260125_Chapter_1D_-_EAP_Scope_of_Work.docx

EMPLOYEE ASSISTANCE PROGRAM (EAP)

Introduction The City of Tucson is soliciting proposals for Employee Assistance Program (EAP) services for employees and household members 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 to 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 current benefit plan information and eligibility can be found in the Insurance Handbook.

The City reserves the right to carve-out any service or program, change contribution strategies, funding, rate structure (e.g., blended/un-blended, etc.), benefit designs or any aspect of their program in the future as it deems appropriate.

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 EAP services for the City’s employees and household members since July 1, 2013.

The City currently offers benefits to approximately 4,158 employees and their household members. Of this, the City has approximately 1,133 police and 688 fire personnel.

The EAP is available to all benefits-eligible City of Tucson employees and their household members. Retirees are not covered. Eligibility is outlined in the Insurance Handbook. The program offers face-to-face counseling sessions, per issue, plus legal & identity theft support and community resources. The plan will also connect a member to a mental health or substance use resource within the member’s medical network as necessary. 40 hours per year of employer services that can be used for critical incident support, health or benefit fair representation, seminars and training, are also included in the current contract.

Details are outlined in the Insurance Handbook.

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

Eligibility: Can be found in the Insurance Handbook on the City’s website:

https://tucsonaz.gov/benefits

Funding: Current funding is $1.96 Per Employee Per Month (PEPM).

Current Contribution Strategy: The City pays 100% of employee and their household members.

Rate Structure: N/A

Requested Plan Design: Match or improve current EAP benefits (6 face to face sessions, per person, per issue) and provisions. The current contract includes 40 hours per year of employer services that can be used for critical incident support, health or benefit fair representation, seminars and training.

Non-Network Claims: N/A

Participant Demographics: A census with number of currently covered employees and home zip code is available (See Request for Confidential Documents form in Request for Proposal document).

Commissions: All proposals should be submitted net of commissions.

Reason Bidding: Market evaluation.

EAP Services Include:

› Access to help 24 hours a day, 7 days a week, 365 days a year › Network management › Work/life services, which includes consultation, resource, and referral › Employer service hours for onsite training services such as wellness seminars, critical incident response, and manager and employee orientations. Please see the financial assumptions below for total number of hours available.

› Unlimited telephonic consultations with licensed EAP staff for managers on workplace issues › EAP communication materials › Online tools and information, including self-assessments, articles, and provider directories › Online access to EAP utilization reports › Account management

› Pricing based on a population of 8,060 employees

› 5 hours per 1,000 employees of employer services per year or 40 actual based on 8,060 Employees (min. 4 hours.)

› If City of Tucson exceeds this annual allotment, the following rates apply: CIR Services: $285 per onsite hour, wellness seminars or management trainings: $255 per onsite hour.

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 shall 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 Proposal 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 and must include a copy of the underwriting rate development (fully insured) including paid claims, trend and retention expense. Additionally, 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 by rate class

d. Additional options for consideration

e. All underwriting caveats

6. Flexibility: The City reserves the right to change any service or program, 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 or re-rate during the contract due to variation in enrollment from the census provided or other contingencies of the quote or renewal will not be applicable unless total program enrollment variance is at least 20%.

8. Proper Licensure: Contractor agrees to maintain proper licensure as required by any state and Department of Insurance Regulations pertaining to this coverage where it relates to the services that Contractor 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, participating provider facility terminations, consolidation or outsourcing of services to foreign workers that will impact/involve services provided to 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. Eligibility Rules and Procedures for Retroactive Termination and Reconciliation: The Contractor agrees to the specified eligibility rules established by the City of Tucson. Upon receipt of a retroactive termination, the Contractor must review the applicable participant histories and initiate recovery efforts for any overpayments resulting from the late termination notice. The City generally will notify Contractor of terminations within 60 days after coverage termination date. However, the City reserves the right to terminate more than 60 days retroactively, under unusual circumstances.

17. 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.

18. Termination Provisions: Contractor agrees the City of Tucson may terminate the contract at any time with or without cause, by giving 30 days written notice. The City may terminate any contract early if it deems such action necessary or appropriate to fulfil its duties to employees, retirees and beneficiaries. Please refer to the Termination clause in the Standard Terms and Conditions provided in the RFP.

19. 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.

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

21. 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 EAP/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.

22. 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.

23. 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.

24. Applicable Law: This Contract shall be governed, and the City and Contractor shall have all remedies afforded to each, by the Tucson Procurement Code and the law of the State of Arizona. State law claims shall be brought only in Pima County Superior Court. 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.

25. 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.

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

27. 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 responses will govern. Any documents not provided are subject to rejection after the contract is awarded.

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

29. Plan Design and Plan Provisions: Contractor’s plan(s) must match or improve upon the current plan designs, provisions, exclusions and limitations.

30. Offshore: Due to security and identity protection concerns, direct services under this contract shall be performed by Contractor within the borders of the United States. Any services that are described in the contract or scope of work that directly serve the City and may involve access to secure or sensitive data or personal client data or development or modification of software for the City shall be performed within the borders of the United States. Unless specifically stated otherwise in the contract, this definition does not apply to indirect or “overhead” services, redundant back-up services or services that are incidental to the performance of the contract. This provision applies to work performed by Contractor and subcontractors at all tiers.

Data and Reporting

1. Contractor shall provide a quarterly utilization report by service class including number of services.

2. Contractor shall annually provide a summary utilization report by service class including number of services.

3. Contractor shall provide all required data in an electronic format file as requested and specified by the City of Tucson.

Administration

1. Contractor shall provide all required services to all eligible members including a toll free number for member questions.

2. Contractor agrees to provide performance guarantees, measured periodically as specified, and to financial penalties for failure to meet standards.

3. Contractor shall provide quality services, meeting or exceeding the City-approved industry standards as specified in the Proposed Performance Standards. 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.

Contractor shall provide resources to respond within five business days to all inquiries related to quality assurance, corrective actions, deficiencies and/or inefficiencies in operations. In matters of extreme urgency and time-sensitive issues, contractor agrees to provide resolution within two business days of City notification.

4. Contractor shall provide 6 face to face sessions per issue to employees and their household members (e.g. dependents, domestic partners, parents, grandparents, etc.).

5. Contractor shall provide 40 hours per year of employer services that can be used for critical incident support, health or benefit fair representation, seminars and training.

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 provide a team of individuals designated to implementing the provisions of this contract upon award. The implementation team shall include, but not be limited to: programmers; data analysts; project manager; account manager; and member service staff.

3. Contractor’s implementation team shall meet with the City regularly during the implementation process.

4. Contractor shall perform comprehensive testing and quality assurance checks prior to the implementation date of July 1, 2026. Contractor shall report the results to the City no later than May 15, 2026. Meeting these milestones shall be provided at no cost to the City.

5. Contractor shall have City of Tucson’s toll-free telephone number and website available to all plan members by July 1, 2026.

Open Enrollment, New Hire Orientations & Health Fairs

1. Contractor must comply with the following open enrollment, orientation and health fair procedures:

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

b. Contractor shall begin services prior to the plan year effective date in order to prepare for the City’s open enrollment. The plan year for City of Tucson is July 1 through June 30, with open enrollment, generally scheduled for during the month of May. The City of Tucson reserves the right to change these dates with a fourteen (14) day notice to Contractor.

c. Conduct an orderly transition for an implementation date of July 1 of each contract year for Active employees and household members.

d. Provide knowledgeable personnel to attend to two annual onsite health fairs and monthly or quarterly webinars as well as quarterly onsite lunch and learns per year and any other meetings that the City deems necessary to administer the plan.

Account Management and Member Service

1. Account Manager – Contractor shall provide one (1), day-to-day 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 service. 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.

2. Contractor shall respond to account issues and member service issues within one to two business days at minimum with a plan to resolve the issue within a specified timeframe established to do so.

3. Contractor shall provide a designated customer service team at a minimum.

4. 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 and City specific customer satisfaction surveys.

5. Contractor shall provide a dedicated fully-operational toll-free telephone line that is answered by a live person 24-hours per day, 365-day per year toll-free telephone access to live US-based customer service representatives.

6. Contractor shall provide a dedicated team of professionals who will be responsible to see that all contract requirements and service deliverables are met by the Contractor.

7. Contractor shall provide an account management team that is experienced in providing services for similar entities, trained in the City’s plan issues, is accessible to the City during normal business hours AZ (8:00 a.m. to 5:00 p.m.) and with capacity and authority to respond to the City’s issues in a timely manner.

8. Contractor shall provide an escalation process to assist in matters that cannot be resolved at the customer service unit level.

9. Contractor shall provide documentation of a process for prompt issue resolution and maintain an issue log.

10. Contractor shall attend in person or via video conference monthly, quarterly and annual program review meetings, meetings with the Benefits Office, Trust Board, Benefits Committee and periodic telephone calls, as requested by the City’s insurance benefits office at no additional cost to the City.

Eligibility

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

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

3. Contractor agrees to accept payment 60 days in arrears. For example, July’s premium would be considered late after August 29.

4. Contractor shall provide coverage for members on approved leave of absence (with or without pay) provided the City continues to pay premiums/contributions according to the City’s rules for the period of the approved leave of absence.

5. 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.

Plan Member Communication Materials

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

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

3. Contractor shall provide bilingual communication/educational materials.

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

5. Contractor shall prepare and provide policies and all other communications including educational videos to describe the City’s plan benefits and provisions at no additional cost to the City.

6. Contractor shall provide a website and/or mobile application(s) for use by employees and household members to obtain information on the City’s benefit plan, services offered and their individual account information.

7. Contractor shall provide web-based consumer tools for members to access EAP benefits and resources.

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

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.

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.

Employee Assistance Program Network

1. Contractor shall own all contracts with behavioral health providers and take responsibility for all subcontracted networks/providers proposed by the Contractor within this RFP.

2. Contractor shall agree to accept and review provider nominations on behalf of the City or its plan members.

3. Contractor shall maintain for the duration of the contract a network of providers in the City’s geographic locations no less than that proposed in this RFP.

4. Contractor shall provide monitoring and evaluation of all types of provider performance and remove providers that do not meet the performance and quality standards required by Contractor to be part of the network.

5. Contractor shall provide to the network of providers both toll-free telephone support and field service support.

6. Contractor shall resolve provider issues that relate to the City’s members in a timely fashion.

Proposal Evaluation Requirements

I. PROPOSAL EVALUATION REQUIREMENTS

A. Network/Provider Access B. Method of Approach C. Cost D. 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. Network/Provider Access

1. Provide EAP Provider Directories B. Method of Approach

1. Complete ALL sections of the Method of Approach Questionnaire and Charts

2. Complete the Performance Guarantees Chart

3. Complete the Reporting Chart

Cost

1. Complete the Fee and Services Page in the Excel Workbook Qualifications and Experience

1. Complete the Qualifications and Experience Questionnaire and Chart

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:

· EAP Cost Proposal

· EAP Questionnaire

· EAP Utilization Report

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 1D (EAP) – Excel workbook

· EAP Questionnaire (Method of Approach and Qualifications and Experience)