25-26-50 COG-GUC Medical RFP Workbook v3.xlsx

Cover

HEALTH WEALTH CAREER

PRIVILEGED AND CONFIDENTIAL

Table of Contents

TABLE OF CONTENTS

Intro & Client Overview

INTRODUCTION & SUBMISSION GUIDELINES

General Information

This RFP reflects COG/GUC's self-funded medical plans, covering approximately 2,812 members (1,513 employees and pre-65 retirees) located in the United States.

COG/GUC's medical plans are currently administered by Cigna. Plan information has been provided in the RFP and supporting attachments.

Evaluation Criteria

Requested Proposal Details

Attachments

Mercer Contact Information

Timeline

Key Deliverables and Bid Requirements

The selected Vendor is expected to provide a demonstrated track record of delivery and innovative best-in-class services and solutions with plan management, including excellence in these areas:

1. Flexible and creative approach to managing cost trends;

a. Ability to mitigate trend through managing the total cost of care for members including fees, network discounts, network management, clinical programs and care management to improve member health and outcomes;

b. Delivery of innovative clinical programs and initiatives aligned with COG/GUC’s clinical risk prevalence, chronic conditions and health improvement opportunities;

2. Competitive and cost-effective pricing terms and guarantees.

3. Ability to partner with other COG/GUC vendors to provide an integrated and seamless service experience to members;

4. Best-in-class claims administration, customer service, and account management to support COG/GUC’s employees and expectations.

a. Accurate plan and claims administration

b. Consistent, high level skilled member service and advocacy that delivers an exceptional member experience, along with consumer-focused tools and resources

c. Minimal disruption for COG/GUC and their employees

5. Administer the plan designs as described and accommodate alternative plan designs in the future.

6. Maintain a highly competitive network of providers providing multiple network solutions to COG/GUC to deploy that drive additional savings while increasing quality of care.

7. Support COG/GUC’s data needs including:

a. Strong reporting capabilities;

b. Proven capability to turn data into actionable recommendations;

8. Willingness to support additional COG/GUC initiatives such as wellness, preventive care, etc.

a. Seamless integration with COG/GUC’s third party vendors;

b. Willingness to coordinate with other vendors as appropriate through data sharing and integration including data warehousing, to support optimal clinical outcomes and quality of care for members.

9. Capacity to customize services and processes to meet COG/GUC’s unique needs.

10. Compliance with ACA and regulatory requirements.

11. Bidder must share 100% of the revenue received from pharmaceutical manufacturers with COG/GUC including but not limited to:

a. access fees;

b. market share fees;

c. data aggregation fees;

d. pharma revenue rebates;

e. formulary access fees and;

f. manufacturer administrative fees.

12. Bidder must pass 100% of the medical pharmacy rebates to COG/GUC.

13. Bidder must provide full disclosure of its contracts/agreements with all pharmaceutical manufacturers to verify the agreed-upon rebate sharing arrangements and undergo an audit by a third party of its contracts/agreements with all pharmaceutical manufacturers.

Mercer's Role

Mercer has been engaged by COG/GUC for consulting services and works to ensure that COG/GUC’s benefit program meets organizational and HR/benefits goals. Mercer has worked with COG/GUC to develop and release this RFP in accordance with their requirements and objectives. Mercer will evaluate the proposal responses and advise COG/GUC of our findings. COG/GUC will make the decisions on finalists and will ultimately select the carrier to administer their program.

Confidentiality Agreement & Submission Guidelines

The vendor agrees to keep the information provided herein confidential. This requirement applies whether or not the recipient of the RFP package agrees to bid. Other than reports submitted to either COG/GUC or Mercer, the recipient/bidder agrees not to publish or reproduce or in any other way divulge such information in whole or part, in any manner of form, or authorize or permit others to do so.

In the event that you are not going to respond to this RFP, you agree to destroy all electronic copies.

Vendor(s) will not issue any public statements or otherwise publicly disclose any information concerning this RFP without prior written approval of COG/GUC.

Award or Rejection – This document is only a Request for Proposal and is in no way a commitment to purchase on the part of COG/GUC. COG/GUC reserves the right to accept or reject any subcontractor the vendor may include in their proposal.

Cost for Proposal Preparation – COG/GUC assumes no responsibility or liability for any costs vendor(s) may incur in responding to their RFP, including attending meetings or negotiations. Any costs incurred by vendor(s) in preparing and submitting responses are the vendor’s sole responsibility. Vendor(s) will not be reimbursed for these costs.

Time for Acceptance – The vendor(s) agrees to be bound by its proposal until the effective date, during which time COG/GUC may request clarification or correction of the proposal for the purpose of evaluation.

Elaboration and Clarifications – If you make assumptions about the meaning or accuracy of information contained herein, you should state the assumptions in your submission. If you do not ask questions or clarify any assumptions COG/GUC will assume that you agree with and understand the requirements in this RFP.

Changes and Amendments – COG/GUC reserves the right to make changes to the RFP by issuance of one or more addenda or amendments and to distribute additional supporting information.

Binding Proposal Acknowledgement – A duly authorized officer of the bidder must sign each proposal and the completed proposal shall be without alterations or erasures. It will be assumed that all representations made in your proposal will be binding and that your organization has agreed to all the requirements of the RFP unless specifically stated otherwise in your proposal.

Accuracy of Information – While COG/GUC endeavored to provide accurate information to the vendor(s), COG/GUC makes no such warranty or representation of accuracy.

COG/GUC reserves the right, but does not have the obligation, to verify all information provided by a vendor, including directly contacting the vendor’s prior clients. Vendors must agree to provide and release necessary authorizations for COG/GUC to verify any of the vendor’s previous work. Misstatements about experience and scope or prior projects may be grounds for disqualification of the vendor and/or the vendor’s submission.

Confirmation

By submitting a proposal, Bidder agrees to all requirements outlined above:

Carrier Info Request

Carrier Information Request

Provide the name and contact information of the individual from your organization who will be responding to this RFP.

Carrier Name:

Prepared by Carrier Representative:

Date Prepared:

Representative Phone Number: (Provide office and cell phone numbers)

Carrier Web Site:

Requirements

Proposal Requirements

Review the following RFP requirements. If your proposal deviates in any respect from the requirements listed below, clearly specify all such deviations. If your company has any issues with the plan design or other aspects of the proposal requirements, you are required to list the assumptions, conditions or limitations of your proposal. If no conditions or assumptions are listed, your acceptance of all terms of the RFP will be binding.

The vendor(s) will indemnify, hold harmless and save COG/GUC, its agents, officers and employees from liability of any kind or nature (including costs, expenses or attorney's fees) for damages suffered by any entity or person as a result of error, negligence, reckless or willful acts or omissions of the administrator, its agents, officers or employees.

This agreement shall hold for the term of the contract, even if not expressly provided for in the contract.

General Questionnaire

General Questionnaire

Bidder Instructions: Provide your responses in column D as applicable. Limit responses to 250 words unless otherwise specified.

Pharma Questionnaire

Pharmacy Questionnaire

Bidder Instructions: Provide your responses in column D as applicable. Limit responses to 250 words unless otherwise specified.

Core PPO Plan

Core PPO Plan

Bidder Instructions: Confirm your ability to match current plan designs in columns R and S.

*If there is a discrepancy between this sheet and the benefit summary / SBC, the benefit summary / SBC should govern.

Enhanced PPO Plan

Enhanced PPO Plan

Bidder Instructions: Confirm your ability to match current plan designs in columns R and S.

*If there is a discrepancy between this sheet and the benefit summary / SBC, the benefit summary / SBC should govern.

HSA Plan

Bidder Instructions: Confirm your ability to match current plan designs in columns R and S.

*If there is a discrepancy between this sheet and the benefit summary / SBC, the benefit summary / SBC should govern.

Performance Guarantees

Performance Guarantees

Question Response

Performance Guarantee Minimum Standard Fees at Risk

- Eligibility Updating

- Eligibility Accuracy - 98% of electronic eligibility files processed within 2 business days of receipt of data delivered sFTP

- Load clean eligibility data with at least 99% accuracy

Financial Quote

Financial Quote

Bidder Instructions:

- Complete the financial exhibits providing ASO fees for the proposed program of benefits, for the following options:

1. Core PPO

2. Enhanced PPO

3. HSA

- Provide fee quotes for the current plan designs included for all eligible employees

- Multi-year rate guarantees, if applicable

- You should provide proposed fees assuming self-funded medical ASO services with carved-in pharmacy benefit administration

- Describe any rating caveats or assumptions associated with your quoted fees. All caveats must be listed in the space provided

- Medical ASO fees should be net of commissions and benefit administration services

- COG/GUC will not be responsible for any additional costs or fees that are not clearly specified in this exhibit

- Final enrollment is subject to change

List all underwriting and financial caveats here. If they are not listed here, they will not apply to the final contract.

Disruption Report Disruption Report

Bidder Instructions: Using the disruption file below, compare the current utilized providers to the network that will be offered. Respond with a "Y" or "N" in column O to indicate the upcoming year's Participating vs. Non-Participating providers.

Only respond "Y" to vendors that are currently participating in your provider network. Put any notes about anticipated outstanding or forthcoming contracts negotiations (or assumptions that you made) in column P.

Exclusions/Inclusions:

Geo Access

Financial Quote

Provide a full geo access report listing all participating providers, inclusive of your quoted national network

TRDS

Health Plan Vendor Name:

Disclosure type: Retrospective (Actual) / Prospective (Estimated) Retrospective

Employer Group Name: City of Greenville / Greenville Utilities Commission

Effective Period: Start End

Plan Name(s) For Which Disclosure Applies:

Enrolled subscribers:

Average Contract Size:

This statement is intended to capture the full and complete variable revenue as pertaining to this group's relationship with you, the carrier. The carrier represents that the information provided below reflects an accurate and complete picture of all revenue sources.

Note that members with Medicare coverage should be captured on a separate statements vs. actives.

For purposes of this disclosure:

• Variable Fees represent amounts charged by programs where fees are dependent on the level of savings.

• Other Fees will capture revenue outside of variable fees which are not part of fixed fees captured separately (see below for more details).

As you complete this Revenue Disclosure, be mindful of the following expectations.

• Actuals should be completed if you are the current carrier for this employer and are asked to complete a retrospective lookback of variable fees. Estimates should be provided for non-incumbents in RFP situations, and for prospective requests for current employer groups.

• For new business opportunities, estimates of variable fees should reflect best estimates based on information available from the client and your book of business. There is an understanding that these fees will vary from actual experience.

• Should terms vary by plan, complete a Total Revenue Disclosure for each of the client’s plans (for all coverages included in the fees - e.g. medical and behavioral)

• This Revenue Disclosure contemplates the medical plan only (e.g. PBM, dental, and other coverages are outside of this scope). All revenue generated at either your company or your parent level (as applicable), as well as amounts paid to a 3rd party who is charged with administering programs is required to be disclosed herein.

• The 'Other' category is intended to capture any items that are part of your Total Revenue but fall outside named categories, such as specialty drug rebates coming through the medical plan.

• Pass through of claims expenses can be excluded unless carrier will retain a portion of these revenues. However, if there are fees, charges, or other mechanisms that represent an incremental net revenue (or possibility thereof), such disclosure is required. An example of this might be any spread pricing, such as what you the carrier charges the client on a capitated basis (higher) as compared to what then gets paid to providers.

• If there are sources of revenue that you are unable or unwilling to disclose, detail below the nature of the revenue stream and the reason for not disclosing. The client has the right to audit any and all of the components of this disclosure.

• We ask that an authorized representative of the company attest to accuracy of the statement on the signature line below the grid.

Provide for each program that falls within category

Provide for each program that falls within category

(e.g. Bill Review, Audits, etc.)

Provide for each program that falls within category

Provide for each program that falls within category

Total Capped Rate Offered (PEPM, across all revenue sources - both fixed + variable) (if applicable)

3. For programs where you are estimating a range of variable fees, explain how you calculate client-specific estimates. This response can include, but is not limited to, how you leverage book of business or client-specific information like demographics, geography, claims experience, etc. to develop your calculations.

4. Describe any other Variable Fee programs not specified above or circumstances where any of the above disclosures do not apply.

Name:

Title:

Signature:

Date:

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