

Average Hospital Discount xx %

Average Provider Discount xx %

Do you wholly own and operate the network you are proposing for the District? If not, explain.

PBM Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Pharmacy Benefit Manager (PBM)

Insert Carrier Name

Do you participate in rebates received for the drug manufacturers?

Do you use identical AWP & MAC lists when calculating the price to clients and the payments to pharmacies? Is your MAC list identical for mail order, specialty, and retail?

Do you offer full transparency and 100% pass-through?

What is included in your admin fee? Can you provide a detailed explanation of your fee schedule specifically highlighting the costs of the clinical programs offered?

What is your average prior authorization approval/denial rate?

Do you offer a generic optimization program or similar cost-saving member programs?

Does your formulary limit the drugs covered and does the client have the final say in the formulary used?

How do you account for drugs dispensed with a Medical Rx code (e.g., hospital, doctor office, infusion center, in-home infusion, etc..) to ensure rebates are received, if applicable?

How often do you change your formulary?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Stop Loss Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Stop Loss

Insert Carrier Name

Please describe the funding arrangement you are proposing.

Do you agree to extend coverage to all participants currently insured by the employer? If not, explain why.

Please describe any stop loss underwriting contingencies included in your offer.

Is the customer required to complete a disclosure statement at renewal?

In simple terms, summarize the process of termination for the stop loss contract that the client would be subject to.

Would a Terminal Liability Option (TLO) coverage apply if the client returns to fully insured coverage after being covered by your company? Or would it also apply if the client stays self-funded and moves to a different stop loss carrier?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Dental Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Dental Insurance

Insert Carrier Name

What experience period will be used for the first renewal (e.g., first 9 months)? What period will be used in second and later renewals?

Will any implementation credit be provided?

Will claims reporting be provided? If so, what information will be provided and how often?

Do you work with online enrollment systems? If so, which is preferred, and do you offer any technology credits with this offer?

Do you accept EDI file feeds or have established connections with any BenAdmin systems currently?

Do you provide ID cards to plan participants?

Are there any timely entrant waiting period limitations? Any late entrant restrictions?

Is general anesthesia included? Cosmetic Teeth Whitening?

Describe any missing tooth exclusions. Discuss how your plan handles re-treatment of previous root canal therapy, anterior, bicuspid, and molar.

How is emergency care handled for individuals both inside and outside the service areas? Are claims incurred outside of the USA accepted?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Network (Indicate Name of Network)

Number of unique providers for each quoted network by city or county below: General Oral Surgeon Periodontist Orthodontist Pediatric Total

Pardise Valley Enter # Enter # Enter # Enter # Enter # Enter #

Scottsdale Enter # Enter # Enter # Enter # Enter # Enter #

Phoenix Enter # Enter # Enter # Enter # Enter # Enter #

Maricopa County Enter # Enter # Enter # Enter # Enter # Enter #

Provide a Geo Access Report based on the client census and following critera and indicate the applicable percentages below:

2 General, 1 Specialist within 5 miles xx % / xx %

2 General, 1 Specialist within 8 miles xx % / xx %

Do you wholly own and operate the network you are proposing for the District? If not, explain.

Vision Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Vision Insurance

Insert Carrier Name

Do you provide ID cards to plan participants?

Does your proposed plan include any exclusions or limitations that are more restrictive than the current plan?

How are standard progressives covered on your proposed plan?

Are youth polycarbonate lenses covered in full on your proposed plan?

How many “standard” frames are included under your proposed plan that would not involve an extra charge to the participant?

Does your proposed plan offer discounts on purchases after benefits have been used (i.e., 2nd pair)?

Does your proposed plan offer additional exams for diabetics?

Are there discount arrangements for laser surgery?

Does your proposed plan include any hearing benefits? If so, what benefit is available and who is the administrator?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Network (Indicate Name of Network)

Number of unique providers for each quoted network by city or county below: Optometrists Ophthamologists

Pardise Valley Enter # Enter #

Scottsdale Enter # Enter #

Phoenix Enter # Enter #

Maricopa County Enter # Enter #

Provide a Geo Access Report based on the client census and following critera and indicate the applicable percentages below:

Optometrist- 1 within 5 miles xxx %

Opthalmologist - 2 within 8 miles xxx %

List all major retail chains in-network.

Do you wholly own and operate the network you are proposing for the District? If not, explain.

Disability Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Short Term Disability

Insert Carrier Name

Fully describe any waiver of premium provision for eligible employees once benefits begin on Short-Term Disability (STD).

Please identify the minimum participation required for Voluntary STD (if applicable).

Discuss your average turn-around-time from time of receipt until claim approval.

Is a mental health diagnosis covered by your quoted STD policy?

Do you allow a true Open Enrollment for Voluntary STD plans where newly enrolled employees wouldn’t need to complete Evidence of Insurability (EOI) (if applicable)? Would pre-ex apply for new enrollments?

a. If Evidence of Insurability is required, does your company have an online platform for employees to complete the EOI and how is the employer notified of EOI decisions to adjust premium collection?

Will you prepare the necessary IRS forms – including W-2 forms – and withhold proper amounts of FICA and pay the employer’s portion of the FICA tax? If you pay the employer FICA share, is there any additional load to the rates for this service?

For total disability, do you require loss of earnings or loss of duties?

a. If loss of earnings, how much of a loss is required to be considered total disability?

b. What is considered income?

How do you accept claims submission (i.e., paper submission, web-based submission, telephonic submission)? Will you accept a data feed from an online enrollment system as the needed info so that the employer doesn't need to complete their portion of the STD claim?

At what level of enrollment will you provide claims experience for the client?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Life & ADD Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Basic Life/AD&D

Basic Life/AD&D Insert Carrier Name

May any individual whose insurance terminates convert all or part of the Life/AD&D coverages without evidence of insurability (EOI)?

Is this policy portable (i.e., can the employee retain the same coverage at essentially the same rate if he/she leaves employment)?

a. If so, how do the rates for terminated employees compare to those for active employees?

b. If this policy is not portable, what is the impact on the quoted premium to include this provision?

c. If the master contract/policy is terminated, will ported life policies continue?

d. At what age does the ported coverage expire? Any other port age limitations?

e. Will you agree to grandfather existing ported members from the prior carrier?

f. Are retiring employees eligible for portability?

What processes are in place to ensure an employee who is not actively at work at the time of transition does not lose the opportunity to enroll upon returning to work?

Please explain your processes for covering any non-actively-at-work employees?

Will you credit time that employees have been employed under the prior carrier contract towards satisfying the suicide exclusion?

How are benefits handled when an employee is on a leave of absence and how are premiums handled?

Does your program include an embedded EAP? If so, describe the program details and any associated costs.

If an employee is disabled, does the customer have the option to keep them on the plan with premium payment? If so, for how long?

Do you allow eligibility file feeds? If so, what is the cost and preferred vendor(s)?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

Voluntary Life & ADD Vendors

TOWN OF PARADISE VALLEY (Please format all answers/pages for printing)

Basis for Award Analysis - Voluntary Life/AD&D

Voluntary Life/AD&D Insert Carrier Name

Please indicate your participation requirements for the quoted rates.

If Evidence of Insurability (EOI) is required, does your company have an online platform for employees to complete the EOI and how is the employer notified of EOI decisions to adjust premium collection?

For takeover coverage, will you agree to grandfather all the current voluntary life insurance amounts?

Will you allow a modified open enrollment annually? (Ie. Will you allow employees/spouses to increase their benefit incrementally without EOI whether currently enrolled or not?)

Is this policy portable (i.e., can the employee retain the same coverage at essentially the same rate if he/she leaves employment)?

a. If so, how do the rates for terminated employees compare to those for active employees?

b. If this policy is not portable, what is the impact on the quoted premium to include this provision?

c. If the master contract/policy is terminated, will ported life policies continue?

d. At what age does the ported coverage expire? Any other port age limitations?

e. Will you agree to grandfather existing ported members from the prior carrier?

f. Are retiring employees eligible for portability?

Are the rates for a spouse based on the employee’s age or that of the spouse? To what age are dependents covered?

Are Domestic Partners allowed to participate?

Please explain your processes for covering any non-actively-at-work employees?

How do you handle employees that are called for active military duty? How long is the coverage allowed to be continued and do premiums need to be paid?

What are the elements of your offer that are significant and unique that should be given special consideration by the evaluating members?

image2.emf

Rate Sheet - Medical.docx

RATES FOR GROUP MEDICAL INSURANCE

Vendor Name

RFP#

Active EE Rates

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

Employee Only

EE + Spouse

EE + Child(ren)

Family

Retiree Rates

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

{Plan Name}

Employee Only

EE + Spouse

EE + Child(ren)

Family

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2?

Are the quoted rates priced on a stand-alone or packaged basis?

HSA Vendor / Fee / # of visits

COBRA Vendor / Fee

EAP Vendor / Fee / # of visits image3.emf

Rate Sheet - TPA.docx

RATES FOR THIRD PARTY ADMINISTRATION

Vendor Name

RFP#

Rates

Vendor Name

PEPM Fee

Claims Administration

PPO Network Fee

Pharmacy Benefit Manager (PBM)

Utilization Management

Case/Care Management

Disease Management

Telehealth Services

HSA Administration

COBRA Administration

Employee Assistance Program

(Included # of face to face visits)

Stop Loss Interface Fee

Mexico Network Access

One-time Setup Fee

Please also confirm the following for your quote (if the response differs by plan, please be specific):

What rate guarantee was included? Are you offering a renewal rate cap in year 2 -5?

image14.png