25-1.4 Scope of Services Table.pdf
PDF 96 KB Posted
- Attached to
- Group Medical Benefits
- Solicitation number
- 2026-10
- Issued by
- Seminole County, Florida
About this file
This Scope of Services Table document outlines the service requirements for the Suwannee County Board of County Commissioners' Group Medical Benefits procurement in Florida. The solicitation seeks qualified health insurance carriers to provide comprehensive medical benefits administration for active employees, employee dependents, retirees, and retiree dependents of Suwannee County and its constitutional offices, including the Sheriff, Tax Collector, Property Appraiser, Clerk of Courts, and Supervisor of Elections. The proposed effective date for the contract is October 1, 2026, and the procurement requires bidders to complete a compliance table indicating their ability to meet specific service standards and operational requirements across multiple dimensions of health plan administration and member service delivery.
Key service requirements include 24/7 toll-free customer service lines with local contact availability, full COBRA and HIPAA administration, participation in approximately five annual open enrollment meetings with cost-sharing for materials, a dedicated Account Manager, qualified personnel for in-person meetings, one-business-day-or-less response times to county staff, and a minimum 12-month rate guarantee period. Awardees must provide wellness dollar contributions to support the county's wellness program, budget allocations for a county-selected benefit administration program, and assume full COBRA administration costs. Additional requirements encompass electronic provider directory access, direct mailing of ID cards and member handbooks with postage paid by the awardee, compliance with federal guidelines including ADEA, Medicare, HIPAA, COBRA, and PPACA standards, waiver of actively-at-work provisions, 60-day notice requirements for provider terminations, monthly claims and eligibility data reporting to the county's designated consultant, and continuation of services during the transition period following contract termination. The proposal structure requires bidders to indicate compliance status for each requirement and may include profit-sharing arrangements for fully insured plan options.
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Text version
Scope of Services Table Complete the following table on how your company can accomplish each of the following:
Yes, Can Comply Yes, Can Comply But With Deviations
No, Cannot Comply
Provide customer service lines with a 24/7 toll-free line for employees. If working with a broker or consultant, provide a local contact for customer service at both the employer and employee level.
Provide full COBRA and HIPAA administration services.
If selected as an Awardee, you will need to participate in open enrollment, health fairs, and share in the cost of the materials for open enrollment. The cost of the materials will be at the expense of the Awardee(s). For the 2026-2027 open enrollment period, approximately 5 meetings are planned.
Provide a dedicated Account Manager who will have the overall responsibility for managing the client relationship.
Provide qualified personnel to attend (in person) and participate in meetings.
Provide dedicated personnel for overall Account Management and Customer Service to SCBOCC staff. Response times to SCBOCC staff of one business day or less.
Demonstrate a commitment to customer service by measuring performance against established standards acceptable to SCBOCC.
SCBOCC presently provides Plan Options with in-network benefit levels for employees/dependents and retirees/dependents who obtain care outside the network due to the unavailability of their participating network. This applies to services rendered inside or outside the United States.
Providers/Awardee(s) are expected to negotiate service prices for services received out-of-network and/or out-of-area.
Your fully insured rate quotation shall include a minimum rate guarantee period of 12 months.
Additional rate guarantees are encouraged.
No, Cannot Comply
Awardee agrees to provide wellness dollars in an amount that will support SCBOCC’s wellness program to include wellness communications.
Please provide dollar amount and program details.
Your Proposal should assume an Effective Date of October 1, 2026.
Awardee to include a budget for a Benefit Administration Program to be selected by SCBOCC.
Please provide dollar amount and confirm ability to accept electronic data feeds from the Benefit Administration Company.
Awardee agrees to pay for COBRA Administration for SCBOCC, COBRA administrator to be selected by
SCBOCC.
If selected as an Awardee, you will be required to provide access to an electronic provider directory file.
I.D. cards will be mailed directly to the employee’s home, with the postage costs to be paid by the Awardee(s). Member handbooks and certificate of coverage are to be mailed, in a timely manner, directly to the employee’s home, with postage costs to be paid by the Awardee(s).
You are required to maintain compliance with Federal guidelines for ADEA, Medicare, HIPAA, COBRA and PPACA, as well as all Florida-mandated benefits.
Variations in actual enrollment shall have no effect on your rate quotation. Your Proposal shall be valid regardless of the final enrollment mix, number of plan designs or outcome. No underwriting for the currently enrolled members including no minimum participation or minimum enrollment requirements will be accepted.
The Contract situs will be the State of Florida.
Actively-at-work provisions shall be waived for all participants.
Provide SCBOCC with a minimum of 60 days’ notice for any voluntary or non-voluntary hospital terminations, provider terminations and/or ancillary terminations.
Describe any additional products/services that Proposer is able to provide with relation to the scope of this RFP.
No, Cannot Comply
All full-time active employees, employee dependents, retirees and retiree dependents are eligible to join the group medical plan, Per Florida Statute 112.0801, SCBOCC offers medical benefits to retirees and their dependents.
Awardee(s) must have systems that support timely resolution of member complaints.
Provide a monthly data dump of all claims data and eligibility data to SCBOCC designated Consultant, Actuary or other vendor appointed by SCBOCC.
The Awardee(s) shall agree to provide approval for a 60-day supply of prescription medication to those members leaving the service area for an extended time period, which shall be defined as a period exceeding 30 days. This approval shall be given in a manner sufficient to ensure the employee’s ability to obtain said 60-day supply of medication before he or she leaves the service area.
Awardee(s) will continue to provide services beyond the Agreement termination date, to include but not limited to:
Claims adjudication for services incurred prior to the termination date, Transition of Care, Audits, Grievances, Medicare Part D, Reporting, Customer Service, Reconciliations and Other Services necessary to facilitate transition.
Agree to a profit-sharing arrangement if SCBOCC were to elect a fully insured plan/program. If so, please describe the terms of this arrangement.
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