23-Scope of Services, GEN2129113P1, Group Long Term Disability Insurance.pdf

Scope of Services

Group Long Term Disability Insurance

SECTION 1 – INTRODUCTION

1.1. Broward County (County) makes available to its employees an array of comprehensive, voluntary, affordable, benefit plans and programs. The Human Resources Division is soliciting proposals for the provision of comprehensive fully insured, employee-paid, after-tax, voluntary Group Long Term Disability

Insurance (LTD) Insurance Services including enrollment support and administration services for benefit-eligible employees (Members). Plan benefits should be comparable to or provide better services than the

County’s existing Plan. Comparable is defined as same or better than the County’s existing Plan.

Vendors are not being asked to mirror the current benefit.

1.2. The County employs approximately 6,115 benefit-eligible employees in 50 different agencies throughout

Broward County.

1.3. If there is a conflict between any statement, requirement or provision of any material provided by the

Vendor, and any statement, requirement, or provision of this RFP, the statement, requirement, or provision of this RFP shall prevail and be given superior force and effect.

SECTION 2 – OBJECTIVE

2.1. The objective of this Solicitation is to obtain the best services for covered members and ultimately establish an Agreement for the delivery of comprehensive fully insured, employee-paid, after-tax, voluntary Group Long Term Disability (LTD) Insurance.

Vendor’s proposed plan should be comparable to or improve the County’s existing Plan design by expanding features for possible consideration and inclusion in the County’s Program, at the County’s sole discretion. Current plan design can be accessed through the link below and on the Plan Design

Questionnaire.

Plan currently offered:

The County’s existing Plan may be viewed by accessing the following links:

Long Term Disability Insurance

Group Long Term Disability Insurance Flyer

SECTION 3 – BACKGROUND

3.1. The County offers a voluntary Group LTD Insurance Plan and currently there are 3,025 members enrolled in the LTD insurance plan with premiums 100% paid by Members.

3.2. New Hire/Newly Benefit-Eligible Enrollment Period: Coverage is effective on the first of the month following or coincident to 30 days of benefit-eligible employment, provided timely election is made. The

County defines and determines eligibility for all employees.

SECTION 4 – COVERED MEMBERS

4.1. Covered Members eligible for these services include active benefit-eligible employees defined as:

https://www.broward.org/Benefits/Plans/Pages/LongTermDisability.aspx https://www.standard.com/eforms/20351_619352.pdf

4.1.1. Employee is defined as a Part-Time 20 or Full-Time person employed in a position designated as benefits-eligible through the Office of Budget Management.

4.1.2. LTD coverage is not available to dependents (spouse, Domestic Partner or children), Retirees or

COBRA participants.

4.2. ACTIVE AT WORK is defined as Active Work and Actively at Work mean performing the material duties of employee’s own occupation at employer’s usual place of business. If employee is incapable of Active

Work because of sickness, injury or pregnancy on the day before the scheduled effective date of insurance, or an increase in insurance, the effective date of insurance and an increase in insurance will not become effective until the day after one full day of Active Work.

4.3. Class Definitions:

4.3.1. Class 1: Elected Officials, administrators, executive managers or professional employees whose job is classified as exempt under the Fair Labor Standards Act.

4.3.2. Class 2: All other members

4.4. The following are attached for supplemental information:

4.4.1. Experience Reports:

Claims to Premium Report (Attachment 1) Group Claim Experience (Attachment 2)

Census Report (Attachment 3)

SECTION 5 – GENERAL INFORMATION AND SPECIFICATIONS

5.1. GENERAL INFORMATION

5.1.1. State of issue is Florida.

5.1.2. Benefit eligible employees may enroll in LTD with guaranteed issue if applied for within the employer’s benefit eligibility period, but not later than the benefits effective date.

5.1.3. Enrollment after the benefit eligibility period is subject to Evidence of Insurability and approval from the Vendor.

5.1.4. Employees may cancel coverage at any time during the year. Re-enrollment is subject to

Evidence of Insurability and approval from the Vendor unless it is due to a Vendor approved special enrollment.

5.1.5. Coverage for employees ends on the last day of employment due to retirement or employee leaves County employment. There is no continuation of coverage.

5.1.6. County will not guarantee a minimum number of participants in any plan offered. Premium rates shall be honored as negotiated even if there is a substantial change (increase or decrease) in actual enrollment.

5.1.7. Employee Retirement Income Security Act (ERISA): Although the County is not subject to ERISA, the County follows the ERISA guidelines.

5.2. ADMINISTRATIVE AND RELATED SERVICES

5.2.1. Vendor shall:

5.2.1.1. Assume full risk on the Plan effective date for all lives (County) that are insured by the current carrier as of December 31, 2025, with “no actively at work" exclusion (no loss/no gain), pre-existing exclusions or waiting period.

5.2.1.2. Vendor shall administer the Plan in accordance with the Certificate of Insurance provided herein as Long-Term Disability Insurance unless different provisions are subsequently agreed to in writing by the County.

5.2.1.3. Vendor shall provide a one-time guaranteed issue open enrollment period at the inception of the agreement allowing employees who previously waived coverage to enroll in LTD with no medical underwriting.

5.2.1.4. Vendor shall accept Evidence of Insurability directly from employees through mail, facsimile or online submission.

SECTION 6 - CUSTOMER SERVICE, COMMUNICATIONS, AND TRAINING REQUIREMENTS

6.1. Vendor shall:

6.1.1. Provide the County with an account representative who will assist the County in the administration of the insurance plan, including all necessary and related services, for Members in resolving issues, including but not limited to, claims problems and in any other way requested, related to the Services stated herein.

6.1.2. Meet with County staff, in person or virtually, for quarterly plan review. The Vendor shall provide quarterly reports, including but not limited to Experience Report, Premium vs. Paid Claims Report, Claim Status, Diagnosis, Occupations Counts, Age and Gender Claims Summary, Book of

Business Benchmarks.

6.1.3. Provide a customer service call center with a toll-free number for all telephone inquiries during the County’s regular business hours, Monday through Friday from 8:00am to 6:00pm EST.

6.1.4. Provide a customized website that includes access to information on educational materials, Summary Plan Description, and available benefits, along with a link for posting on the County’s benefits website. If using County logo on website, the website shall be ADA compliant.

6.1.5. Provide access to an employer portal that allows designated Benefits staff to view status of claims, benefits payments, Evidence of Insurability status, run reports, attach supporting documents to a claim, view claims data, run reports, download forms, access plan documents, including marketing materials and send messages through Secure Message function.

6.1.6. Provide access to employee portal to allow Members to file a claim and upload documents, view claim status, submit Evidence of Insurability, view plan documents, and send messages through

Secure Message function.

6.1.7. Provide a minimum of one person to attend all annual open enrollment vendor fairs/meetings, (estimated to be approximately 12 onsite meetings over a two-week period) typically scheduled for October/November. Meeting schedule will be set by the County.

6.1.8. Provide a minimum of one person to attend annual County Financial Fit vendor fairs/meetings, (estimated to be approximately 20 onsite meetings over a two-week period) typically scheduled for June. Meeting schedule will be set by the County.

6.1.9. Furnish nonstandard member communication materials prior to distribution, including flyers, brochures, special notifications, etc. for County’s approval.

6.1.10. Provide an in-service training session (virtual or in person) for County benefits staff prior to the inception of the Plan.

6.1.11. Exchange data containing protected data (eligibility and payment file transmission, email, media, etc.) between Vendor and County in an encrypted format, which can only be decrypted by the specified recipient.

6.1.12. Update eligibility data within three (3) business days from receipt of such data. Vendor shall notify the County of any issues arising within one (1) business day from the time of the data upload.

6.1.13. Administer a written appeal process for reconsideration of any denied benefit.

6.1.14. Resolve all appeals within 30 days after receipt of completed documentation.

6.1.15. Fulfill, upon expiration or termination of any agreement as a result of this Solicitation, all responsibilities of the plan year, including but not limited to, the transfer to the County or new provider, all data and records necessary to administer the Plan.

6.1.16. Furnish an electronic version of the certificates/booklets/policies for the County’s Plans.

6.1.17. Prepare language for amendments to the certificates/booklets/policies due to legislative or other changes.

SECTION 7 – PREMIUM PAYMENTS

7.1. County shall deduct from each enrolled Employee’s wages the applicable biweekly premium for 26 pay periods (years with 27 pay periods will not have a 27th deduction) on an after-tax basis based on Plan payroll deduction. Premiums deducted from enrolled employees each pay period are sent to the Vendor by ACH on a biweekly basis after payroll is run. County shall submit a volume summary report to Vendor at approximately the same time. County will bill and collect premiums for Participating Employees on leave, and remit to Vendor by separate ACH.

7.2. County shall submit a weekly Eligibility Electronic Data Interchange (EDI) file to Vendor.

7.3. Vendor shall accept the County’s self-billing process and remittance for active employees on a biweekly basis, in arrears. The County will remit premium payments based on its records.

SECTION 8 – TRANSITION AND IMPLEMENTATION

8.1. Vendor shall provide a detailed implementation schedule outlining all the tasks and responsibilities such as, but not limited to systems and data transfer, employee communication and education, delivery of

Policy and Certificate of Coverage to the County, with timelines for both the County and Vendor to ensure a smooth transition for Covered Members.

SECTION 9 - ALTERNATE CONTRACT SOURCE

9.1. Other public corporations, entities, or agencies within Broward County, Florida (each, a “Using Entity”) may request to utilize the services resulting from this solicitation on the same terms and conditions set forth in the agreement. If County approves, and Vendor accepts the request to utilize the services on the same terms and conditions, the administration of the agreement and services provided to any Using

Entity must be governed under a separate agreement between Vendor and such Using Entity. County shall have no obligation or liability to Vendor, any Using Entity, or any third party in connection with the administration of services provided to any Using Entity.