25-01 - Specifications.pdf

REQUEST FOR PROPOSAL

FOR

RFP #26-71-P

EMPLOYEE HEALTH AND WELFARE BENEFITS

REQUEST FOR PROPOSAL

INTRODUCTION

The City of Lewisville (the City) is seeking proposal responses from qualified firms services related to Employee Health and Welfare Benefits which include: Third Party Administrator for Medical and Dental, Pharmacy Third Party Administrator, Medical/Rx Stop Loss, ASO Dental, Fully Insured Vision, Basic Life/AD&D, Voluntary Life/AD&D, Long Term Disability, EAP, HSA, FSA, COBRA.

TERM

It is the City’s intent to award a contract for a three-year contract with two one-year renewal options with caps, or a two-year contract with options for three one-year renewals with caps, or a one-year contract with options for four one-year renewal options with caps will be considered. The City will be moving from Benefit Connector to Workday for October Open Enrollment and for a 1/1/2027 effective date.

If it is the respondent’s intent to increase rates at the renewal date, the City must be notified of the maximum increase for each renewal period and the basis for calculating the increase.

The City must be notified of renewal rates at least 120 days prior to the effective date of the rate change.

All renewals are subject to the approval of the City Manager or her designee.

RFP SCHEDULE

The RFP schedule will be as it appears in Bonfire. All changes to the schedule will be communicated via Public Notice “Addendum” through the Bonfire platform.

CONTACT WITH THE CITY

Respondents shall not direct any queries or statements concerning their proposal to the City during the selection process, from the time of submission of a proposal until the execution of a contract. Any Respondent who initiates any discussions with staff contrary to this provision is subject to disqualification from this procurement. No oral interpretation of this RFP shall be considered binding.

All questions or concerns regarding this RFP must be submitted through Bonfire in the questions and answers section no later than the date included on Bonfire. Any responses by the City to Respondents’ questions or concerns will be addressed, if at all, by an Addendum.

STANDARDS OF CONDUCT & CONFLICTS OF INTEREST

This RFP is subject to the City’s policy governing conflicts of interest in procurement and Contract administration that may limit or prohibit certain activities of City personnel and Respondents. Respondents must review and follow the instructions at the City’s Disclosure of Interest.

DISCLOSURES AND DISCLAIMER

The information contained herein is believed to be accurate and up to date but is not intended to be an expressed or implied warranty.

The preparation of response to this RFP will be at the total expense of the proposer. There is no expressed or implied obligation for the City to reimburse Respondents for any expense incurred in responding to this RFP.

The City reserves the right to reject any and all responses, to consider alternatives, to waive any formalities and irregularities, and to re-solicit this RFP. In addition, during the evaluation period, the City may, where it may serve the City’s best interest, request additional information or clarifications from Respondents, or allow corrections of errors or omissions.

All parties submitting proposals are expected to comply with federal, state, and local laws and regulations relative to the preparation of proposals and the services to be provided. Specifically, the services to be provided are expected to be in compliance with the Americans with Disabilities Act (ADA), as well as with federal and state confidentiality laws.

The City reserves the right to retain all proposals submitted. Submission of a proposal indicates the firm’s acceptance of the conditions contained in this RFP, unless clearly and specifically noted in the proposal submitted and confirmed in the Contract between the City of Lewisville and the vendor selected.

CONTRACT TERMINATION

The City shall have the right to terminate the contract for convenience at any time, without penalty, upon thirty (30) days’ written notice to contractor.

Additionally, should the Contractor, in the opinion of the City, fail to faithfully comply with the intent of the Contract as executed or render an unsatisfactory performance of the work pertinent to the Contract, this Contract may be promptly terminated, in whole or in part, by the City with prior written notice. In such event, nothing contained herein shall be construed or interpreted as to prevent the City from immediately entering into another contract with another contractor for an unabated continuance of this service. Monies owed to the Contractor for services rendered to the date of termination shall not constitute a prolonging of the contract.

RECORDS RETENTION REQUIREMENTS

The Contractor shall maintain adequate records to justify all charges, expenses, and costs incurred in performing the Services for at least ten years after completion of the Contract resulting from this RFP The City reserves the right to request additional justification prior to payment of any invoice. The City agrees to make prompt payments for all approved invoices within 30 days of receipt of invoice or a corrected invoice, whichever is later, and agrees to pay interest at the rate approved by law for approved invoices not paid within 30 days from the date of approval.

The City shall have access to all records, documents, and information collected and/or maintained during performance of the Services. This information shall be made accessible to the City at the Contractor’s local place of business for purposes of inspection, reproduction, and audit, without restriction. If records are unavailable locally, it shall be the Contractor’s responsibility to ensure that all required records are provided to the City at the Contractor’s expense.

ASSIGNMENT

The successful Contractor shall not sell, assign, transfer, or convey any Contract resulting from this bid, in whole or in part, without the prior written consent from the City of Lewisville.

PROPOSAL DELIVERABLES

Proposals must be properly signed by the owner/principal having the authority to bind the Respondent in a resulting Contract. Signatures are required where indicated; failure to do so may be cause for rejection of proposal. Electronic signatures are permitted.

A page is generally defined as single-sided 8.5x11 format unless otherwise stated. Page count does not include cover letter; index and/or table of contents, front and back covers, title page, or separation tabs.

Candidates must use 10-point font or larger. Use of figures, photographs, or other graphics within the page constraints indicated is up to the discretion of the candidate.

A. Table of Contents B. Title Page/Letter (not to exceed two (2) pages)

a. This letter will summarize in a brief and concise manner the following:

i. General summary of Respondent’s business operation; how long in business; general approach to tasks and projects; and, why the Respondent should be selected.

ii. Respondent’s understanding of the scope of services, evidenced by previous experience, references, and other relevant information. Please also provide a listing of any litigation, judgments, claims, arbitration proceedings, suits, bankruptcy, or reorganizations that may have occurred during the past five years.

iii. The letter must name all persons or entities interested in the proposal as principals. Identify all of the persons authorized to make representations for the Respondent, including the titles, addresses, and telephone numbers of such persons.

C. Addenda

a. This section shall include a statement acknowledging receipt of each addendum issued by the City. Each Respondent is responsible for obtaining addenda.

D. Similar Projects, References and Other Contractual Obligations (not to exceed six

(6) pages)

b. Provide a minimum of three similar projects and include whether the project was completed on time and within budget.

c. Respondents shall provide a minimum of three references demonstrating their experience and/or skill to provide the requested coverage. Respondents are responsible for verifying correct phone numbers and contact information provided. Failure to provide accurate information may result in the reference not being obtained or considered.

E. Cost Effectiveness

d. Respondents are to provide a cost proposal as listed in Bonfire.

i. Pricing shall be submitted as requested and be inclusive of all transportation, labor, insurance, tools, materials and supplies, and incidental charges required to provide the requested coverage.

ii. DO NOT INCLUDE PRICING WITHIN YOUR OTHER RFP PAPERWORK. Only in the corresponding documents (05-18.)

F. Availability and Qualifications of Proposed Staff

e. Provide qualifications of key personnel that will handle duties related to the

Services. Also provide a narrative description with an organizational chart outlining the methods of operation, operational structure, and services to be provided.

f. This section shall also describe the Respondent’s overall resources, including personnel, equipment (if applicable), and any other relevant resources.

Respondent shall also identify the proportion of personnel that are employees versus independent Contractors or subcontractors and, likewise, the proportion of equipment that is owned versus leased, rented, or subcontracted.

G. Past Performance

a. The respondent(s) must also provide a contact person, telephone number, and e-mail address for each proposal.

H. Purchasing Documents

a. Provide all documents listed as “Required” in Bonfire. Any proposals missing required documents may be deemed non-responsive.

EVALUATION CRITERIA

The City, in its sole discretion, will evaluate and select the most advantageous proposal for contract negotiation and award. The City reserves the right to award a contract to other than the lowest-priced proposer. The selected Respondent will be notified in writing.

The following criteria will be used to evaluate the qualifications of Respondents:

Each area that will be scored will have a maximum of 100 points.

Third-Party Administrators Medical

The objective of the evaluation for proposals will be to select the provider whose proposal is most responsive to the City's relating importance, price, and other factors considered:

1. Cost (40%) Evaluation may include but is not limited to:

a) Fixed Costs: includes insurance costs and administrative costs

b) Variable Costs: costs stated as a percentage of paid claims, cost management (i.e., shifting of more/less workload to City staff)

c) Ability to reduce claims expense: network discounts and network access

d) Allowances, Credits, and Performance Guarantees

e) Financial Stability (AM Best Rating)

2. Customer Service (15%) Evaluation may include but is not limited to:

a) Hours of operation

b) Call and quality monitoring

c) Call abandonment and average wait times

d) Dedicated service contact and/or team

e) Educational material for employees

f) On-line resources and tools

g) Multilingual capability

h) Willingness to contractually establish performance criteria

3. Claims Processing (15%)

a) Hours of operation

b) Turnaround time excluding medical review of claims

c) Pended claims procedures

d) Statistical accuracy

e) General service procedures

f) Dedicated service team

g) Willingness to contractually establish performance criteria

4. Population Health Management Programs (10%) The Respondents demonstrated and proposed abilities to improve health of the population and prevent health plan costs are critical to provider selection. Evaluation may include but is not limited to:

a) Utilization review programs

b) Case management programs

c) Disease management programs

d) Wellness programs, tools and resources

e) Dedicated wellness consultant and coordinator

f) Return on investment analysis and reporting

5. Integrated Systems / Technology Initiative (5%) Capability to integrate are integral to the provider selection. Evaluation may include but is not limited to:

a) Claims Processing

b) Customer Service

c) UR / CM / DM integration

d) Stop loss intrusion

e) Pharmacy integration

f) Near site Health Clinic Integration

g) Internet based enrollment/eligibility capabilities

h) Access, format and frequency of management reporting

6. Cost Containment / Innovative Solutions (5%) The Respondents demonstrated and proposed ability to implement innovative cost containment solutions to provider selection. These can include but are not limited to:

a) Ability to Administer Alternative Low Cost / High Quality Network Solutions Ability to substantially match current plan design structures

b) Provider cost and quality solutions

c) Patient centered medical home

d) Ability to leverage the City’s Health Clinic

e) Health risk management solutions

7. Past Performance (10%)

a) Active and terminated references

b) Past relationship with the City

c) Recognitions / reputation of proposer

8. Required Documents (Pass/Fail)

As required in the proposal deliverables section H.

Dental Administrative Services Only

1. Cost (40%) Evaluation may include but is not limited to:

a) Fixed Costs: includes insurance costs and administrative costs

b) Variable Costs: costs stated as a percentage of paid claims, cost management (i.e., shifting of more/less workload to City staff)

c) Ability to reduce claims expense: network discounts and network access

d) Ability to substantially match current plan design structures

e) Allowances, Credits, and Performance Guarantees

f) Financial Stability (AM Best Rating)

a) Hours of operation

b) Call and quality monitoring

c) Call abandonment and average wait times

d) Dedicated service contact and/or team

e) Educational material for employees

f) On-line resources and tools

a) Hours of operation

b) Turnaround time excluding medical review of claims

c) Pended claims procedures

d) Statistical accuracy

e) General service procedures

a) The Respondents demonstrated and proposed abilities to improve health of the population and prevent health plan costs are critical to provider selection. Evaluation may include but is not limited to:

b) Utilization review programs

c) Case management programs

d) Disease management programs

e) Wellness programs, tools and resources

f) Dedicated wellness consultant and coordinator

g) Return on investment analysis and reporting limited to:

a) Claims Processing

b) Customer Service

c) UR / CM / DM integration

d) Stop loss intrusion

e) Pharmacy integration

f) Near site Health Clinic Integration solutions to provider selection. These can include but are not limited to:

a) Ability to Administer Alternative Low Cost / High Quality Network Solutions

b) Provider cost and quality solutions

c) Patient centered medical home

a) Active and terminated references

Vision

1. Cost (40%) Evaluation may include but is not limited to:

a) Fixed Costs: includes insurance costs and administrative costs

b) Variable Costs: costs stated as a percentage of paid claims, cost management (i.e., shifting of more/less workload to City staff)

c) Ability to reduce claims expense: network discounts and network access

d) Ability to substantially match current plan design structures

e) Allowances, Credits, and Performance Guarantees

f) Financial Stability (AM Best Rating)

a) Hours of operation

b) Call and quality monitoring

c) Call abandonment and average wait times

d) Dedicated service contact and/or team

e) Educational material for employees

f) On-line resources and tools

a) Hours of operation

b) Turnaround time excluding medical review of claims

c) Pended claims procedures

d) Statistical accuracy

e) General service procedures

The Respondents demonstrated and proposed abilities to improve health of the population and prevent health plan costs are critical to provider selection. Evaluation may include but is not limited to:

a) Utilization review programs

b) Case management programs

c) Disease management programs

d) Wellness programs, tools and resources

e) Dedicated wellness consultant and coordinator

f) Return on investment analysis and reporting limited to:

a) Claims Processing

b) Customer Service

c) UR / CM / DM integration

d) Stop loss intrusion

e) Pharmacy integration

f) Near site Health Clinic Integration solutions to provider selection. These can include but are not limited to:

a) Ability to Administer Alternative Low Cost / High Quality Network Solutions

b) Provider cost and quality solutions

c) Patient centered medical home

a) Active and terminated references

Stop Loss

1. Cost (50%)

a) Fixed Premium Costs: includes insurance costs and administrative costs

b) Ability to reduce claims expense: Proposed liability caps, contract language, etc.

c) Financial Stability (AM Best Rating)

2. Claims Processing (30%)

a) Turnaround time

b) Pended claims procedures

c) Statistical accuracy

d) General service procedures

e) Dedicated service team

f) Willingness to contractually establish performance criteria

3. Integrated Systems / Technology Initiative (10%)

Capability to integrate systems between TPA and Stop Loss Vendor are integral to the provider selection. The following components make up the whole of an integrated system:

a) Eligibility

b) Claims function

c) Claims payment

d) Access, format, and frequency of management reporting

e) On-Line Tools

4. References/Past Performance (10%)

a) Active and terminated reference

b) Past relationship with client

c) Recognitions/ Reputation of Proposer

5. Required Documents (Pass/Fail)

Life/Disability

Minimum Qualifications (Pass/Fail) Required three years in business. No outstanding lawsuits during last 5 years or current litigation with the City during the last 5 years. No outstanding regulatory issues in the last 5 years References provided for firm

a) Fixed Costs: includes insurance costs and administrative costs

2. Financial Stability (15%)

a) Financial Stability, AM Best Rating of A- or higher

3. Claims Processing (25%)

a) Turnaround time excluding medical review of claims

b) General service procedures

c) Dedicated service team

Flexible Spending Account (FSA)

Health Savings Account (HSA)

Employee Assistance Program (EAP)

COBRA

INTERVIEW INFORMATION

The top-ranking Proposer(s) may be invited to participate in an interview for a presentation and Q&A session. Interviews of selected qualified firms will be held in Lewisville. Non-local firms will have the option to interview virtually. The Proposer(s) will be contacted to arrange the specific time and place and will be notified of any additional information that may be required to be submitted. The City reserves the right to determine the number of interviewed proposer(s).

SPLIT AWARD

Proposers may furnish pricing for all or any portion of the proposal invitation. Unless the proposer specifies otherwise in their proposal, the City may award the contract for any item or group of items shown on the proposal invitation.

PROPOSAL SUBMISSIONS

The RFP will be available to interested parties at https://cityoflewisville.bonfirehub. com/portal or may be picked up in person at the Purchasing office.

Proposals may be uploaded directly to Bonfire or by sealed RFPs, one (1) original proposal, one

(1) cost proposal, and one (1) PDF copy of each document on a flash drive may be delivered to the City of Lewisville Purchasing Division office at the address below, in a sealed envelope or box, clearly marked with the Project Title, Name & Address of the Proposer, and the RFP#26-71-P

Delivery address:

City of Lewisville Finance Administration – Purchasing Division

Attn: Kristi Byrd, Procurement Supervisor 151 W. Church Street Lewisville, TX 75057

No telephone, email, or fax proposals will be accepted. Proposals may be accepted if delivered in person or by U.S. Postal Service, Federal Express, UPS, etc. or uploaded to Bonfire. The City is not responsible for missing, lost, or late delivery. Any RFP responses received after the time set for opening will be returned to the proposer unopened.

Each proposer shall guarantee and honor its response to this RFP for a period of one hundred and twenty (120) days, or until the City enters a contract with one of the proposers, whichever occurs first.

All forms requiring either a signature or requested information are to be returned with the proposal.

PRE-PROPOSAL

A pre-proposal conference will be held at the date and time specified in Bonfire. While attendance of the pre-proposal conference is not mandatory, it is recommended due to the nature of the project.

MISCELLANEOUS

All forms requiring either a signature or information to be filled in are to be returned with your proposal. In addition, the language contained in the attached form entitled Purchase Order Terms and Conditions is made part of this request for proposal through reference herein.