26-23HR_Exhibit_B_Scope.pdf

Exhibit B Scope of Services Broker/Agent Services for Health-Related Employee Benefits

I. INTENT:

The City of Sarasota, Florida, is requesting proposals from experienced and qualified individuals/firms with expertise in Agent/Broker Services regarding the evaluation and obtaining of insurance coverage and management of a self-funded medical, pharmacy and dental plans as well as supplemental insurance. Firms and/or persons responding to this Request for Proposal shall be able to demonstrate that they will have the continuing capabilities to perform these services and possess the necessary license and/or certification to do so. Minimum requirements and specifications have been developed and are included herein.

The initial contract period shall be for three (3) years. The contract agreement may be renewed at the same terms and conditions, by mutual agreement and subject to budgetary constraints, for two (2) additional one (1) year extension periods.

II. ELIGIBILITY;

Any Respondent who operates as a managing general agent, managing general underwriter, has any ownership interest in an entity which contracts with a joint insurance fund, has any financial interest in any joint insurance fund, or in any similar capacity for any underwriting organization shall fully disclose the nature and extent of its service as such. Such statement shall include confirmation that such service shall not present a conflict of interest with regard to Respondent's responsibilities to the City.

No commissions can be accepted by the broker from any carrier, Third Party Administrator (TPA) or provider on behalf of the City or for any products purchased for the City.

III. HISTORY:

The City offers a comprehensive self-funded group insurance program, in addition to an Employee Health Center and numerous supplemental insurance offerings to its employees, retirees, Consolidated Omnibus Budget Reconciliation Act) (COBRA) participants and dependents. There are approximately 804 full time employees and approximately 642 retirees enrolled in benefits. Approximately 271 of those retirees remain enrolled on the self-insured medical plans. The City also offers a fully insured Medicare Advantage Plan to retirees which has approximately 221 Medicare eligible pre- 1993 retirees enrolled. The City has 2 COBRA participants covered under the City's program currently. Overall, there are approximately 1782 total lives including dependents enrolled in the medical plans. The City currently offers the following benefit options to all active employees and retirees, and all plans are renewed with an effective date of January

1. The City's plan year is January 1 through December 31. The City has three unions with which benefits are negotiated. The City currently uses Workday for benefits enrollment.

The current benefit plans include these various insurance coverages:

City Self-Insured Medical Plans:

1. Preferred Provider Organization (PPO) Plan

2. High Deductible Plan

3. Pharmacy

4. Health Reimbursement Arrangement (HRA)Accounts

5. Health Savings Account (HSA) Accounts

6. Retiree Reimbursement Accounts

7. Medicare Advantage PPO (Retirees)

8. Stop Loss coverage - $250,000 level

-Dental Self-Insured Plan -Group Vision Insurance - employee paid and retiree paid -Group Legal Protection Plan - employee paid -Group Life Insurance (with Accidental Death and Dismemberment (AD&D) for Employees and eligible Retirees - sponsored by employer -Flexible Spending Accounts for Employees -Lifestyle Spending Accounts for Employees -Supplemental Life Insurance -Health Clinic -Pet Insurance -Other Supplemental Insurances (i.e. Cancer, Accident, Critical Illness, Short-term Disability, Long-Term Disability, Employee Assistance Program (EAP) etc.)

IV. SCOPE OF WORK:

The Consultant awarded the contract under this Request for Proposal shall provide comprehensive Broker/Agent Services and Actuarial Study support for self-funded medical and dental, stop loss coverage, vision, legal services, life, long-term and/or short-term disability, EAP, flexible spending plans and other supplemental benefits for the City of Sarasota, Florida. The City requires that qualified respondents be licensed insurance agents in the State of Florida that are independent and not employees of any insurance company, third party administrative agency or provider network.

The Broker/Agent to be contracted by the City to provide insurance agent services shall be expected to provide, at minimum, the following insurance services:

1. Initial Task:

A. Audit the performance of the City's current group plans and supplemental options to become familiar with the history of the City and claim trends. This benefit analysis includes self-funded group medical and dental plans, stop loss coverage, vision, legal services, life, long-term disability, EAP, flexible spending plans and other supplemental benefits. Provide the City with the findings and options for enhancement of its benefit offerings.

B. Perform a market analysis and obtain quotes for vision, legal services, life, long-term and/or short-term disability, Employee Assistance Program, flexible spending plans and other supplemental benefits as directed by the City.

C. Present all market quotes and products to the City.

D. Provide recommendations for cost mitigation opportunities that do not impact Bargaining unit agreements.

E. Assist the City in the development of final agreements with the insurance carrier(s) or third-party administrators selected by the City, and act as a liaison between insurance carrier(s) or third-party administrators and the City during implementation process.

F. Assist the City in obtaining proposals annually for stop loss coverage renewal.

G. Obtain and have knowledge of Medicare plans and requirements and assist with Coordination of Benefits between Medicare and self-funded plans. Also, host Medicare seminars.

H. Provide any necessary filings to ensure compliance, including Office of Insurance Regulations (OIR) FS112.08 reporting.

H. Assist in responding to Retiree Drug Subsidy (RDS) inquiries, denials or other communication upon request.

I. Quarterly invoice audit for each vendor.

2. Annual On-Going Services

Cost Analysis:

A. Prepare a medical and pharmacy plan design analysis that identifies the potential cost savings by a re-design of deductibles, co-payments, co-insurance, out of pocket maximums and other structural changes.

B. Provide an estimated renewal projection in advance of renewal(s), based on standard underwriting formula.

C. Coordinate with the City prior to renewal(s) with an updated estimate of renewal changes in premium, along with possible changes in coverage, policy terms, etc.

D. Present final renewal pricing and policy changes about 120 days before renewal.

E. Annually, go to market for quotes on stop loss for self-funded medical plan. Present market quotes and analyze renewal at least 60 days prior to plan year start.

F. Assist with actuarial data or reporting to set the plan rates.

3. Regulatory:

A. Inform the City of current issues in the area of benefits law and administration including advice regarding Health Insurance Portability and Accountability Act (HIPAA), Family and Medical Leave Act (FMLA), Continuation of Health Coverage (COBRA), Medicare, Affordable Care Act and other similar state and federal laws that govern group insurance programs. The successful proposer shall have access to qualified staff or outside employee benefits legal counsel at no cost to the City.

B. Keep the city abreast of changes in statutory and regulatory changes affecting their health insurance and other benefits, review pending legislation and trends in health insurance and other benefits, and report to the city of any impact it may have on existing. Benefits include bearing the cost and expense for their reproduction of any copyrighted materials necessary for such performance, inform the City of any future legislation on health insurance and other benefits, and assist the City and required procedures to achieve compliance with any future legislation.

C. Provide general information, updates, document preparation/review, and assistance with filings of required documents.

4. Benefits Administration Support:

A. Provide the city with no less than 30 hours of available free training for benefits issues, laws and regulations for the Human Resources and benefit staff annually. This could also include FMLA situations that may arise.

B. Assist in the review of summary plan descriptions, newsletter articles to employees and retirees, communicating the cities employee benefits, insurance and Wellness programs.

C. Assist, as needed with implementation of program changes when they occur.

This may include on site visits at no additional cost to the city.

D. Act as a liaison between the city and insurance providers. A response time from broker within 24 business hours.

E. Respond to questions regarding the insurance programs as may be presented by the City, and maintain verbal contact with the employee benefits staff at least monthly.

F. Attend meetings with the city, insurance carriers and related service companies to discuss insurance benefits, service issues, Wellness and other programs to manage costs and improve communications and/or address specific problems.

G. Meet with the city at regular intervals (at least quarterly) to review and discuss plan performance, premium/claims history, market trends, insurance trends, and provide observations.

H. Draft Annual benefit highlights book for employees and retirees, with review and comment by the City. Provide an electronic computer copy to be published on the City's intranet site with 500 hard copy booklets for distribution at the Health Fair. The electronic booklet must be ADA compliant and accessible by city standards and also available in Spanish when requested.

I. Support the Section 125 process on an annual basis

J. Provide and fund appropriate FMLA review, tracking and approval support software to be included with broker fee.

K. Provide access to employees/retirees to reach out to broker for questions regarding insurance claims and benefits coverage.

L. Provide year-round benefits calendar and planning support.

5. Plan Review Analysis:

A. Review and evaluate the City's existing employee benefits group plans or programs, including plan demographics, premiums/claims ratios, utilization of benefits and wellness programs to procure new insurance or manage associated costs.

B. Compare and contrast the City's plan and performance with other like plans, if asked by the City.

C. Provide reporting and analysis the City deems necessary and beneficial to the City in making a sound financial decision regarding their plan programs.

D. As the Broker of Record for the City, obtain all data from the carriers and analyze trends and issues for presentation to the City. Provide raw data to City upon request.

E. Manage the data gathering and support for annual actuarial report. Review draft of report and provide feedback.

F. Present creative approaches for benefit options and design with the intent of cost containment.

G. Review all Summary Plan Documents for compliance with plan design. Work with carriers to ensure they are correct.

H. Review Health Reimbursement Account (HRA), Health Savings Account (HSA), or other medical saving account options and make recommendations to the City.

I. Conduct satisfaction surveys, feasibility studies, performance audits, and benchmarking of other employers' benefits and inform the City of findings no less than annually.

6. Open Enrollment:

Open enrollment Services shall include, at minimum:

A. Support with open enrollment project management including drafting all open enrollment material, rate information and flyers for retirees and employees including a timeline of events.

B. Assistance with benefits system integrations (file feeds) with new/current vendors as needed.

C. Facilitate providing identification cards, Summary Plan Descriptions, and other required documentation and necessary forms for all insurance benefit plans, if requested.

D. Schedule Teams meeting with each vendor at least 60 days prior to open enrollment to discuss the file feed requirements. Included in the meeting should be City IT staff, Benefits Team, Broker and an appointed contact on the vendor’s side.

E. Review and respond to online enrollment discrepancy reports sent from carriers.

F. Contact all members who waived medical insurance by phone to ensure their coverage is correct within 5 days of open enrollment closing.

G. Prepare presentation for and conduct open enrollment meetings by providing onsite meetings for employees and retirees. In addition, online meetings shall be provided which can be attended by remote employees. These shall include various times such as morning, afternoon and evening meetings. Presentation is prepared and given by the Consultant.

H. Also assist employees and retirees with enrolling in benefits using the HRIS system and phone support for retirees during open enrollment.

I. Conduct retiree satisfaction surveys and provide results annually.

7. Personnel:

A. The Consultant shall designate a principal to be assigned to this account to act as the primary contact for the City. The City must approve the principal and any other personnel to be assigned to perform services for the City (hereafter collectively referred to as "assigned personnel").

B. If for any reason the City finds, in its sole discretion, that the service provided by any assigned personnel is unsatisfactory; the Consultant shall agree to assign replacement personnel that must be approved by the City.

8. Contract Renewal:

A. Provide a complete contract renewal package, to include the quotes provided by carriers, for the City with carrier renewal formula analysis, claims experience analysis, pricing and benefit analysis including utilization review by top providers.

B. Negotiate renewal positions with the carrier to develop appropriate renewal pricing.

C. Develop benefits plans that meet the benefit needs and budget considerations of the city.

D. Design benefit alternatives and identify saving opportunities through benefit, utilization and behavioral changes.

E. Review contract and policy language to ensure plan is in compliance.

9. Other:

A. Participate with the City in conducting an annual Benefits Fair, at no cost to the City.

B. Create annual open enrollment Power Point presentations in person and online for both retirees and employees.

C. Other related services when and as requested by the City.

D. Broker to provide a direct contact for escalated insurance questions that employees/retirees can contact directly.

V. MINIMUM REQUIREMENTS:

Interested parties should possess the following minimum requirements:

1. The Proposing individual/firm shall have at least ten (10) consecutive years of experience in Florida providing similar brokerage and benefits consulting services to public or private entities, similar in scope and size; in the fields of Group Insurance, namely Health, Life, Disability, Dental, Pharmacy, Vision and Medicare Supplement/Risk Plans; Employee Assistance Programs; Flexible Spending Accounts;

• Must have serviced an employer that had at least 500 eligible members on benefits.

2. Public entity experience with a similar entity would be beneficial.

3. Senior Consultant assigned to the account shall have a minimum of ten (10) years' full-time experience in that capacity; providing simi1ar services both in size and scope.

4. Personnel assigned to the account shall have a minimum of five (5) years' full time experience as an agent/broker; providing similar services both in size and scope.

5. Personnel assigned to this account shall have a minimum of five (5) years' experience with related IRS regulations (e.g. IRS Section 125, COBRA, HIPAA, etc.); experience with the Medicare Supplement, Advantage and Part D Plans and Retiree subsidy applications, since inception, as well as Governmental Accounting Standards Board (GASB) regulations.

6. The proposer shall possess knowledge of applicable laws, regulations and codes and shall be familiar with local conditions and trends relating to group insurance in Florida.

7. The proposer must be legally authorized to do business in the State of Florida and shall meet all licensing and other requirements imposed by State and Federal laws and regulations.

8. The proposer shall have experienced management staff, possessing comprehensive knowledge of benefit administration pertaining to public and/or private employers.

9. The proposer's office must provide assurance of reasonable staffing continuity over the contract period.

VI. SUBMITTALS:

1. Provide the City with verifiable confirmation on their part of knowledge and experience regarding related state/federal statues/laws governing their services.

2. Provide Organization chart with names and titles, office locations of individuals assigned to city account.

3. Provide information on any proprietary software and the use.

4. Sample quarterly reports provided to other municipalities of self-funded groups.

5. How is legal advice solicited?

6. Describe the plan of operation for handling in project management of open enrollment for 800 employees and retirees.

7. Provide alternative engagement options to an onsite health fair.

8. Provide a list of references from municipalities within the state of Florida and a direct contact within the Human Resources dept.

9. List of government municipalities that are currently included in your book of business.

10. Provide information on cost containment success with government self-insured programs and what the strategy was.

11. What type of analysis of the data is done on a quarterly basis and do you have the ability to incorporate clinic data with carrier data?

12. What experience with alternative pharmacy approaches or vendors have you used with public entities and has it contained any specialty drug costs?

VII. PRICE PROPOSAL FORM:

All Proposers shall complete the enclosed Price Proposal Form and provide an Annual Fee amount both for the regular Broker/ Agent services as specified herein, as applicable for each year of the initial contract period. Payment is to be made on a quarterly basis.

The Annual Fee(s) shall account for overhead, profit, miscellaneous expenses, and travel.

Consultant shall be paid for all specified and scheduled services based on these approved amounts. Any other required services, not specified herein, shall be paid at the mutually agreed upon rate as negotiated with the City’s Project Manager.