260125_Chapter_1C_-_Wellness_Scope_of_Work.docx

RFP# 260125 Attachment 1C - Wellness

WELLNESS SERVICES

Introduction The City of Tucson is soliciting proposals for Wellness Services for employees and retirees for a July 1, 2026 effective date.

Contractors should match or improve upon current plan design features as close as possible, specifically noting any differences in the Deviations section of this Attachment.

The City requires contractors provide ALL services in this Attachment. Contractors must (1) on their own or (2) with partners provide ALL services included in this Attachment.

The City’s website: https://tucsonaz.gov/benefits contains benefit plan information. Wellness plan details can be found at Wellness - City of Tucson . Current benefit booklets can be found on the City’s Procurement website with the RFP documents.

Please note that the requirements listed in the Scope of Work in this RFP are minimum service levels the City expects to receive through this solicitation. Any offeror may introduce enhanced services as part of their comprehensive response to this solicitation given that the minimum service levels are met.

MINIMUM REQUIREMENTS

At minimum, Contractor shall meet the following:

Any Offeror not meeting the minimum requirements will be rejected.

Background Cigna has provided the Wellness Services and one full time onsite Well-Being Coordinator for the City’s employees and retirees since July 1, 2013. Currently, CIGNA provides a $410,000 general fund ($50,000 can rollover). The general fund is used for wellness initiatives, open enrollment costs, and communications. Cigna also provides a $50,000 Innovation Fund to be used for Pilot Programs. A Wellness Incentive Fund is also provided in the budgeted amount of $100 per subscriber per year for MovitaveMe incentives as well as the Healthy Babies Incentives. Please note: members can earn up to $250 in wellness incentives and an additional $150 or $75 incentive for Healthy Babies enrollment (if applicable). The budgeted amount is an estimated average and has historically covered all incentives earned. .

The City currently covers approximately 4,466 employees/retirees (3,884 active employees/COBRA beneficiaries and 582 retirees under its medical plans).

Underwriting Information Current Carrier: CIGNA since July 1, 2013.

Eligibility:

Eligibility varies based on the programs offered. Please see some examples of the various programs and eligibility below:

· Only active, benefits-eligible employees who are enrolled as the primary subscriber in one of the City’s medical plans are eligible for wellness incentives (gift cards, raffle prizes, etc.).

· For some programs tied to the medical plan like MotivateMe, only employees and retirees enrolled in City medical as a primary subscriber (not as a dependent, if, for example, two City employees are married and together on a plan) may participate.

· For onsite flu shots, all employees may participate, and they either pay directly or offer their own insurance as payment if they are not enrolled in City medical insurance.

· Mammography generally follows the same eligibility as flu shots.

· Additional wellness programs will likely be limited to active employees.

The City has interest in exploring opportunities for expanding the wellness program to include retirees and dependents of actives and/or retirees.

There is information on the City’s wellness page with all the offerings of the wellness program. Each one will include information about who is eligible to participate. Wellness - City of Tucson

Insurance eligibility can be found in the Insurance Handbook on the City’s website:

https://tucsonaz.gov/benefits

Funding: There is currently no additional cost to the City for these services. They are currently funded by Cigna.

Current Contribution Strategy: N/A

Rate Structure: N/A

Requested Plan Design: Match or improve current wellness benefits and provide services to support the City either by providing an onsite coordinator or the City is open to alternative approaches to providing the same level of service to employees, retirees and their dependents as provided by the onsite coordinator. The City may choose to engage separate firms based on what it learns during the RFP process. If your proposal requires the bundling of any service, you must make that clear in your pricing proposal.

Underwriting Data: An Excel workbook with a pricing exhibit will be provided (See Request for Confidential Documents form in Request for Proposal document).

Commissions: Submit net of commissions.

Reason Bidding: Market evaluation.

Scope of Work The City’s goal is to select the firm that will be the most effective and proactive partner. The minimum program services include:

General

1. Proposal, Interview, and Best and Final Responses Become Part of Contract: Contractor’s written response to this RFP, written information provided as part of an interview and written responses provided during a Best and Final negotiation become part of the contract between Contractor’s organization and the City of Tucson.

2. Contractor’s Bid Terms: Are guaranteed for at least 180 days from the proposal due date.

3. Contract Length: The Contract has a length of one (1) year with the option to renew for six (6) additional one-year periods.

4. Rate Guarantee: Rates are guaranteed for a minimum of three (3) years (July 1, 2026 through June 30, 2029).

5. Renewal Notification: The contractor must provide any rate changes in writing at least 180 days prior to the contract anniversary date (i.e., January 1 of the prior plan year for a July 1 effective date). Any requested increase must be provided in writing. The Contractor must provide the following with each renewal package:

a. Any contract language changes requested

b. Specific justification of rate/fee changes

c. Current enrollment

d. Additional options for consideration

e. All underwriting caveats

6. Flexibility: The City reserves the right to carve-out any service or program, change contribution strategies, funding, benefit designs or any aspect of their program in the future as they deem appropriate.

7. Variance Provision: Contractor agrees that any provisions relating to reevaluation of proposed rates/fees or re-rate during the contract due to variation in enrollment from the census provided or other contingencies of the quote or renewal are no less than 20%.

8. Proper Licensure: Contractor agrees to maintain proper licensure as required by any state law and Department of Insurance Regulations pertaining to this coverage where it relates to the services that you will be performing for the City of Tucson.

9. Prior Notice of Major Operational Changes: Contractor agrees to provide no less than 30-day notice to the City of Tucson for any changes involving the sale, merger, data breaches, layoffs, consolidation or outsourcing of services to foreign workers that will impact the City of Tucson.

10. Subcontracting: Unless otherwise explained in this RFP, contractor agrees that they will disclose all subcontractor arrangements, and any additional fees associated with the subcontractor arrangements, that involve the services provided to the City of Tucson.

11. Subcontracting: Contractor agrees that all subcontract relationships are subject to the City’s consent prior to implementation.

12. Damages: Contractor accepts responsibility for all damages caused by their own negligence, gross negligence, willful misconduct and/or breaches of the contract. The contractor will not require the City to indemnify bidder for its own negligence.

13. HIPAA Compliance: Contractor attests to meeting all applicable HIPAA EDI, Privacy, Security, and HITECH requirements and agrees to hold the City of Tucson harmless for breaches that are the result of the contractor’s actions. Further, contractor agrees to perform all of the duties associated with breach notification, and assume financial responsibilities for the breach notice and notify plan participants if there is a breach and will pay for 24 months of identity theft repair and credit monitoring services for those plan participants impacted by the breach.

14. HIPAA Compliance: Contractor certifies that all services provided as part of this contract will be in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and HITECH and their subsequent amendments and changes. Violations shall be reported immediately to the City in writing. Contractor will notify the City of any and all actions taken as a result of any violation.

15. Eligibility Rules and Uncertain Claimant Eligibility Situations: Contractor agrees to the specified eligibility rules established by City of Tucson. The contractor must communicate directly with the City of Tucson regarding any uncertain claimant eligibility situations before notifying the claimant of ineligibility.

16. Member Services: Contractor will record one hundred percent (100%) of member calls into a Customer Service Center and the recordings will be available to the City within 24 hours of recording and should be retained for a minimum of 12 months.

17. Termination Provisions: Contractor agrees the City of Tucson may terminate the contract at any time without cause, by giving 60 days written notice. The City of Tucson can terminate with cause with 30-day notice unless proper remedy is provided by the contractor. The City may terminate any contract early if it deems such action necessary or appropriate to fulfil its duties to employees, retirees and beneficiaries.

18. Termination: Upon termination contractor agrees to cooperate with the City in transitioning services to a successor contractor in a manner designed to mitigate disruption to participants and beneficiaries at no additional cost to the City.

19. Termination: In the event of termination, the City will only be obligated to pay fees for services actually provided through the termination date.

20. Maintenance, Ownership, and Transfer of Records:

a. The contractor will be required to maintain all pertinent records for seven years. This is in conjunction with prudent business practice and (as applicable) ERISA provisions; and

b. The contractor will be charged with the safekeeping of plan experience information; and

c. In the event of contract termination, and related to contract termination, the contractor will be required to cooperate with the City of Tucson, or their representative, in the prompt, accurate, and orderly transfer of the City of Tucson's plan experience and utilization information to the City of Tucson or its designated succeeding health plan/carrier at no additional cost to the City and

d. Contractor shall maintain a record of all complaints from all members and shall provide the same to the City of Tucson within ten (10) business days of the initial request. Such record shall include all correspondence relating to the disposition of the complaint.

21. Assignment or Transfer of Rights: Contractor agrees that they will not assign or transfer the rights or obligations of the contract or any portion thereof, without the prior written approval of the City of Tucson.

22. Duties: Contractor acknowledges that their firm will perform all duties contracted for in accordance with the standard of care for a professional with expertise in all areas contracted for.

23. Applicable Law: Contractor agrees to comply with all applicable federal, state, and local laws, rules, regulations, and ordinances. Further, contractor certifies compliance with all provisions, laws, acts, regulations, etc.

24. Contract: Contractor shall represent the complete contractual understanding of the parties and changes must be signed by both parties. The contract shall not incorporate policies or documents that are subject to unilateral change or are not agreed to in advance.

25. Contract: Contractor agrees that any service contract arising from this RFP will not include any limitations of liability or disclaimer of warranties.

26. Contract: Contractor shall provide with this proposal any additional documents or contracts the City will be required to sign. The documents provided must be updated with language based upon the specific requirements of this RFP. The documents should contain the following language: To the extent there is an inconsistency between the contract and the Request for Proposal (RFP) between the parties, the RFP will govern.

27. Business Associate Agreement: Contractor shall agree to sign the City’s Business Associate Agreement as written and provided prior to award.

28. Plan Design and Plan Provisions: Contractor’s plan(s) must match or improve upon the current plan designs, provisions, exclusions and limitations. Specific deviations, if any, are identified in the proposal responses and not just a general disclaimer indicating “some differences may exist” or “refer to our proposal”. The burden is on the Contractor to point out any differences. Differences not noted on the deviation form, shall not be accepted, even if not negotiated.

29. Offshore: Contractor shall NOT provide any services, nor shall their subcontractors provide any services offshore including administration, customer service and ALL data related to the City’s participants will remain within the United States.

30. Offerors are encouraged to propose solutions that will facilitate high participation levels in health risk assessments, clinics and screenings and that have a proven history of reducing employer costs related to illness, injury, absenteeism and presenteeism.

Data and Reporting

Administration

1. Contractor shall attend health fairs and staff/organize annual on-site flu shot clinics. Contractor will pass through the cost of flu shots as a preventive service claim at the on-site flu shot clinics for enrolled primary subscribers (note this does not include dependents). Non-permanent employees (who are not eligible to enroll in the City’s medical plan) may also participate in the on-site flu shot clinics, and the administrator must have the capability to invoice all major medical plans and collect payment directly from flu shot recipients who don’t carry insurance. CIGNA currently uses El Rio to organize the flu shot clinic and El Rio sends the claim to CIGNA or other medical plan that the member is covered under.

2. Contractor shall provide online Health Risk Assessments. The City has interest in providing on-site biometric screenings in the future, the claim cost of which would be covered at 100% under preventive care. Vendor must report participation on a per-participant basis for the City to utilize in incentive programs and/or contribution rate differentials.

3. Contractor must provide a portal for plan participants to access on-line health risk assessments and programs including tracking incentives.

4. Contractor must provide self-paced coaching programs through the member portal and telephonic goal-based coaching with a live health coach.

5. Contractor must develop a Healthy Rewards Program, including but not limited to: Nutritional Meal Delivery Service, Fitness Memberships and Devices, Alternative Medicine, Yoga Products and Virtual Workouts.

6. Contractor shall provide support to City of Tucson for a coordinated effort around its tobacco cessation program. Support shall include, but not be limited to, a coordinated member-enrolled program with scheduled member counseling and other tobacco cessation support.

7. Contractor shall provide quality services, meeting or exceeding the City-approved industry standards as specified in the Performance Guarantees below. Contractor shall take immediate corrective action and provide a written plan, as requested by the City, should the City identify any issue related to poor quality or lack of responsiveness uncovered in any audit conducted, either internally or externally, of contractor’s required processes or procedures. This action plan shall clearly outline the corrective steps and timeframes for completion when services do not meet industry standards to include standards that are inappropriate, undesirable, and/or of poor quality, as identified by the City. Any additional resources required to support corrective actions shall be provided at no additional cost to the City. Corrective measures taken to ensure the City quality standards, reporting standards or performance standards will be provided at no additional cost to the City through fees or hidden charges.

8. Contractor shall provide resources to respond within one business days to all inquiries related to quality assurance, corrective actions, deficiencies and/or inefficiencies in operations.

9. Contractor agrees to work actively and closely with the City’s Medical Management contractor to coordinate services and enhance the wellbeing of plan participants.

10. Contractor shall be proactive in terms of applying for wellness awards on behalf of the City and with input from the City.

Implementation

1. Upon completion of the award, contractor shall provide to the City communications and data support within a specified timeframe designated by the City during implementation for a successful transition to the new contractor.

2. Contractor shall meet with the City no less than bi-weekly (or as needed) during the implementation of the process or more often as needed.

Health Fairs & Other Wellness Events

1. Contractor must comply with the following wellness procedures:

a. Contractor shall provide, at no additional cost to the City, the necessary staff for planning, transition, implementation of wellness services.

b. Conduct an orderly transition for an implementation date of July 1 of each contract year for Active employees and Retirees.

c. Provide knowledgeable personnel to attend 2 days per year onsite health fairs and bi-weekly onsite new hire orientation (frequency and format to be determined by City, at no additional cost to the City). Locations of meetings may vary within the greater Tucson area. Contractor will be responsible for brief presentations and answering questions.

Account Management and Member Service

1. Contractor shall provide an onsite Well-Being Coordinator or the City is open to alternative approaches to providing the same level of service to employees, retirees and their dependents as provided by the onsite coordinator.

a. Currently duties of the Well-Being Coordinator include collaborating with the healthcare contractor management team, external contractors, community resources and the City in development and execution of programs promoting health and wellness. The focus of the Onsite Well-Being Coordinator is the working well population for employees and retirees in aggregate. A core objective of this position is to facilitate wellness programs that educate and influence employees at the worksite to lead healthy lifestyles. Current wellness activities include the following:

i. Develop and execute a health promotion strategy including 1, 3 and 5 year strategic plans and related budgets.

ii. Collaborate with the City to develop and maintain a committee of wellness ambassadors; partnering with the ambassadors in delivery and promotion of the health promotion strategy

iii. Conduct meetings and presentations, preparing written and graphic communications and responding timely to requests in support of health promotion strategy, including but not limited to newsletters, posters, email, a wellness calendar, raffles, reminders, health awareness seminars and workshops, and education for various health related topics (nutrition/healthy eating, physical activity, etc.)

iv. End-to-end coordination and delivery of wellness campaigns aimed at re-shaping behavior toward health improvement

v. Plan, organize and execute large-scale events such as wellness fairs, wellbeing events, and family day in the park hosted by the City’s Parks and Recreation Department

vi. Assist with implementation of new systems, program offerings, processes and procedures; evaluating and documenting processes and procedures, and making recommendations regarding opportunities to improve standards and efficiencies

vii. Construct and conduct benefits-related employee surveys’ analyzing and reporting on responses

viii. Provide reporting to determine population’s health risks and costs associated with each risk category

ix. Track program costs and provide regular status reporting thereof to the City

x. Track the completion of all activities and screenings, and provide reporting to the City on participation

xi. Order and maintain a supply of appropriate collateral, materials and giveaways

xii. Understand organizational trends and opportunities and leverage available data sets to drive innovative population health strategies.

xiii. Handle difficult situations with diplomacy, good judgment and professionalism; exercising global and cultural awareness

xiv. Maintain confidentiality throughout all communications and data interactions

2. Account Manager – Contractor shall provide one (1), day-to-day point of contact for City of Tucson with the primary responsibilities of responding to all plan issues, coordinating with the Contractor’s various departments to resolve issues, and overseeing all aspects of project management including, but not limited to, initial implementation and any ongoing or new program facilitation. The Account Manager shall have a minimum of five (5) years’ experience with the Contractor’s organization or in a similar industry. If possible, the Account Manager shall also be a local resident of Arizona or have intensive familiarity with factors influencing care and services in the local market.

3. Contractor shall provide exceptional customer service support via phone, e-mail, and website for the City and their plan participants as documented by consistent reporting through performance guarantees.

4. Contractor shall be responsible for providing reasonable accommodations related to wellness program, in accordance with EEO and ADA legislation.

5. Contractor shall stay abreast of emerging and evolving regulation surrounding wellness programs and shall keep the City apprised of important related issues and decision points.

Eligibility

1. Contractor agrees that the City shall be the final authority in deciding eligibility of participants.

2. Contractor agrees to receive eligibility and enrollment information via a weekly electronic feed from the City’s online enrollment system (currently Workday), at no additional cost to the City. The City reserves the right to change enrollment system providers at any time. Should a different enrollment system provider be used, there shall be no charge from the Contractor to the City to change providers including any changes to data files or feeds, etc.

3. Contractor shall establish appropriate FTP site(s) to exchange eligibility data at no additional cost to the City.

4. Contractor must agree to load eligibility file weekly within 2 working days of receipt and notify City of discrepancies and errors within the eligibility file within 2 working days of receipt of each eligibility file.

5. Contractor shall absorb any/all programming costs associated with data file transfers (weekly eligibility feed) in current data file compliant format.

6. Contractor agrees to accept the City's self-bill (no true up of any eligibility discrepancies other than those based on eligibility file transfer).

7. Contractor agrees to accept payment 60 days in arrears. For example, July’s fees would be considered late after August 29. Members may change plans outside of open enrollment due to qualifying life events, as defined by the City in the Insurance Handbook posted at: https://www.tucsonaz.gov/insurance/coverage-information.

8. Contractor shall provide City benefits/finance/management with access to secure email at no additional cost to the City for resolving confidential issues relating to wellness programs, transmitting secure data and having secure discussions.

9. Contractor shall agree to communicate through HIPAA-compliant electronic sites to exchange data between themselves and any other required contractor as requested by the City at no additional cost.

Wellness Communication Materials

1. Contractor shall submit all copies of wellness materials, web portal member communications and promotional materials for written approval by the City.

2. Contractor shall ensure that members with limited English proficiency, Spanish-speaking, and those who are deaf or hearing impaired have access to communication services that enable them to utilize the phone lines.

3. Contractor shall supply both written and electronic member communication materials (flyers, etc.) at no additional cost to the City. Documents will be requested in English and Spanish (when available)

4. Contractor shall provide a website and/or mobile application(s) for use by employees, retirees and eligible dependents to obtain information on the City’s wellness plans, services offered and their individual account information.

Public Information Requests or Other Communications

1. Contractor shall notify the City within 1 business day of receipt of any public information written request regarding any information that relates to the City’s benefit plans. Contractor shall review all responses with the City and obtain approval prior to the release or response of any inquiry.

2. No Member Communication Without the City’s Consent: The contractor will not automatically enroll the City of Tucson in any programs that involve any type of communication with members, without express written consent from the City of Tucson.

Commissions, Overrides and Bonuses

1. Contractor agrees commissions shall not to be included in the fees/rates submitted, (i.e., all fees/rates are to be quoted net of commission.). Any proposal that includes payment of commissions to a third party may be deemed non-responsive.

2. Contractor agrees that if commissions are included in their filed rates and cannot be removed from the rates provided, the level of commissions included in the proposed rates must be disclosed. Contractor agrees to disclose all direct and indirect compensation, fees, commissions, incentive awards, rebates, payments, fees or remuneration of any sort, however characterized, as a result of or arising from the City account. If commissions cannot be removed dollar for dollar from contractor’s rates commissions will be payable to the City’s consulting firm.

Proposal Evaluation Requirements

I. PROPOSAL EVALUATION REQUIREMENTS

A. Method of Approach B. Cost C. Qualifications and Experience

II. REQUIREMENTS SPECIFIC TO EVALUATION CRITERIA: The narrative portion and the materials presented in response to this Request for Proposal should be submitted in the same order as requested and must contain, at a minimum, the following:

A. Method of Approach

1. Complete the Method of Approach Questionnaire

2. Complete the Reporting Chart

Cost

1. Complete the Fee/Rate Pages in the Excel Workbook

2. Complete the Performance Guarantees Qualifications and Experience

1. Complete the Qualifications and Experience Questionnaire

DEVIATIONS AND EXCEPTIONS

Offerors shall indicate any and all deviations or exceptions taken to the provisions or specifications in this RFP below. If exceptions or deviations are not listed, it will be assumed you will conform to all of the requirements in this RFP.

List each specific deviation by reference in the RFP or reference any materials included or referenced in the RFP along with the specific deviation. General deviation statements such as “our intent is to conform” or unclear statements are not desired and may impact our ability to fully understand your offer.

Exceptions (mark one):

__________ No exceptions

__________ Exceptions taken (describe below). Please list each and every deviation to anything written in this RFP and this Attachment. If you do not list any deviations, it will be assumed that your proposal conforms to all of the requirements unless otherwise noted.

Deviations

Offeror Name:

Signature:

Date:

CONFIDENTIAL/PROPRIETARY SUBMITTAL FORM

Confidential/Proprietary Submittals (mark one):

No confidential/proprietary materials have been included with this offer

Confidential/proprietary materials included. Offerors should identify below any portion of their proposal deemed confidential or proprietary. The City will only review the specific areas listed below and will not review the entire proposal for confidential information indicators. Identification in this section does not guarantee that disclosure will be prevented but that the items will be subject to review by the Contractor and the City prior to any public disclosure. Requests to deem the entire proposal or price as confidential will not be considered.

Firm

Authorized Signature Date

ADDITIONAL MATERIALS SUBMITTED

(Mark One):

__________ No additional materials have been included with this offer

__________ Additional Materials attached (describe—attach additional pages if needed)

Firm

Authorized Signature

ATTACHMENTS INCLUDED IN RFP:

· Wellness Cost Proposal

· Wellness Questionnaire

· Incentives Earned

· Incentives Redeemed

FINAL CHECKLIST

The items listed below must be included electronically in the file format noted. Other materials with your proposal may be provided in pdf format.

Attachment 1C (Wellness Questionnaire) – Excel workbook

· Method of Approach

· Qualifications and Experience