29-D3 - City of Burleson - Voluntary Benefits - RFP.xlsx
XLSX spreadsheet 186 KB Posted
- Attached to
- Ancillary Insurance Benefits
- Solicitation number
- RFP 2026-018
- Issued by
- Johnson County, Texas
About this file
This is a Request for Proposal (RFP) from the City of Burleson, Texas, for ancillary insurance benefits and voluntary worksite products. The City seeks vendors to provide Life Insurance, Disability Insurance, Employee Assistance Program (EAP), Health Savings Account (HSA)/Flexible Spending Accounts (FSA)/Health Reimbursement Arrangement (HRA) administration, COBRA administration, and voluntary worksite products. The RFP covers municipal employees and their dependents, with the objective of awarding contracts to qualified carriers and administrators capable of delivering comprehensive ancillary benefit solutions. Specific response dates, due dates, site visit requirements, and bidder conference schedules should be referenced within the RFP document for submission and evaluation timelines, with contract awards anticipated following the formal procurement process.
Pricing terms, renewal options, contract duration, and any incumbent vendor preferences are detailed in the RFP documentation. The City's procurement process may include set-asides for small or local businesses, dependent upon Texas state procurement regulations. Funding for ancillary benefits is typically derived from municipal employee contributions and City budget allocations designated for employee benefits administration. Prospective vendors should review all pricing schedules, service level agreements, and performance requirements outlined in the RFP to ensure full compliance with the City of Burleson's operational and financial expectations.
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Front Cover Request for Proposal - Worksite (Accident, Critical illness, and Hospital Indemnity), Legal, ID Theft, and Pet Insurance
City of Burleson
| Prepared by: Lockton Companies |
| Date: _______________ |
Introduction City of Burleson
| Overview of the City of Burleson |
| Corporate Address: City of Burleson |
141 W Renfro Street, Burleson, TX 76028
| Business Type: Municipality |
| Primary SIC Code: 9111 - Executive Offices |
| Web site: https://www.burlesontx.com/ |
| Current Programs: |
| The group has fully insured plans offered to active employees meeting the eligibility requirements. Please see the attached benefit summaries for plan designs. |
| Proposal Guidelines: |
| The group is requesting a proposal from your company and would like to bundle coverages with fewer carriers for preferred pricing and reduce the administrative burden although they may be separated as needed by the city. Please provide pricing for the current plan designs, requested alternatives plan designs. All deviations from the current plan must be clearly defined. See the Requested Proposal-Questions Tab which provides specific proposal requirements for all lines of coverage in this RFP including Voluntary Plans. Alternative plan designs may be considered |
| Please provide the following information: |
| Fully Insured pricing assuming current plans and alternatives listed in the Requested Proposals/Questionnaire Tab. |
| Complete all Questions in the Excel format as requested |
| Our evaluation will be based on the following criteria: |
| Price |
| Qualifications of company and service team |
| Vendor Flexibility/Creativity |
| Ability to match current plans and/or adhere to requested plan specifics |
Effective Date: 1/1/2027
| Commission Level: |
| 25% Level |
| Service |
| Rates |
| Rate Validation/Check |
| Network Accessibility |
| Claims Service |
| New Client/Prospect |
| Renewal Review |
| Other |
| Flat fee |
| Capitated fee (per employee per month) |
| Flat percentage of premium |
| Graded percentage of premium |
| Member-based sliding schedule |
| Net of commission |
| Other |
&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P
Eligibility Eligibility
Waiting Period:
All Employees: Date of Hire PET INSURANCE, PREPAID LEGAL - Definition of Eligibility:
Active: All employees including part-time and full-time staff. Seasonal workers are excluded from coverage.
ALL OTHER (ACCIDENT, CRITICAL ILLNESS, HOSPITAL INDEMNITY) - Definition of Eligibility:
Active: a regular, full-time employee working 30 or more hours per week. Seasonal workers are excluded from coverage.
Definition of Eligible Dependent:
•Your legally married spouse, registered domestic partner or registered spouse through informal marriage.
•Your children who are your natural children, stepchildren, adopted children, your registered domestic partner’s children or children for whom you have legal custody (up to age 26). Disabled children age 26 or older who meet certain criteria may continue on your health coverage.
| Date of Hire |
| 1st of Month Following Date of Hire |
| 1st of Month Following 30 Days |
| 1st of Month Following 60 Days |
| 1st of Month Following 90 Days |
| None |
| 30 Days from Date of Hire |
| 60 Days from Date of Hire |
| 90 Days from Date of Hire |
| Other |
| Full-Time Regular Working 40 Hours Per Week |
| Full-Time Regular Working 45 Hours Per Week |
| Part-Time Regular Working 20 Hours Per Week |
| Part-Time Regular Working 1,000 Hours Per 12 Months |
| Other |
| Spouse |
| Unmarried Child to Age 18 |
| Unmarried Child to Age 19 |
| Unmarried Child to Age 20 |
| Handicapped Dependent |
| Other |
| Full-Time Student to Age 23 |
| Full-Time Student to Age 24 |
| Full-Time Student to Age 25 |
| Full-Time Student to Age 26 |
| Full-Time Student to Age 27 |
| Full-Time Student to Age 28 |
| Full-Time Student to Age 29 |
| Full-Time Student to Age 30 |
| Other |
| Same Gender |
| Same Gender and Opposite Gender |
| Opposite Gender |
| Civil Union Partner |
| Other |
&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P
Template Life and Disability Questionnaire Comparison
| Organization | Carrier 1 | Carrier 2 | ||
| v | Identify and describe your relevant experience with administering ancillary services similar to these plans in both size and design. | |||
| v | Provide three current client references similar in size (based on funded lives) and industry. Include contact name, title and phone number. | |||
| v | Provide three prior client references similar in size (based on funded lives) and industry. Include contact name, title, and phone number. | |||
| Implementation | ||||
| v | Describe your process for implementation of the benefit plan including: | |||
| v | Timeline required by your company. | |||
| v | Participant material production, review, approval, and distribution process. | |||
| v | Implementation and open enrollment communication strategy. | |||
| v | Assuming a business award date of (date), please include a copy of your detailed transition plan/timeline that includes completion dates for each specific task. List any start-up fees. | |||
| v | What type of cost and performance guarantees are you willing to provide for the following areas, along with the amount you will be putting at risk: | |||
| v | Implementation | |||
| v | Delivery of Contract/SPD | |||
| v | Account Management | |||
| v | Claims Processing | |||
| v | Customer Service | |||
| v | Reporting | |||
| v | Are your fees (rates) guaranteed for more than two years? If not, are you willing to provide a guarantee of three years or longer? | |||
| v | Would you offer open enrollment for supplemental coverage, or would the open enrollment only be offered to individuals currently covered? | |||
| v | Are you willing to set up and host a "Net Meeting" or a "Web Cast" in order to accommodate open enrollment for employees who live in more rural areas or areas with few employees? | |||
| v | Do you allow enrolled members to change or drop coverage during an annual open enrollment period. | |||
| v | What is the minimum amount of time you believe is necessary to implement City of Burleson's plans in an efficient and effective manner? | |||
| v | What specific information, not already provided in this RFP, do you need in order to be able to implement properly? | |||
| v | Do you offer an integrated program (one system, one member, service number, etc.)? | |||
| v | Will you require City of Burleson's members/employees to complete new enrollment forms? | |||
| Communication | ||||
| v | Do you provide member access to a Web site for educational tools at no additional cost? | |||
| Customer Service/Member Service | ||||
| v | Describe your standards and procedures for maintaining contact with the employer and employee. Provide timing of these contacts. | |||
| v | Does your organization have service offices in [City/State]? If not, from which location will you service City of Burleson's account? | |||
| v | Do these offices have previous experience in City of Burleson's type of business? If yes, please specify which and what size employee groups. If not, what will you do to become familiar with the claims experience and nuances of City of Burleson's business? | |||
| v | Will you guarantee that all incoming calls form City of Burleson will be returned the same day they are placed? | |||
| v | The bidder will provide a description of their resources for effective and timely customer service. This will include current customer service staffing levels, dedicated staff commitments, customer service representative (CSR) training (initial and ongoing), systems for CSR call reporting and tracking, CSR performance management and other related activities. | |||
| v | Specify the documentation procedures for inquiries to the customer service department. | |||
| v | What percentage of inquiries are documented? | |||
| v | Are inquiries updated immediately? | |||
| v | Please answer the following regarding your customer service reporting capabilities. | |||
| v | Will you provide client-specific reports? | |||
| v | Will you provide issue-specific reports? | |||
| v | How frequently will customer service reports be provided to City of Burleson? | |||
| Account Management | ||||
| v | What is the current number of clients serviced by the account manager/account executive that would be assigned to City of Burleson? | |||
| v | Do you provide a dedicated account manager? | |||
| v | What was the turnover rates of your account managers for the last three years, respectively? | |||
| v | Will you provide support to City of Burleson to manage client eligibility and other administrative tasks? Can City of Burleson update in real time on-line? | |||
| v | How will you help City of Burleson monitor plan performance? | |||
| v | How frequently do you provide status updates to your clients? What information is documented and provided at these meeting? | |||
| v | How often will your account manager review the quality and effectiveness of the program with the client? | |||
| Claims | ||||
| v | Please provide the location(s) where [client] claims would be paid. | |||
| v | How long have you been processing claims in this location(s)? | |||
| v | How many employees are located in this claims office(s)? | |||
| v | In this claims office(s), how many covered employees do you process claims for? | |||
| v | In this claims office(s), specify the number of accounts you process claims for by employee. | |||
| v | In this claims office(s), how many covered employees are included in the largest account for which your serve as claims administrator? | |||
| v | In this claims office(s), what is the average size account? | |||
| v | Do you provide a hold harmless agreement to the employer in the event of a claim against your company? | |||
| Financial Information | ||||
| v | Please provide a detailed list of the standard exclusions and limitations included within your standard contract. | |||
| v | Have you waived the actively at work/non-confinement clause? Please explain. | |||
| v | Do you agree that currently covered employees would not lose any coverage as a result of a change in carriers? | |||
| v | Have you waived all limitations for preexisting conditions, subject to plan provisions (no loss-no gain)? | |||
| v | Will you accept current participants on a no-loss, no-gain basis? | |||
| LTD Contract Provisions | ||||
| v | What Social Security integration method are you quoting? | |||
| v | What is your definition of "total disability?" Does it include the elimination period? | |||
| v | What is your definition of "partial disability?" Describe your benefit formula for payment. Does your proposal include a residual benefit? | |||
| v | Does your proposal include a cost-of-living increase for benefits? | |||
| v | Describe limitations of this plan with regard to mental/nervous, alcohol and substance abuse? | |||
| v | Are the following limitations included in your contract and if so, for what time period? | |||
| v | Prudent Person | |||
| v | Self-Reported Limitations | |||
| v | Soft Tissue Limitations | |||
| v | Do you include indexing in your contract? | |||
| v | How do you establish and maintain reserves for unreported claims? How do you establish and maintain reserves for known claimants? What actuarial table and interest rate are used? | |||
| v | To what extent would our client’s own experience be used in determining renewal rate levels? Would claims experience be available to justify renewal action? | |||
| v | Do you have an in-house rehabilitation staff dedicated solely to LTD claimants? What is the background of your rehabilitation staff? | |||
| v | How do you notify the client and employee of an approved or denied disability claim? Please provide the disability approval process and any technology related systems that can ease the administrative process for the client? | |||
| v | What rehabilitation services are provided to claimants to encourage them to return to work? | |||
| v | How many claimants per 1,000 of open, active claims are involved in an active rehabilitation program? | |||
| v | Confirm that you will perform the administration of tax withholding, reporting, and filing of appropriate IRS W2 forms. | |||
| v | What services are provided to give comfort to claimants with ongoing disabilities? | |||
| v | What services are provided to assist claimants in obtaining Social Security disability? | |||
| v | Provide your Social Security approval percentage. | |||
| v | Will you provide assistance with Life Insurance Waiver or Premium Notifications? | |||
| v | Will you provide a three-year rate guarantee of employees covered on the effective date of the contract? | |||
| v | What is the termination provision of your contract? How much notice would you require for policyholder termination? | |||
| Life Contract Provisions | ||||
| v | Do you agree to provide an open enrollment for life insurance coverage? If so, please describe. | |||
| v | Can previously denied individuals reapply for basic and optional life insurance coverage? If so, please describe any conditions for reapplication. | |||
| v | Describe any limitations and exclusions that would result in non-payment of benefits (i.e., Acts of War, attempted suicide, etc.). | |||
| v | Are you willing to offer life conversions to plan participants? Is the converted policy non-cancelable to age 65? Indicate the coverage and amounts which may be converted, and the rates you would charge for such conversion both to the plan sponsor and the plan participants. | |||
| v | Do you offer portability of basic life insurance? Is there an additional cost for this provision? | |||
| v | Do you offer an “Accelerated Death Benefit” or “Living Needs” Benefit? If so, please describe. Include the percentage of life amount payable, when it is payable and the cost for this feature if any. | |||
| v | Describe your process for providing life/disability underwriting, claim payment and claim processing notifications to the employer? | |||
| v | Describe your implementation process and timing. | |||
| v | What is your minimum participation requirement for contributory coverages? | |||
| v | If your proposal is accepted, will you require any additional information before you commit to insuring/administering the group (i.e., group health statements, financial reports, etc.)? | |||
| v | Define any automated or Web-based programs for obtaining information on the status of a claim that are included in your proposal. If your program does not currently offer these features, will your company offer them in the future? If so, when will they be implemented? | |||
| v | Are you willing to ‘hold’ the guarantee issue amounts regardless of final plan participation? | |||
| v | Will you provide a three-year rate guarantee of employees covered on the effective date of the contract? | |||
| v | What is the termination provision of your contract? How much notice would you require for policyholder termination? | |||
| Benefit Plan Design | ||||
| v | Describe how recent improvements in your administrative systems and billing capabilities will enhance the internal administration at City of Burleson. |
v What resources will you provide to ensure effective and timely communication of the new program?
| v | Please describe your willingness to waive pre-existing condition limitations? | |
| Reporting | ||
| v | Describe what reporting is available to City of Burleson. | |
| v | Can City of Burleson generate these reports? Is this reporting capability available on-line at no additional charge? | |
| v | Do you offer ad hoc or special-request reporting? Are these also available on-line? Are there additional fees for the standard reporting package and/or ad hoc reports? If so, explain costs. | |
| v | What standard reports are available and how frequently (monthly, quarterly, annually)? Are there additional costs associated with any of these reports? | |
| v | Are customized reports available through your organization's web site? | |
| v | What reporting features are included in the proposal that provide the employer with claims’ viewing status? Is there additional pricing or is in included in the pricing? | |
| Underwriting and Renewal | ||
| v | Do you agree to provide the renewal no later than 120 days prior to the renewal date? | |
| v | What credibility blend will be used for the first year renewal? | |
| v | What credibility blend will be used for subsequent renewals? | |
| v | What is your required retention percentage for a group of this size? | |
| v | Do you use more than the most recent 12 months of claims in the calculation of the renewal? | |
| v | Will you use incurred or paid claims for the renewal calculation? | |
| v | Would renewal rate adjustments be made on policy anniversary? What supportive information will you provide with renewal increases? | |
| Performance Standards | ||
| v | What guarantees are your company willing to offer in relation to turnaround time for quoting? | |
| v | Under what circumstances will you agree to provide “Not to Exceed” caps or rate guarantees? |
&"Garamond,Regular"&8&G &"Garamond,Regular"&8&P
Requested Proposals-Questions
| Requested Proposals and Questionnaire | |||
| Carrier Name | |||
| Worksite Benefits | Response | ||
| v | Requested Worksite Benefit Proposals: | ||
| v | Please confirm whether you are a Broker, Consultant, or an Insurance Provider (i.e. Are you a direct provider of the requested Worksite Benefits or are you a liaison to access these benefits such as a broker or a consultant) | ||
| v | Name of insurance company whom the proposed plans are written on behalf of. (i.e. Who's paper are these plans written on). Please disclose if any of the products are on different paper. | ||
| v | How many years has your company been offering AT LEAST Accident, Critical Illness and Hospital Indemnity (i.e. if you started offering Accident and Critical Illness in 2010, but didn’t start offering Hospital Indemnity until 2013, your response should be 2013 as that is the year which you first offered all THREE products) | ||
| v | Please speak to your ability to host the requested products within the BenTek BenAdmin system. | ||
| v | Are you able to provide any technology subsidy that is NOT RATE-IMPACTING to assist with the development cost, EDI build cost, implementation and ongoing administration? If so, how much and is this first year or all years? We require that this NOT be payable to the City of Burleson, but to the Benefits Administration vendor or insurance broker. If you see any concern with payment of this sort, please advise. | ||
| v | Provide proposals AND complete the appropriate tab IN FULL, for all the plans currently being offered. Products include Accident, Critical Illness, Hospital Indemnity, Identity Theft Insurance, Prepaid Legal Insurance, and Pet Insurance. |
•All rates must be shown as monthly •Incomplete responses or responses missing the completed tabs can be disregarded at will
| v | Worksite Questions: | |
| v | Confirm whether plans are based on a group or individual rated product. | |
| v | Are employee meetings required? Provide details. | |
| v | Are the plans portable when the employee terminates employment with City of Burleson? | |
| v | Provide details of the portability rates associated with each of the quoted products (i.e. do the plans port at the same rate as payroll deduction rates) | |
| v | Do any state variations exist? (i.e. Employer is sitused in Texas. If an EE resides in a different state, are there any differences in the benefit?) | |
| v | How many years are your rates guaranteed? | |
| Does your company allow accept payroll deduction? | ||
| Explain all options for premium remittance from the employer, if any? | ||
| Describe the end-to-end claims process for accident, critical illness, and hospital indemnity benefits from an employee insured’s perspective. | ||
| What claim submission methods are available (mobile app, online portal, email, mail, phone)? | ||
| Provide your average claims processing times for each product | ||
| Describe customer service support available to employees (including hours of operation) | ||
| Are representatives dedicated or specially trained for worksite benefits? | ||
| How are your customer service, advocacy, and call center reps trained to ensure accuracy, professionalism, and timely handling of member needs and inquiries? | ||
| How do employees receive claim status updates and payment notifications? | ||
| Describe the member website and mobile experience for worksite benefits. | ||
| What can members do after logging in (submit claims, upload documents, view payments, update beneficiaries, etc.)? | ||
| Is the member site mobile-optimized or supported by a dedicated app? | ||
| Describe your employer portal functionality related to worksite benefits. | ||
| Can employers view aggregate claims data without accessing PHI? | ||
| How often is data refreshed in the employer portal? | ||
| Provide a list of standard reports to the employer. | ||
| Can reports be exported, scheduled, or customized? | ||
| What implementation and training support is provided for employer portal users? | ||
| Do you provide the following at no additional cost; if cost, provide cost of service. | ||
| Enrollment kits, posters, brochures | ||
| Monthly employee articles | ||
| Monthly payroll stuffers | ||
| Wallet cards | ||
| Ongoing employee orientations | ||
| Participate in health fairs and/or organizational events and how many per year? | ||
| Monthly HR e-mailer | ||
| Member access to a mobile friendly app with digital ID cards, dashboards, claims data and benefit coverage details | ||
| Member access to a website for educational tools | ||
| v | Accident: |
•Meet or beat current plan Designs & Rate •Include an AD&D benefit •Quote 24 Hour Coverage •Quote $50 Wellness •Quote Matching Emergency Room, Urgent Care and Primary Care Physician Benefit.
•Four-tier rate structure
| v | Critical Illness: | ||
| • | Meet or beat current plan Designs & Rate | ||
| • | Quote based on Issue and Attained Age | ||
| • | Quote $50 Wellness |
•Quote $5K - $50K in $1K increments
| • | Quote with the maximum guaranteed issue possible for employee, spouse and child (prefer to have Spouse and Child ability to enroll in up to 100% of employee benefit) |
| • | Plans must be perpetually guaranteed issue. Please confirm that they were quoted as such. |
| • | Include all payable event triggers/diagnosis |
| • | Include recurrence & restoration |
| • | Quote tobacco distinct rates AND uni-tobacco rates |
| • | Provide Monthly rates in $1,000 increments (including wellness in rate per $1,000) |
| • | Waive pre-existing conditions |
•Waive reduction schedule v Hospital Indemnity •Plan must be HSA Compatible •Quote $50 Wellness •Composite Rates (ee, eesp, eech, fam) •Waive pre-existing conditions •Include maternity coverage day 1
• Include mental health & addiction coverage •Quote as perpetually guaranteed issue •Four-tier rate structure
| Legal Protection Plan | ||
| v | Requested Legal Benefit Proposals: | |
| v | Show Price for Uncontested Divorce & Contested Divorce Separately | |
| v | Quote one composite rate including employee + family. | |
| v | If you have a Legal plan that also includes Identity Theft Protection, please quote all of the aforementioned plans WITH the ID portion as well. (you can notate these underneath the plans that they correspond to in the response portion of the Legal tab spreadsheet) | |
| v | Please provide a GeoAccess analysis | |
| v | Company ownership (private, public, private equity) | |
| v | Total covered lives (bellybuttons) | |
| v | Total covered Employer Groups | |
| v | Mobile App (yes/no) | |
| What actions can members complete after login (request services, upload documents, track case status, message attorneys)? | ||
| Is the website mobile-optimized or supported by a dedicated mobile app? | ||
| Describe customer service support available to employees (including hours of operation) | ||
| How are your customer service, advocacy, and call center reps trained to ensure accuracy, professionalism, and timely handling of member needs and inquiries? | ||
| Describe how members initiate service (phone, online request, mobile app). | ||
| Is there a centralized intake or triage team prior to attorney assignment? Describe qualifications and training. | ||
| What is the average speed to answer for member calls? | ||
| Are calls answered live or via voicemail? If voicemail is used, what is the guaranteed callback time? | ||
| Are calls routed to in-network attorneys directly or through a service center? | ||
| What is the average and guaranteed response time from initial member contact to attorney outreach? | ||
| How are urgent or time-sensitive legal matters identified and prioritized? | ||
| How is case status communicated to members? | ||
| v | Employer Admin Portal (yes/no) | |
| Describe your employer portal functionality | ||
| Can you take enrollment updates from Bentek Benefits Administration software? | ||
| Provide a list of standard reports to the employer. | ||
| Can reports be exported, scheduled, or customized? | ||
| How often is data refreshed in the employer portal? | ||
| What implementation and training support is provided for employer portal users? | ||
| v | # of W2 employees | |
| v | # of employees dedicated to customer service | |
| v | # of employees dedicated to restoration | |
| v | How many years are your rates guaranteed? | |
| Does your company allow accept payroll deduction? | ||
| Explain all options for premium remittance from the employer, if any? | ||
| Do you provide the following at no additional cost; if cost, provide cost of service. | ||
| Enrollment kits, posters, brochures | ||
| Monthly employee articles | ||
| Monthly payroll stuffers | ||
| Wallet cards | ||
| Ongoing employee orientations | ||
| Participate in health fairs and/or organizational events and how many per year? | ||
| Monthly HR e-mailer | ||
| Member access to a mobile friendly app with digital ID cards, dashboards, claims data and benefit coverage details | ||
| Member access to a website for educational tools | ||
| ID Theft Protection Plan | ||
| v | Requested Identity Theft Benefit Proposals: | |
| v | Quote 1 Bureau and 3 Bureau | |
| v | Quote individual and family rates | |
| v | Company ownership (private, public, private equity) | |
| v | Total covered lives (bellybuttons) | |
| v | Total covered Employer Groups | |
| v | Mobile App (yes/no) | |
| What actions can members complete after login (alerts, credit freeze, document upload, case tracking, messaging specialists)? | ||
| Is the website mobile-optimized or supported by a dedicated mobile app? | ||
| Describe customer service support available to employees (including hours of operation) | ||
| How are your customer service, advocacy, and call center reps trained to ensure accuracy, professionalism, and timely handling of member needs and inquiries? | ||
| Describe how members initiate service (phone, online request, mobile app). | ||
| Is there a centralized intake or triage team prior to attorney assignment? Describe qualifications and training. | ||
| What is the average speed to answer for member calls? | ||
| Are calls answered live or via voicemail? If voicemail is used, what is the guaranteed callback time? | ||
| Are members routed to a dedicated fraud resolution specialist or a general customer service representative? | ||
| What is the average and guaranteed time from initial member contact to assignment of a fraud resolution specialist? | ||
| What is the average time to initiate recovery actions after fraud is reported? | ||
| How are urgent or high-risk incidents escalated and prioritized? | ||
| How is case status communicated to members? | ||
| v | Employer Admin Portal (yes/no) | |
| Describe your employer portal functionality | ||
| Can you take enrollment updates from Bentek Benefits Administration software? | ||
| Provide a list of standard reports to the employer. | ||
| Can reports be exported, scheduled, or customized? | ||
| How often is data refreshed in the employer portal? | ||
| What implementation and training support is provided for employer portal users? | ||
| v | # of W2 employees | |
| v | # of employees dedicated to customer service | |
| v | # of employees dedicated to restoration | |
| v | Call center hours | |
| v | How many years are your rates guaranteed? | |
| Does your company allow accept payroll deduction? | ||
| Explain all options for premium remittance from the employer, if any? | ||
| Do you provide the following at no additional cost; if cost, provide cost of service. | ||
| Enrollment kits, posters, brochures | ||
| Monthly employee articles | ||
| Monthly payroll stuffers | ||
| Wallet cards | ||
| Ongoing employee orientations | ||
| Participate in health fairs and/or organizational events and how many per year? | ||
| Monthly HR e-mailer | ||
| Member access to a mobile friendly app with digital ID cards, dashboards, claims data and benefit coverage details | ||
| Member access to a website for educational tools | ||
| Pet Insurance | ||
| v | Requested Pet Coverage Proposals: | |
| v | Confirm type of coverage (Discount or true Insurance) | |
| v | Confirm whether plans are based on a group or individual rated product. | |
| Confirm if there is a discount for multiplepet coverage | ||
| v | Mobile App (yes/no) | |
| Describe the end-to-end claims process from an employee insured’s perspective. | ||
| What claim submission methods are available (mobile app, online portal, email, mail, phone)? | ||
| Describe customer service support available to employees (including hours of operation) | ||
| How are your customer service, advocacy, and call center reps trained to ensure accuracy, professionalism, and timely handling of member needs and inquiries? | ||
| How do employees receive claim status updates and payment notifications? | ||
| Describe the member website and mobile experience for worksite benefits. | ||
| What can members do after logging in (submit claims, upload documents, view payments, update beneficiaries, etc.)? | ||
| Is the member site mobile-optimized or supported by a dedicated app? | ||
| v | Payroll or Direct Bill? | |
| v | Is file feed supported? | |
| v | Confirm enrollment option (Benadmin or co-branded landing page) | |
| v | Is there pre-existing conditon takeover provision? | |
| v | Notate all plan exclusions | |
| v | How many years are your rates guaranteed? | |
| Do you provide the following at no additional cost; if cost, provide cost of service. | ||
| Enrollment kits, posters, brochures | ||
| Monthly employee articles | ||
| Monthly payroll stuffers | ||
| Wallet cards | ||
| Ongoing employee orientations | ||
| Participate in health fairs and/or organizational events and how many per year? | ||
| Monthly HR e-mailer | ||
| Member access to a mobile friendly app with digital ID cards, dashboards, claims data and benefit coverage details | ||
| Member access to a website for educational tools |
Accident
| VOLUNTARY ACCIDENT BENEFIT SUMMARY | |||
| OPTION 1 | |||
| (INSERT CARRIER NAME HERE) | <-- carrier name goes here!!! (ONLY carrier name. ALL CAPS | ||
| <-- If you are showing more than one plan, label them accordingly | |||
| For presentations: | <-- 24 hour or Non-Occupational | ||
| Participation Requirement | |||
| Rate Guarantee | <-- "X" years (do not show Months) | ||
| Portability | <-- Included or Not Included | ||
| Covered Treatment / Services | |||
| x | Emergency Room | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | |
| x | Urgent Care | ||
| x | Primary Care Physician | ||
| Chiropractor | |||
| Physical Therapy | |||
| Physician Follow-Up | |||
| Hospital Benefits | |||
| x | Hospital Admission Benefit | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | |
| Hospital Daily Benefit | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | ||
| x | Quantity of Days Payable | ||
| x | ICU Admission Benefit | <-- ONLY show what is paid IN ADDITION to Base Hospitalization Benefit. | |
| x | ICU Daily Benefit | <-- ONLY show what is paid IN ADDITION to Base Hospitalization Benefit. | |
| Quantity of Days Payable | |||
| Rehabilitation Unit Daily Benefit | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | ||
| Quantity of Days Payable | |||
| Accidental Death / Dismemberment | |||
| Employee | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | ||
| Spouse | |||
| Each Child | |||
| Paralysis (Paraplegia / Quadriplegia) | |||
| Schedule of Fractures | (show OPEN benefit amount ONLY) | ||
| Skull Depressed | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | ||
| Skull Non-Depressed | |||
| Hip | |||
| Thigh | |||
| Vertebrae (Body) | |||
| Vertebral Processes | |||
| Pelvis | |||
| Leg | |||
| Bones of the Face or Nose | |||
| Upper Jaw | |||
| Upper Arm | |||
| Lower Jaw | |||
| Shoulder Blade | |||
| Sternum | |||
| Kneecap | |||
| Hand or Wrist | |||
| Forearm | |||
| Foot (except toes) | |||
| Coccyx | |||
| Ankle | |||
| Collarbone (Clavicle) | |||
| Rib | |||
| Finger or Toe | |||
| Chip Fracture | |||
| x | Open Reduction (requires surgery) | ||
| Schedule of Dislocations | (show OPEN benefit amount ONLY) | ||
| Hip | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. | ||
| Knee | |||
| Ankle | |||
| Collarbone (sternoclavicular) | |||
| Lower Jaw | |||
| Shoulder | |||
| Hand | |||
| Collarbone (acromioclavicular and separation) | |||
| Elbow | |||
| Wrist | |||
| Finger or Toe | |||
| x | Open Reduction (requires surgery) | ||
| Additional Benefits | |||
| x | Ambulance (air / ground) | <--ONLY show the $$$ amount benefit in this field. NO OTHER text. |
If there is a "schedule of benefits" that applies to the category, show "up to $xx" in the field.
| x | Appliance Benefit | |
| Blood / Plasma / Platelets | ||
| x | Burns | |
| x | Coma | |
| x | Concussion | |
| x | Diagnostic Exams/Medical Imaging | |
| Emergency Dental Work (Crown) | ||
| x | Eye Injury | |
| General Anesthesia | ||
| Hernia Repair | ||
| Joint Replacement | ||
| Knee Cartilage (Torn) | ||
| x | Lacerations | |
| Lodging (Per Night) | ||
| x | Open Abdominal Surgery | |
| x | Outpatient Surgery | |
| Pain Management (Epidural) | ||
| Prosthetic Device or Artificial Limb (1) | ||
| x | Ruptured Disc (with surgical repair) | |
| x | Tendon / Ligament / Rotator Cuff Repair (1) | |
| Transfusion(s) | ||
| x | Transportation (per trip) | |
| Monthly Premium | 24 Hour Coverage with Wellness | |
| x | Employee | |
| x | Employee + Spouse | |
| x | Employee + Child(ren) | |
| x | Family |
Notes
| x | |
| x | |
| x | |
| x | COMMISSION AMOUNT (1st year) |
| COMMISSION AMOUNT (2+ year) | |
| SITUS STATE |
| NON-OCCUPATIONAL |
| 24-HOUR COVERAGE |
Critical Illness
| VOLUNTARY CRITICAL ILLNESS BENEFIT SUMMARY | |
| OPTION 1 | |
| (INSERT CARRIER NAME HERE) |
| Participation Requirement | |||
| Rate Guarantee | <-- "X" years (do not show Months) | ||
| Age Rating | <-- issue age or attained age | ||
| Portability | <-- Included or Not Included | ||
| Perpetual Guaranteed Issue Enrollment | <-- Included or Not Included | ||
| For presentations: | MAXIMUM BENEFIT - GUARANTEED ISSUE AMOUNT | ||
| x | Employee | <-- $xx,xxxx ONLY (Show ALL increments) | |
| x | Spouse | ||
| x | Child | ||
| Maximum Benefit | 2x / 5x / Unlimited | ||
| Base Plan Benefits | |||
| x | Advanced Alzheimer's Disease | <-- Show Percentage benefit ONLY if covered (other than skin cancer). If NOT included in contract, cell should be left BLANK | |
| Addison's Disease | |||
| x | Advanced Parkinson's Disease | ||
| Aneurysm or Angioplasty | |||
| x | Benign Brain Tumor | ||
| Bone Marrow Transplant | |||
| x | Cancer - Invasive | ||
| x | Cancer - Non-Invasive | ||
| Cerebrospinal Meningitis | |||
| x | Coma | ||
| x | Complete Blindness | ||
| x | Complete Loss of Hearing | ||
| x | Complete Loss of Speech | ||
| x | Coronary Artery Bypass Surgery | ||
| Diphtheria | |||
| Encephalitis | |||
| x | End Stage Renal Failure | ||
| Functional Loss | |||
| x | Heart Attack | ||
| Huntington's Disease | |||
| Infectious Disease | |||
| Legionnaire’s Disease | |||
| x | Lou Gehrig's Disease or ALS | ||
| x | Major Organ Transplant | ||
| Malaria | |||
| Multiple Sclerosis | |||
| Myasthenia Gravis | |||
| Necrotizing Fasciitis | |||
| Occupational HIV | |||
| Osteomyelitis | |||
| x | Permanent Paralysis | ||
| Poliomyelitis | |||
| Rabies | |||
| Severe Burns | |||
| Sickle Cell Anemia | |||
| x | Skin Cancer | ||
| Stem Cell Transplant | |||
| x | Stroke | ||
| Systemic Lupus Erythematosus | |||
| Systemic Sclerosis | |||
| Tetanus | |||
| Tuberculosis | |||
| Type I Diabetes | |||
| Additional Covered Conditions for Dependent Children | |||
| x | Cerebral Palsy | <-- Show Percentage benefit ONLY if covered. If NOT included in contract, cell should be left BLANK | |
| Cleft Lip or Palate | |||
| Congenital Metabolic Disorders | |||
| x | Cystic Fibrosis | ||
| Down Syndrome | |||
| Genetic Disorders | |||
| x | Muscular Dystrophy | ||
| PKU Disease | |||
| Spina Bifida | |||
| Structure Defects | |||
| Type I Diabetes | |||
| Plan Conditions | |||
| x | Additional Occurrence Benefit | __% benefit with __ month separation | <-- fill in the "__" |
| x | Recurrence Benefit | __% benefit with __ month separation | <-- fill in the "__" |
| x | Pre-existing Condition | <-- if waived, notate waived | |
| x | Benefit Reduction at age 70 | Yes or No | |
| Wellness | |||
| x | Benefit Amount (EE / SP / CH) |
| x | Monthly NON-TOBACCO Employee Only Premium - RATE PER $1,000 | ||
| x | Benefit Amount: | $1,000 | <-- key in the rate per $1,000 in these cells. The cells below will automatically calculate the premium for the $10,000 benefit example illustrated. THESE ORANGE CELLS WILL BE HIDDEN for presentation purposes. |
| x | 0-24 | ||
| x | 25-29 | ||
| x | 30-34 | ||
| x | 35-39 | ||
| x | 40-44 | ||
| x | 45-49 | ||
| x | 50-54 | ||
| x | 55-59 | ||
| x | 60-64 | ||
| x | 65-69 | ||
| x | 70-74 | ||
| x | 75-79 | ||
| x | 80+ | ||
| x | Monthly NON-TOBACCO Employee Only Premium | ||
| x | Benefit Amount: | $10,000 | |
| x | 0-24 | $0.00 | |
| x | 25-29 | $0.00 | |
| x | 30-34 | $0.00 | |
| x | 35-39 | $0.00 | |
| x | 40-44 | $0.00 | |
| x | 45-49 | $0.00 | |
| x | 50-54 | $0.00 | |
| x | 55-59 | $0.00 | |
| x | 60-64 | $0.00 | |
| x | 65-69 | $0.00 | |
| x | 70-74 | $0.00 | |
| x | 75-79 | $0.00 | |
| x | 80+ | $0.00 | |
| x | Monthly TOBACCO Employee Only Premium - RATE PER $1,000 | ||
| x | Benefit Amount: | $1,000 | <-- key in the rate per $1,000 in these cells. The cells below will automatically calculate the premium for the $10,000 benefit example illustrated. THESE ORANGE CELLS WILL BE HIDDEN for presentation purposes. |
IF YOU ARE QUOTING UNI-TOBACCO RATES, LEAVE THIS SECTION BLANK!!!!!
| x | 0-24 | ||
| x | 25-29 | ||
| x | 30-34 | ||
| x | 35-39 | ||
| x | 40-44 | ||
| x | 45-49 | ||
| x | 50-54 | ||
| x | 55-59 | ||
| x | 60-64 | ||
| x | 65-69 | ||
| x | 70-74 | ||
| x | 75-79 | ||
| x | 80+ | ||
| x | Monthly TOBACCO Employee Only Premium | ||
| x | Benefit Amount: | $10,000 | |
| x | 0-24 | $0.00 | |
| x | 25-29 | $0.00 | |
| x | 30-34 | $0.00 | |
| x | 35-39 | $0.00 | |
| x | 40-44 | $0.00 | |
| x | 45-49 | $0.00 | |
| x | 50-54 | $0.00 | |
| x | 55-59 | $0.00 | |
| x | 60-64 | $0.00 | |
| x | 65-69 | $0.00 | |
| x | 70-74 | $0.00 | |
| x | 75-79 | $0.00 | |
| x | 80+ | $0.00 | |
| x | Monthly UNI-TOBACCO Employee Only Premium - RATE PER $1,000 | ||
| x | Benefit Amount: | $1,000 | <-- key in the rate per $1,000 in these cells. The cells below will automatically calculate the premium for the $10,000 benefit example illustrated. THESE ORANGE CELLS WILL BE HIDDEN for presentation purposes. |
| x | 0-24 | |
| x | 25-29 | |
| 30-34 | ||
| 35-39 | ||
| x | 40-44 | |
| x | 45-49 | |
| 50-54 | ||
| 55-59 | ||
| x | 60-64 | |
| x | 65-69 | |
| x | 70-74 | |
| x | 75-79 | |
| x | 80+ | |
| Monthly UNI-TOBACCO Employee Only Premium | ||
| Benefit Amount: | $10,000 | |
| x | 0-24 | $0.00 |
| x | 25-29 | $0.00 |
| 30-34 | $0.00 | |
| 35-39 | $0.00 | |
| x | 40-44 | $0.00 |
| 45-49 | $0.00 | |
| 50-54 | $0.00 | |
| x | 55-59 | $0.00 |
| x | 60-64 | $0.00 |
| 65-69 | $0.00 | |
| 70-74 | $0.00 | |
| 75-79 | $0.00 | |
| 80+ | $0.00 | |
| Notes: | ||
| Rates shown are for employee only. Buy-Up coverage will be available for dependents as well. Age Brackets do not match 100% from carrier to carrier. Please refer to actual carrier quote for final rates. |
| COMMISSION AMOUNT (1st year) | <--REMEMBER TO FILL THIS IN please |
| COMMISSION AMOUNT (2+ year) | |
| SITUS STATE |
Hospital indemnity
| VOLUNTARY HOSPITAL INDEMNITY BENEFIT SUMMARY | |||
| OPTION 1 | |||
| (INSERT CARRIER NAME HERE) | |||
| For presentations: | |||
| Participation Requirement | |||
| Rate Guarantee | |||
| HSA Compatible | <-- yes or no | ||
| Portability | <-- included or not included | ||
| Age Rating | <-- issue age or attained age | ||
| Guaranteed Issue | <-- If perpetually GI, show "Yes; All Years" if not, show, "1st Year Only" |
| x | Hospital Admission (per confinement) | <-- $$ Benefit amount only |
| x | Hospital Confinement (per day benefit) | <-- $$ Benefit amount only |
| x | Maximum Days Payable | |
| x | Hospital ICU Admission (per confinement) | <-- $$ Benefit amount only (show the amount paid IN ADDITION to Standard Hospitalization benefit |
| x | Hospital ICU Confinement (per day benefit) | |
| x | Maximum Days Payable | |
| Rehabilitation Unit (per day benefit) | <-- $$ Benefit amount only | |
| Maximum Days Payable | ||
| Plan Conditions | ||
| x | Pre-Existing Condition Exclusion | <-- if waived, notate waived |
| x | Maternity Coverage | <-- options: 1st day, after 9-months, Complications from Pregnancy Only, Covered as any other Hospitalization |
| Monthly Premium | ||
| x | Employee | |
| x | Employee + Spouse | |
| x | Employee + Child(ren) | |
| x | Family | |
| Notes |
| COMMISSION AMOUNT (1st year) | <--REMEMBER TO FILL THIS IN please |
| COMMISSION AMOUNT (2+ year) | |
| SITUS STATE |
Pre-paid Legal
VOLUNTARY LEGAL PROTECTION SUMMARY
| OPTION 1 - Without Divorce | OPTION 2 - With Divorce | ||
| (INSERT CARRIER NAME HERE) | (INSERT CARRIER NAME HERE) | ||
| General Services for Covered Matters | |||
| x | Coverage of Pre-existing Matters | ||
| x | Document Review | ||
| x | Office Consultations | ||
| Phone Consultations with Attorney | |||
| Write Letters & Make Phone Calls | |||
| x | Real Estate | ||
| x | Boundary or Title Disputes | ||
| Deeds | |||
| x | Eviction and Tenant Problems | ||
| Foreclosure | |||
| Garnishment | |||
| x | Home Equity Loan | ||
| x | Mortgages | ||
| x | Property Tax Assessments | ||
| Purchase/Sale of Home (Primary & Secondary Home) | |||
| x | Refinancing / Home Equity Loans (Primary & Secondary Home) | ||
| Zoning Applications | |||
| x | Family Matters | ||
| Administrative Hearings | |||
| x | Divorce Uncontested | ||
| x | Divorce Contested | ||
| x | Adoption | ||
| x | Domestic Violence | ||
| x | Elder Care Issues | ||
| Guardianship/Conservatorship | |||
| x | Immigration Assistance | ||
| Incompetency Defense | |||
| Juvenile Court Defense | |||
| x | Name Change | ||
| x | Prenuptial Agreement | ||
| x | Financial Matters | ||
| x | Affidavits | ||
| x | Bankruptcy | ||
| x | Civil Litigation | ||
| Consumer Protection | |||
| Debt Collection | |||
| Identity Theft | |||
| x | Personal Property | ||
| x | Promissory Notes | ||
| x | Small Claims Assistance | ||
| x | Tax Audit and Collection Service | ||
| Auto | |||
| Driver's License Restoration | |||
| Motor Vehicle Property Damage | |||
| Moving Traffic Violations | |||
| x | Estate Planning | ||
| x | Wills and Codicils | ||
| x | Powers of Attorney | ||
| x | Probate | ||
| x | Trusts (Revocable and Irrevocable) | ||
| Additional Benefits | |||
| 24/7 Emergency Access | |||
| Additional Discount | |||
| Mobile App | |||
| Legal Forms | |||
| Additonal third-party services | |||
| x | Pricing | ||
| x | Individual | ||
| Family |
| COMMISSION AMOUNT (1st year) |
| COMMISSION AMOUNT (2+ year) |
| SITUS STATE |
&G
ID Theft Protection
| VOLUNTARY IDENTITY THEFT PROTECTION SUMMARY | ||
| OPTION 1 - 1 Bureau | OPTION 2 - 3 Bureau | |
| (INSERT CARRIER NAME HERE) | (INSERT CARRIER NAME HERE) | |
| Monitoring and Alerts | ||
| Actionable Identity Alerts (Email) | ||
| Actionable Identity Alerts (Alert Center) | ||
| Actionable Identity Alerts (Mobile) | ||
| Identity Alert system (proactive protection, application level with near real time alert notification in network) | ||
| Stolen Funds Replacement | ||
| Service Guarantee | ||
| Personal expense Compensation | ||
| Lost Wallet Protection / Document Recovery Assistance | ||
| Address Change Verification | ||
| Court Records | ||
| Solicitation Reduction tools | ||
| Black Market Website/Cyber Surveillance | ||
| Live Member Support 24/7/365 | ||
| Credit Card Monitoring | ||
| Checking and Savings Account Monitoring | ||
| Payday Loan Monitoring | ||
| Online Annual Credit Report(s) | ||
| Online Annual Credit Score(s) | ||
| Credit Bureau Monitoring | ||
| Credit Score Tracker | ||
| Credit Inquiry Activity | ||
| Drivers License Number Monitoring | ||
| Passport Number Monitoring | ||
| Discovery Based (pre-existing) | ||
| Medical/Insurance ID Theft | ||
| Social Security Number Trace | ||
| Resolution/Restoration Services | ||
| Resolution Services | ||
| Benefit Limits | ||
| Monthly Rates | ||
| Individual | ||
| Family | ||
| COMMISSION AMOUNT (1st year) | ||
| COMMISSION AMOUNT (2+ year) | ||
| SITUS STATE |
Pet Insurance
| Pet Insurance | |
| OPTION 1 | |
| (INSERT CARRIER NAME HERE) |
| Types of Pet covered | <-- Cat / Dog |
| Exotic Pet Coverage | <-- Included or not, Avian etc. |
| Reimbursement | |
| Annual deductible | |
| Maximum annual benefit amount | |
| Pre-existing conditions | <-- included or not, or indicate if there is a takeover provision |
| Accidents | <-- Included or not |
| Illnesses | <-- Included or not |
| Wellness | <-- Included or not |
| Telehealth Service | <-- Included or not |
| Employer Benefit Discount | <-- Notate as % |
| Multiple Pet Discount | <-- Additional % to the employer benefit discount |
| Processing time for claim | <-- In days |
| Pricing Structure | |
| Notes: |
| COMMISSION AMOUNT (1st year) |
| COMMISSION AMOUNT (2+ year) |
| SITUS STATE |
Subsidies
| Carrier Name | Implementation Credits | Year 1 subsidy | Year 2+ subsidy | Are subsidies rate impacting? |
| Y/N? | ||||
| The premiums illustrated in this exhibit are inclusive of any rate impact for the aforementioned technology or implementation subsidy. Actuarial rating and impact to premium varies by carrier. | ||||
| Please include the following details regarding the credit | ||||
| o What are the contingencies? (package sale with core, active enrollment, etc.) | ||||
| o What services are eligible under the credit? Please include your definitions for all. (plan build, file feed, communications, etc.) | ||||
| o Do you pay the credit to the benadmin system directly? If not, who can it be paid to? | ||||
| o What is the frequency of the tech credit payment? | ||||
| o What documentation is required to pay the credit? |
Attachments Attachments
| The following data is provided in the Attachment Document: |
| 1) Summary Plan Description and/or Certificates of coverages for all lines of coverage. |
| 2) Census data for all plans |
| 3) Worksite Benefit Plans - participation and premium data |
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File details come from the government source that posted it. Updated .