5-RFP No. 2523-02062 Employer Sponsored Dental Benefits.pdf

COOK COUNTY GOVERNMENT

Office of the Chief Procurement Officer

Request for Proposal (RFP) No. 2325-02062 for

Employer Sponsored Dental Benefits

Non-Mandatory Pre-Proposal Meeting:

Date: September 24, 2025 Time: 10:00 AM Local Time – Chicago Web Link: Microsoft Teams

Questions:

Questions must be submitted in Bonfire no later than: September 25 at 12:00 p.m. Local Time – Chicago

Proposal Due Date:

Proposals are due in Bonfire no later than: 10:00 a.m. Local Time – Chicago on October 29, 2025

Proposal and Questions Must be Uploaded on the Contract Opportunity in Bonfire via:

https://cookcountyil.bonfirehub.com/portal/?tab=openOpportunities

LATE PROPOSALS WILL NOT BE CONSIDERED

Buyer Contact Information:

Edmund Rendon, Procurement Manager, at (312) 603-6824

E-MAIL: EDMUND.RENDON@COOKCOUNTYIL.GOV

Toni Preckwinkle Raffi Sarrafian Cook County Board President Chief Procurement Officer https://www.google.com/url?q=https://teams.microsoft.com/l/meetup-join/19%253ameeting_OWFjNzlhNjQtN2M2ZC00NmQ4LWEzZWItYjIwMDMxZGI0NTE3%2540thread.v2/0?context%3D%257b%2522Tid%2522%253a%2522a40e3dcb-ee86-4181-8ede-cc9e1836463d%2522%252c%2522Oid%2522%253a%2522b94d328c-5c7d-47c4-8d81-067ea0661883%2522%257d%26launchAgent%3DGSuiteAddOn%26correlationId%3Dbe001362-6a09-4024-9b5b-29d4f37d7287&sa=D&source=calendar&ust=1757880325849385&usg=AOvVaw3ftL2ag0roHM34TQs8hB9J https://cookcountyil.bonfirehub.com/portal/?tab=openOpportunities

RFP N0. 2523-02062

1 INTRODUCTION

1.1 Overview

1.2 Purpose

1.3 Cook County Background

2 SCOPE

2.1 Scope of Service

2.1.1 General

2.1.2 Account Management

2.1.3 Implementation

2.1.4 Eligibility, Claims and Account Administration

2.1.5 Enrollment

2.1.6 Member Services

2.1.7 Web Capabilities

2.1.8 Dental Care Management

2.1.9 Network Management

2.1.10 Network Access

2.1.11 Network Discounts

2.1.12 Reporting and Data

2.1.13 Billing & Banking

2.1.14 Financials and Performance Guarantees

3 SCHEDULE

4 INSTRUCTIONS TO PROPOSERS

4.1 Instructions

4.2 Availability of Documents

4.3 Pre-Proposal Conference

4.4 Special Access to the Pre-Proposal Conference

4.5 Clarifications

4.6 Submitting the Proposal Package

4.7 Uniformity

4.8 Proposal Material

4.9 Addenda

4.10 Proposer’s Responsibility for Services Proposed

4.11 Errors and Omissions in the RFP

4.12 RFP Interpretation

4.13 Confidentiality and Response Cost and Ownership

4.14 Use of Subcontractors

4.15 MBE/WBE Participation Goals

4.16 Proposer’s Disclosure and Conflict of Interest

4.17 Cook County RFP Format

4.18 Pricing

4.19 Period of Firm Proposal

4.20 Awards

4.21 Cook County Rights

4.22 Alteration/Modification of RFP Content

4.23 Recycling

5 EVALUATION AND SELECTION PROCESS

5.1 Responsiveness Review

5.2 Acceptance of Proposals

5.3 Evaluation Process

5.3.1 Proposer Presentations

5.3.2 Right to Inspect

5.3.3 Best and Final Offer

5.4 Selection Process

6 EVALUATION CRITERIA

6.1 Responsiveness of Proposal

6.2 Technical Proposal

6.3 Oral Presentations

6.4 Price Proposal

7 SUBMISSION OF PROPOSAL

7.1 Instructions for Submissions

7.1.1 Electronic Submission

7.1.2 Time for Submission

7.1.3 Format

7.1.4 Complete Proposals

7.1.5 Packaging and Labeling

7.1.6 Timely Delivery if Proposals

7.1.7 Late Proposals

7.1.8 Schedule of Revisions to RFP Schedule

7.2 Submission Requirements

7.2.1 Cover Letter

7.2.2 Executive Summary

7.2.3 Qualifications of the Proposer

7.2.4 Proposed Plan of Action, Implementation and Solution

7.2.5 Key Personnel

7.2.6 Subcontracting or Teaming

7.2.7 MBE/WBE Participation

7.2.8 Financial Status

7.2.9 Legal Actions

7.2.10 Conflict of Interest

7.2.11 Economic Disclosure Statement

7.2.12 Cook County Professional Services Agreement (PSA)

7.2.13 Identification of Subcontractor/Supplier/Subconsultant Form

7.2.14 Addendum Acknowledgement Form

7.2.15 Price Proposal

7.2.16 Other

EXHIBIT I Instructions for Submitting Electronic Bid/Proposal/Qualification

EXHIBIT II Price Proposal Form

EXHIBIT III Dental Discount and Network

EXHIBIT IV Cook County Employee Census

EXHIBIT V DHMO and DPPO Claims History

EXHIBIT VI Cook County Professional Services Agreement

EXHIBIT VII Addendum Acknowledgement Form

EXHIBIT VIII Certification of Consulting or Auditing Form

EXHIBIT IX MBE/WBE Utilization Plan Forms

EXHIBIT X Identification of Subcontractor/Supplier/Subconsultant Form

EXHIBIT XI Electronic Payables Form

EXHIBIT XII Insurance Requirements

EXHIBIT XIII Economic Disclosure Forms

1 INTRODUCTION

1.1 Overview

Cook County Government (“the County”) is seeking proposals from interested insurance provider(s) to provide Employer Sponsored Dental Benefits. The County is seeking fully insured and self-insured proposals for the administration of dental plans effective December 1, 2026.

The County has approximately 21,000 active employees, and 19,050 are currently enrolled in one of the County’s two dental plans. Eligible dependents are also covered under the plan.

2025 DENTAL PLANS ENROLLMENT (# OF EES) ENROLLMENT (# OF DEPENDENTS)

DHMO 5482 5042

DENTAL PPO 13568 19703

WAIVE 1097

The DHMO is currently fully-insured and has a schedule of benefits that identifies the member’s cost share based on the service provided. The Dental PPO is currently self-insured, with differentiated benefit levels between in and out of network. Eligible County employees and dependents have access to a number of other health and welfare benefits that are not included within the scope of the RFP.

This RFP is for dental services only.

COBRA administration is currently done in-house and is also not included as part of this solicitation.

The successful Proposer must be able to demonstrate and be willing to guarantee the following:

A. Responsiveness during the proposal and implementation process;

B. Business vision that aligns with County’s goals and objectives, which include offering a comprehensive and affordable dental plan to participants;

C. Demonstrated superior member service and claims processing;

D. Ability to proactively meet County’s ongoing service needs;

E. Willingness, experience and capability to effectively administer the programs as proposed, any deviations must be noted;

F. Proven and innovative programs that support the overall health and well-being of members;

G. Broad provider network with competitive discount arrangements;

H. Competitive fees/rates and performance guarantees.

1.2 Purpose

The purpose of this RFP is to contract with an administrator who can provide quality dental services in a cost-effective manner. Successful proposers shall demonstrate a combination of competitive fees/premium rates, strong networks, innovative program offerings and excellent member and client service.

The County intends to enter into a three (3) year agreement with two (2) two (2) year renewal options with the successful Proposer.

1.3 Cook County Background

Cook County Government is a home rule county pursuant to Article VII, Section 6 of the Illinois State Constitution and is governed by a 17-member Board of Commissioners that is elected from single-member districts. The Commissioners and County Board President are elected to four-year terms by the citizens of the County. Cook County represents one of the major metropolitan areas in the state and nation, and contains 134 municipalities, (including the City of Chicago), 29 townships, 221 special districts, and 164 school districts. Cook County is home to 5.28 million residents making is the second most populous County in the United States.

The County’s fiscal year begins on December 1 and ends on November 30. As mandated by state law, the County has principal responsibility for the protection of persons and property, the operation of public health services, the administration of the property tax levy, assessment, collection, and distribution process, and the maintenance of County highways. The obligation to protect persons and property, commonly called public safety, is fulfilled by the provision of County judicial and law enforcement services. The Circuit Court of Cook County which is one of the largest unified court systems in the United States, and the County Jail which is one of the largest single site jail facilities on the country, are solely the responsibility of Cook County Government. Also, Cook County Government administers the second largest property taxation system in the United States, with 1.8 million parcels of real estate.

The obligation to provide public health services is fulfilled by the operation of a comprehensive network of medical facilities for the citizens of the County, and provision of services regardless of their ability to pay. Cook County Health (CCH) consists of the Bureau Health Services, John, H.

Stroger, Jr. Hospital of Cook County, Provident Hospital of Cook County, Department of Public Health, Correctional Health Services at Cermak, Correctional Health Services at the Juvenile Temporary Detention Center, Ruth Rothstein CORE Center and County Care Health Plan (a managed care program for county residents). The Cook County Board of Commissioners established the Cook County Health Board (CCH Board) in 2008 to provide independent oversight of health care operations. The CCH Board is accountable to the Cook County Board of Commissioners. CCH is included in the reporting entity of Cook County, Illinois as an enterprise fund. As an enterprise fund, CCH’s financial statements are prepared using proprietary fund accounting that focuses on the determination of changes in net assets. Financial position, and cash flows in a manner similar to private sector businesses. Financial statements are prepared on an accrual basis of accounting.

2 SCOPE

2.1 Scope of Service

Exhibits I, II, and VI through XIII will be accessible to Proposers upon registration for this solicitation. Exhibits III, IV and V will be made available upon execution and submission of a Confidentiality and Non-Disclosure Agreement (available in Bonfire). Confidentiality Agreements must be submitted to the Buyer identified on the Cover Page of this RFP.

Information about Cook County benefit programs, including the plan documents and program descriptions are available at the County’s website www.cookcountyrisk.com

The County is requesting Proposers provide a proposal based on matching current plan designs and schedules. In addition, the County is interested in receiving proposals for alternate, market-competitive HMO and/or PPO plan designs that could potentially be offered to the non-union population (approximately 20% of the workforce) in 2027. Please note that any alternative programs recommended must be at least as valuable as the current programs but must not be more costly to the

County when adding member premium sharing for the alternate plans. Also note that any plan design changes negotiated in the future through the collective bargaining process will require implementation by the successful Proposer.

Proposers shall provide rates for the following scenarios in the provided “Exhibit II – Price Proposal”.

Proposers may provide alternate, market-competitive HMO/PPO plan designs for the non-union population, also in the provided “Exhibit II – Price Proposal.xlsx”

A. Scenario 1: Fully-insured quote for each of the current and alternate plans B. Scenario 2: Fully-insured quote for all of the current and alternate plans C. Scenario 3: Self-funded ASO quotes for each of the current and alternate plans D. Scenario 4: Self-funded ASO quotes for all of the current and alternate plans

Proposers shall complete the following table by responding “Yes” or “No” to the following questions:

General Requirements YES / NO

1 Proposer shall have at least five (5) years of satisfactory experience in providing fully-insured dental plans.

2 Proposer shall have at least five (5) years of satisfactory experience in administering self-insured dental plans.

3 Proposer shall have at least five (5) years of satisfactory experience contracting with at least three

(3) employers with enrollment of 20,000 or more covered employees.

4 Proposer must have capacity to implement coverage for Cook County members with minimal disruption.

5 Proposer shall comply with the National Provider Identification (NPI) provisions of HIPAA.

6 Proposer provides toll-free telephone and TDD access for customer service that will be available to all enrollees 24 hours per day, 7 days per week.

7 Proposer resources are to include a sufficient number of staff and phone lines and adequate backup capability to ensure access in the event of a system shutdown.

8 Proposer agrees that the Cook County Auditor or its designee shall have access and the right to examine any records related to this contract or to the contractor’s compliance with any term, condition or provision thereof. The Proposer must cooperate in any audit undertaken/ordered, including but not limited to annual audits and any specific audit ordered by the Cook County. The costs of audits will be borne by the Proposer.

9 Proposer shall coordinate benefit payments for covered individuals, aggressively identifying primary payment sources such as other coverages, tracking savings, and effectiveness.

http://www.cookcountyrisk.com/

10 Proposer shall maintain a website and if available a mobile application that will be accessible by enrollees for gathering information about network providers, claims information / EOBs, etc.

11 Proposer shall have established formal appeals procedures.

12 Proposer shall have a Disaster Recovery Plan and procedures including off-site storage of critical data and specific provisions for responses to inquiries, continuation of customer service, access to eligibility files, claims processing, and financial data.

13 Proposer shall pay claims for services based on Proposer liability per the County’s membership files and according to approved benefit design, or as subsequently revised by Cook County.

14 (Self-funded plans only)

Proposer shall account for administrative service charges and claim reimbursements received;

services rendered (processed and pending but not yet paid recorded separately); reserves and expenses; subrogation recoveries; overpayment recoveries; and other credits and debits in accordance with the financial accounting system utilized by the Proposer, with separate accounting for each of the County’s Plans.

15 Proposer must agree to place a minimum of 25% of administrative fees at risk for mutually-agreed performance guarantees and an additional 10% of fees at risk in year 1, related to implementation and transition activities.

16 Proposer shall have the ability to duplicate and support the Dental PPO plan designs currently in place (see Attachment VIII for detailed plan designs). In addition, the Proposer shall comply with eligibility and membership provisions.

17 Proposer shall have the ability to duplicate and support the DHMO schedule currently in place (see Attachment VIII for schedule). In addition, the Proposer shall comply with eligibility and membership provisions.

18 Proposer shall provide and distribute documents and forms, including, but not limited to:

member information and/or enrollment materials, Notice of Privacy Practices, certificates of coverage or summary plan documents, claim forms (for out-of-network services), explanations of benefit determinations, exclusive provider directories with provider identifiers, and any other communications and marketing materials required by Cook County. All cost associated with this service will be borne by Proposer.

19 Proposer must obtain Cook County approval of all marketing materials, general correspondence, or materials to be advertised in the media prior to publication and distribution. All costs associated with this service will be borne by Proposer.

20 The issuance of certificates of coverage and identification cards to members (initial and revised) must be within 5 business days of request. The Proposer will bear all costs associated with this service.

21 Proposer shall maintain timeliness, comprehensive auditing, and internal quality control procedures.

22 Proposer shall have a program in place to prevent and detect internal and external fraud and fraudulent practices. The program must have the ability to screen for potential fraud and systemically review provider claims. The Proposer will report its fraud findings to the County and any corrective measures, where necessary.

23 Proposer must fund a pre-implementation audit to verify various aspects of the plan set-up (e.g.

plan design, eligibility, customer service scripts) and provide the allotted fees in the financial quote.

24 Proposer must agree that all plan experience and financial data resulting from the administration of the plans is the property of Cook County and will be provided in its entirety to Cook County or its designee upon request at no additional charge.

Proposers shall respond to the following questions:

2.1.1 General

1. Please provide the contract information for the individual authorized to answer questions regarding your response to the request for proposal.

Information Requested Contract Information

Company Name

Contact Name

Contract Title

Address

Telephone Number

Email Address

2. Indicate how long your organization has been operational for the services that you are proposing to Cook County. Be sure to provide information on the PPO and Dental HMO nationally, as well as in the State of Illinois.

Information Requested Nationally In State of Illinois

Dental PPO

Dental HMO

3. Please provide the most recent ratings for your company by the major rating organizations.

Ratings for PPO Ratings for HMO

Standard & Poor’s

Fitch

A.M. Best

Moody’s

Not Rated

4. Which services do you subcontract? Provide brief details of how and by whom these services are provided and your role in managing their delivery. Specify if the service is provided outside of the United States.

5. Define the nature of any existing contractual relationships you currently have with the County.

Give a brief description of these contracts and the financial value in terms of premium, where possible.

6. If your organization has been involved in a merger or acquisition within the past three (3) years, specify when the merger took effect, and how you have or will assimilate(ed) operations, account management, claims, and clinical systems into your organization.

7. Please provide your experience providing dental services nationally, Chicagoland, and for public sector organizations, including number of clients and membership counts.

Information Requested PPO (Group Insurance Only)

Dental HMO (Group Insurance Only)

Number of National Clients served as of 1/1/2025

Number of National members (employees +dependents) covered as of 1/1/2025

Number of Chicagoland Clients served as of 1/1/2025

Number of Chicagoland members (employees +dependents) covered as of 1/1/2025

Number of Public Sector Clients served as of 1/1/2025

Number of Public Sector members (employees +dependents) covered as of 1/1/2025

8. Please provide financial trend (before plan design changes) information for your Dental PPO and Dental HMO books of business.

PPO Book of Business Trend

NATIONAL

PPO Book of Business Trend

CHICAGOLAND

HMO Book of Business Trend

NATIONAL

HMO Book of Business Trend

CHICAGOLAND

CY2024

CY2025

Projected

CY2026

9. Please conduct a detailed review of the Plan Descriptions and confirm you are able to duplicate these plan designs. If not, please explain.

10. What are your top three short-term strategic priorities for 2026?

11. What are your top three long-term strategic priorities for the next five years?

12. In what areas does your organization plan to invest over the next five years, and how will this benefit Cook County?

13. What are your greatest organizational challenges, and how will this impact Cook County?

14. How do you differentiate your capabilities/products from your competitors?

2.1.2 Account Management

1. Confirm you will provide a designated account manager to handle day-to-day requests from the County and any service issues that arise.

2. Please provide a brief biography for your proposed account manager, including educational and career background, any professional designations, length of service within your organization, and length of service in current position.

3. Indicate the approximate number of accounts for which the proposed account manager will have responsibility. Indicate how many of these are government/public sector accounts versus corporate accounts.

4. Please provide three references from organizations of similar size to the County, for which the proposed account manager provides or has provided account management services. If possible, include a combination of government/public sector and corporate account references

Reference 1 Reference 2 Reference 3

Organization / Company Name

Contact Name

Contact Title

Contact Email Address

Contact Telephone Number

Period of Time Served

Products / Coverages Managed

5. Confirm that you will allow the County the ability to interview and approve any key account changes.

6. Describe the organizational and team chain of command through which the County’s account manager and other account team members will gather information and escalate questions or concerns. Through your response, the County expects to gain an understanding of your team’s ability to be responsive to the County’s needs in a timely manner.

7. Confirm that you will provide on-site counselors knowledgeable with regard to the County’s plans/programs to participate in as many open enrollment meetings and wellness fairs each year as deemed necessary by the County. As a point of reference, in 2024 the County held 4 benefits fairs and 4 open enrollment meetings, though needs may change from year to year.

8. How often does the account team formally meet with their clients? Do you agree to meet w/the County at least on a quarterly basis?

9. What is your proposed mechanism for monitoring the County’s satisfaction with your account team?

2.1.3 Implementation

1. What is the minimum amount of lead time required to implement your proposed program?

2. Confirm you will provide an implementation manager to lead the implementation process if selected by the County.

3. Describe any ongoing responsibilities the implementation manager will have related to the County’s account.

4. Provide a proposed implementation plan, including key milestone dates and task responsibilities for a 12/01/2026 implementation.

5. Please confirm that your fee proposal includes all costs associated with implementation services.

You must provide a detailed description of any possible implementation service and/or fee charge not specifically included in your base fee proposal.

6. Will you provide the County with an implementation credit to assist with the cost of any transition activities, employee communications, information technology services, etc.? If so, explain.

2.1.4 Eligibility, Claims and Account Administration

For the following questions, if your answers vary based on PPO vs HMO, please provide a clear response for each product.

1. Describe what options are available to transfer member eligibility from Cook County to your organization? Confirm that your eligibility file requirements are HIPAA and EDI compliant.

2. Please confirm whether you have the capability of receiving and loading data provided by the current carrier to allow for tracking of historical maximums (e.g., orthodontia).

3. Can Cook County make eligibility changes online? If not, do you have a process for making eligibility updates more immediate?

4. Are eligibility updates shared online in real-time with providers? Yes or no.

5. Describe your internal controls related to eligibility. What protocols to you have to audit eligibility?

6. What is the name of your claims system? Do you anticipate any significant changes to your claim system during the duration of this contract, if awarded the business?

7. Are your eligibility and claims systems integrated?

8. Describe your proposed model for the County’s claims processing team. Address:

a. Whether the team would be dedicated or designated

b. Number of team members

c. Approximate number of clients serviced by team members (if a designated model).

9. Confirm you will provide administrative manuals including procedural information on all plan administration and claims procedures by the plan effective date.

a. Confirm you will update the administrative manuals and provide to the County within one month of change of practice or procedure affecting the administration of the plan.

10. Describe your claims administration procedures. Include:

a. How Reasonable & Customary expense allowance is determined

b. How often UCR is updated

c. What Usual, Customary & Reasonable percentile is utilized to process dental claims.

11. What guarantees do you provide to ensure members will not be balance billed for in-network services for the PPO?

12. Indicate in the chart below your claims processing accuracy service standards and results for the most recent two years.

Element Standards as of 1/1/2025

Actual For CY2024

Actual For CY2023

Claims Processing Turnaround time (xx.xx% with xx business days)

Claims Processing Accuracy (xx.xx% of all claims paid)

Claims Payment Accuracy (xx.xxx% of all claims paid)

13. What percentage of claims are submitted electronically and auto-adjudicated?

PPO HMO

% of claims submitted electronically for CY2024

% of claims auto adjudicated for CY2024

14. Describe your internal control procedures to detect claims processing errors, including any internal Quality Assurance process to sample claims along with supporting documentation.

15. Is your DHMO a capitated arrangement? If so, what claims data are providers expected to provide to your organization? What level of claims data (if any) can be provided related to HMO experience?

16. Will any aspect of the County’s current plans, as documented, require special handling by claims processors? If so, please identify the plan, the plan provision, and your proposed approach to handling.

17. Briefly describe the process utilized to set up and verify the County’s plan provisions in your system.

18. Provide a brief summary of the training programs in which your claims processors are required to participate.

19. What guidelines, processes, or procedures do you use to determine whether a service is “necessary and appropriate” vs “experimental or investigational” in nature? Please provide details.

20. Does your standard contract include a “Lowest Expensive Professionally Acceptable Treatment (LEPAT) clause or similar provisions? Please describe any provisions you have in your contracts related to this area.

21. How do you identify and address inappropriate patterns of dental treatment? Briefly describe your fraud and abuse program.

22. Do you have any mandatory pre-determination provisions?

23. Related to ID cards:

a. Confirm you have provided a sample ID card. If not explain.

b. Confirm ID cards will be customized at no additional cost. If not, explain?

24. Will you provide printed HMO and PPO directories at no cost to the County for use in the HR department?

a. If yes, how often will these provided?

b. Are you willing to provide a supply of them for distribution for employees that visit the office at no cost?

25. Describe the steps you take to protect patient privacy. How is Protected Health Information (PHI) handled?

2.1.5 Enrollment

1. Describe any eligibility tools you offer.

2. Describe any enrollment tools you offer.

2.1.6 Member Services

1. For the Member Services team proposed for the County, provide:

Proposed location(s) of Member Service Center

Proposed model (dedicated, designated, other)

Estimated # of team members

Average # of clients serviced by each team member

Average # of members serviced by each team member

Average tenure of team

Median tenure of team

Annual turnover rate

Member Service Lead

Name

# of Accounts/Clients Serviced and Total Members

Years/Experience

2. What are the hours of operation?

3. Can members chat with a live person via their computer, or are there only chatbots?

4. Describe any required training in which your member services representatives are required to participate.

5. Confirm you will work with the County to develop and approve member service scripts prior to the effective date and throughout the contract period as the County deems necessary. If not, explain.

6. Confirm you will provide the County with a dedicated IVR member services phone number at no additional cost. If not, explain.

7. Is there a mechanism for members to quickly reach a live member services representative? If so, explain.

8. For the member services call center proposed for the County, indicate in the chart below your member service standards and results for the most recent two years.

Element Standards as of 1/1/2025

Actual For CY2024

Actual for CY2023

Average Speed of Answer (xx seconds)

Abandonment Rate (xx.xx%)

First Call Resolution (% of calls without callbacks within 45 calendar days)

Wait Time (xx seconds)

9. Describe your process for first call resolution.

10. Describe how service inquiries are tracked and reported.

Are all calls recorded?

Will you allow the County to listen to a recorded call if an issue arises?

How long are recorded calls archived?

What types of calls do you document in your call tracking system?

What percentage of member service inquiries are documented in your call tracking system?

How are calls prioritized?

What percentage of member service calls is audited?

11. Describe your process for handling grievances.

12. Do providers and members utilize the same customer service phone number? If so, please explain how each is routed to the proper resources.

13. Will your customer service team accept warm transfers from and provide warm transfers to the County’s other vendor partners, including its medical vendor, any third-party wellness and consumer tool providers, etc.? If not, please explain.

14. Do all member services representatives have real-time access to claims history/status, plan design summaries/plan documents, and the history and status of member questions/complaints?

15. Can member services representatives re-process a claim?

16. How are after-hours calls handled?

17. Will your member services department support the annual enrollment prior to the plan effective date to answer questions from non-members at no additional cost? Please explain.

2.1.7 Web Capabilities

1. Please provide your web address and a guest logon ID and password so that County may view your online site demo.

2. Which of the following services are currently available through your member website? For those that are not currently available, which will be available by December 2026 through your website?

Current Y/N

As of 12/1/2026

Member Support

Can members:

1. Access provider credentialing/statistical information?

2. Access provider directories? Or check whether providers are in the network?

3. Access provider directories with driving instructions?

4. Access provider quality information?

5. Participate in community forums?

If no, does your website link to this type of site?

6. Access benefit plan summaries?

7. Check eligibility?

8. Order replacement ID cards?

9. View and print ID cards from the website?

10. “Talk” to providers (i.e., “Ask-the-Dentist”)?

11. Research symptoms, conditions or wellness information?

12. File a claim?

13. Review a history of claims?

14. Download printable versions of claim forms?

15. Check claim status?

16. Submit appeals?

17. Access cost estimators?

18. Submit inquiries to member service via email?

19. Ability to access and complete satisfaction surveys?

20. Access to download smart phone applications?

Provider Support

Can providers:

21. Verify in “real-time” the eligibility status of members?

22. Create virtual dental records for their patients?

23. Access dental history for their patients?

24. Submit claims?

Plan Sponsor/Employer Support

Can the employer:

25. Check claim status online?

26. Update eligibility online?

27. Create reports online?

3. Please describe any other services or resources available through your website but not referenced above.

4. What is your BOB percentage for members that are registered on your web portal?

5. What metrics are used to evaluate web portal usage?

Yes or No?

Number of unique users

Average hits per unique user

Type of information sought

Number of times a particular link/data page is accessed

Usage by business unit segment (via account structure)

6. What mobile technology applications do you currently offer to engage members? Which ones are currently in development?

2.1.8 Dental Care Management

1. Describe any dental care management programs and services (e.g. risk assessments, disease management programs, care reminders, etc.) you can offer the County. Indicate whether these programs/services are offered as part of your base fee or at an additional cost. If there is an additional cost, please detail.

2. Describe your approach to ensuring members receive appropriate preventive and diagnostic services.

3. Outline your approach to proactively identify members in need of covered dental services beyond preventive and diagnostic services.

Communications

1. Confirm you will draft an introductory communications piece and disseminate to all employees via US Mail prior to open enrollment at no additional cost. Confirm postage is included? If not,

2. Confirm you will draft plan booklets for all of the County’s plans and will work with the County to customize these documents as necessary at no additional cost. If not, explain.

3. Indicate the types of communications support you will provide the County and its members with regard to general information / education and with regard to open enrollment.

Communications

Vehicle

General

Information/Education

(Y/N)

Open

Enrollment

(Y/N)

Can it be customized?

(Y/N)

Website

Newsletters

Brochures

Direct Mail

Posters

Enrollment Guides

Employee Meeting Support

Videos

Employee Training

Employee Worksheets

Smart Phone Apps

Other (please list)

4. Confirm that communications can be co-branded. If not explain.

5. Confirm you have provided a sample EOB. If not, explain.

6. Can EOB messages be customized? Explain and identify any restrictions.

2.1.9 Network Management

Please answer all network-related questions relative to your Chicago-area network. If your answers vary PPO vs Dental HMO, please answer for both.

1. Does your organization still print provider directories? If so, please provide an electronic version for the Chicago area for both the PPO and the Dental HMO.

1. Confirm the following indicators are included for each provider within your provider directory.

Indicator Included in Directory (Y / N)

Accepting new patients?

Services provided

Specialties

Board accreditation

Languages spoken

Hours of operation

Accepts credit cards?

Other (please describe)

2. Do you own your provider network or contract with other organizations? If you contract with other organizations, please provide those organizations’ names.

3. How often is your online directory updated?

4. How often is your print directory updated?

5. Please provide an indication of your network access by completing the following table for each of your networks offered in the Chicagoland area.

Type of Dentist

/ Specialist

Number of Unique

Providers

(Chicagoland Area)

Number of Provider

Locations

(Chicagoland Area)

Number of Providers with

Open Practices

(Chicagoland Area)

PPO Network: What is the name of this network? (Indicate here)

General / family dentist

Endodontist

Oral surgeon

Orthodontist

Pediatric dentist

Periodontist

Other (explain)

Total

Dental HMO Network What is the name of this network? (Indicate here)

General / family dentist

Endodontist

Oral surgeon

Orthodontist

Pediatric dentist

Periodontist

Alternative Network (if any) What is the name of this network, and what type of network is it (PPO vs HMO)?

General / family dentist

Endodontist

Oral surgeon

Orthodontist

Pediatric dentist

Periodontist

For each network you are proposing, please answer the following questions if the answers vary by network. (Clearly state if they are the same PPO vs HMO).

6. What percentage of providers are not accepting new patients?

7. What percentage of your providers have office visit waiting times in excess of 30 days?

8. Do you anticipate any significant contract changes that will impact your provider network breadth or discount levels in the Chicago-area in the next 24 months? If so, please explain.

9. Are you willing and committed to recruiting “must have” providers? If so, please explain your recruitment process.

10. Provide your network turnover rate or rate of termination. What is the provider-initiated rate of termination? What is the network-initiated rate of termination?

11. Within what timeframe will you commit to reflecting network changes in your provider directories and online look-up/search tools?

12. Describe your credentialing and re-credentialing processes.

13. Do you have a set of quality indicators that are utilized to evaluate providers within your Chicago area network? If so, do you administer an incentive program to reward providers that are evaluated favorably against your quality indicators? If so, explain.

14. Outline the steps you take to investigate member-reported quality of care issues regarding a provider.

15. Have you terminated network dentists based on your investigation of a member-reported quality complaint? If so, please explain.

2.1.10 Network Access

In order to allow our assessment of your Chicago area network adequacy, please follow the instructions below when preparing the requested GeoAccess and Disruption Analyses. Please prepare both analyses for each network option you propose offering the County.

GeoAccess

Please identify the percentage of Cook County enrollees by market that have access to:

Provider Type Standard

General dentist 2 providers within 5 miles

Provider Type Standard

Oral surgeon 2 providers within 5 miles

Orthodontist 2 providers within 5 miles

Please use the following guidelines while performing the analysis:

1. Include all records on the census data provided in Exhibit IV Cook County Employee Census

2. Exclude closed practices from analysis.

3. Use driving distance to calculate GeoAccess results.

Responses should include at least three reports (one based on Proposed DHMO Network, one based on

Proposed PPO Network, and a report for each alternative plan offering). Each report should contain the following sections repeated for each provider type. Please provide the reports in excel as well as in PDF format.

1. Title Page

2. Accessibility Summary: EEs with Access

3. Accessibility Summary: EEs without Access

The above 3 sections should be repeated for each of the following provider types:

1. General dentist

2. Oral surgeon

3. Orthodontist

Please do not provide maps or other pages not requested above.

Disruption Analysis In order to determine the potentially disrupted provider relationships and recruitment needs, please append at least one column to the appropriate tabs in “Exhibit III Dental Discount and Network” Please provide the name of the network used as the field header and either a “Y” or “N” for each provider record to indicate if the listed provider is an in-network provider. If you are offering multiple PPO or HMO network options, you may append additional columns to either the HMO or PPO file as appropriate. Please remember to perform this analysis for each of your proposed networks:

1. DHMO network

2. PPO Network

3. Alternative network(s)

Please use the following guidelines while performing the analysis:

1. You may include providers in your rental networks as in-network if they are part of the networks that are being quoted for the RFP.

2. If a provider is not currently a part of your network but has a contract in place and will be effective at a later date, you can include them as a “Yes-Effective [Insert Date]” response, but you must include a provider contract effective date.

2.1.11 Network Discounts

In order to assess your network financials and capabilities please follow the instructions below to provide Self-Reported Discount Levels, Market Basket Discount Levels and Repricing Information. Please provide all three sets of information for each proposed network.

Self-Reported Provider Discount Levels

Complete the tables in “Exhibit III Dental Discount and Network Usage, related to average provider discounts, based on your book of business for services delivered in the Chicago area, which were reimbursed on a fee-for-service basis to persons covered under group dental plans.

Please remember to perform this exercise for each of the proposed networks:

1. DHMO network

Market Basket Analysis

Please provide Average Allowed Charges and Average Discount Percentages for in-network providers from your Book of Business (most recent 12-month period) for each combination of 3-Digit Zip Code and

Procedure Code in the spreadsheet, “Exhibit III Dental Discount and Network” Please remember to perform this exercise for each of your proposed networks:

1. DHMO

Repricing Analysis

Please reprice each claim line in the provided files named “Exhibit III PPO Repricing Data.xlsx” and append the amounts allowed under your current network contracts, excluding any and all network access and TPA fees, as the last field in the file. This repricing must be performed for the following proposed networks:

1. PPO Network

2. Alternative PPO network(s)

If your organization is unable to reprice a claim or the provider is a non-participating provider, the eligible billed amount (100% of the total charge) must be input into the repriced amount. The repriced amount is to represent your allowed amount (allowed = total eligible billed amount - network discount) of your network contract with the provider for services rendered and must not represent prompt pay discounts. Your organization is to assume that all charges are covered and there is to be no adjustment for plan design - allowed amount is all that is represented in the repriced amount.

All network analysis documents must be returned to the County with all of the original fields and the exact number of records that were included on the original file. Please utilize the below naming convention for all returned documents:

Original attachment: PPO Repricing Data.xlsx

Renamed attachment: Your Company Name – PPO Repricing Data.xlsx

2.1.12 Reporting and Data

1. Provide a list and provide samples of the reports (electronically, in Excel or PDF) included in your standard reporting package and the frequency of the reports. Please be sure to demonstrate all plan costs and utilization metrics that will be reported upon. Provide reports made available for your PPO product as well as the Dental HMO Product.

2. Confirm you will provide reporting by whatever plans, locations, unions etc., that the County deems necessary. If not, explain.

3. Describe the online reporting system that the County will have access to. Provide an overview of functionality. Describe the County’s ability to customize reporting using the online system.

4. Can online reports be scheduled to automatically push to the County, or must the County visit the portal to get all reports?

5. Confirm that during implementation, you will set up any custom report forms that the County deems necessary at no additional cost. If not, explain.

6. Please provide login information for access to an online reporting demo site.

Confirm you will provide reporting to support analyses related to the agreed upon performance guarantees. If not, explain.

2.1.13 Billing & Banking

1. Please confirm your agreement with the following invoicing/payment arrangement. Proposer will invoice the County for premiums or claims payments and administrative services on a monthly basis. Please outline the various timeframes and methods you accept for remitting payment, noting any favorable financial terms of each.

2. Please describe your standard banking arrangement and all options available to the County.

3. Do you offer early-pay discounts with ACH transactions?

4. Do you require an initial or ongoing balance in the bank account from which self-insured claims are paid? If so, describe.

5. Confirm you have provided a sample bill/invoice, similar to what you would regularly supply the County. If not, please explain.

6. Do you have the ability to customize your bills/invoices based on the County’s needs? Please

7. What options exist for the payment of penalties resulting from unmet performance guarantees (e.g. check, offset to monthly billing, etc.)?

2.1.14 Financials and Performance Guarantees

1. Confirm all quoted premiums and/or administrative fees have been provided in “Exhibit II Price

Proposal.xlsx” and are guaranteed for a minimum of 3 years. If not, please explain.

2. Confirm rates do not include any commissions.

3. Please describe the performance guarantees that you would suggest offering the County.

4. Confirm you have included in Exhibit II Price Proposal.xlsx all possible fees that could be charged to the County beyond your provided base premiums or fees.

3 SCHEDULE

The County anticipates the following Schedule:

RFP Posted to Bonfire Wednesday, September 17, 2025

Pre-Proposal Conference Wednesday, September 24, 2025

Proposer Inquiry Deadline Thursday, September 25, 2025

Proposal Due Date Wednesday, October 29, 2025

4 INSTRUCTIONS TO PROPOSERS

4.1 Instructions

This RFP provides potential proposers with sufficient information to enable them to prepare and submit proposals. This RFP also contains the instructions governing the submittal of a proposal and the materials to be included therein, including the County requirements, which must be met to be eligible for consideration. All proposals must be complete as to the information requested in this RFP in order to be considered responsive and eligible for award. Proposers providing insufficient details will be deemed non-responsive. The County is not obligated, either to purchase the full services or the products proposed by the proposer, nor to enter into an agreement with any one proposer.

4.2 Availability of Documents

The County will publish its competitive RFP, and other procurement notices, as well as award information at:

Current Contract Opportunities - Cook County (cookcountyil.gov)

Bonfire Vendor Portal - Open Opportunities

Procurement - Awarded Contracts & Amendments | Cook County Open Data (cookcountyil.gov)

Interested proposers should note that, unless otherwise stated in the Bid or RFP documents, there is no charge to obtain a copy of the RFP documents and respond to documents posted for competitive solicitations. Proposers intending to respond to any posted solicitation are encouraged to visit the web site above to ensure that they have received a complete and current set of documents. Some procurement notices may provide a downloadable version of the pertinent documents and any amendments to them, that will be available to proposers after they have completed a simple registration process.

Any proposers receiving a copy of procurement documents from a bid referral service and/or other third party are solely responsible for ensuring that they have received all necessary procurement documentation, including amendments and schedules. The County is not responsible for ensuring that all or any procurement documentation is received by any proposer that is not appropriately registered with the County.

4.3 Pre-Proposal Conference

The county will hold a Pre-Proposal Conference on the date and time indicated below.

Representatives of the County will be available to answer any questions regarding services requested or proposal procedures.

Click the Link Below to Join the Live Pre-Proposal conference:

Date: Wednesday, September 24, 2025, at 10:00 AM (Local Time – Chicago)

Web Link: Microsoft Teams

4.4 Special Access to the Pre-Proposal Conference

If special accommodations are required for Proposer to participate in the Pre-Proposal conference, contact the contact person listed on the cover page of this RFP via email no later than three (3) days before the event.

4.5 Clarifications

All questions/inquiries regarding this RFP must be submitted in writing no later than Thursday, September 25, 2025 at 12:00 PM Local Time – Chicago only via the link below:

4.6 Submitting the Proposal Package

The Proposal and the Pricing Proposal shall be submitted to the OCPO electronically as per the instruction in Exhibit I – Instructions for Submitting an electronic Bid/Proposal/Qualification. OCPO will not accept hardcopy proposals. The proposer remains responsible for ensuring that its Proposal is received at the time, date, and manner specified. The County assumes no responsibility for any Proposal not so received. Late Proposals will not be accepted.

https://www.cookcountyil.gov/service/current-contract-opportunities https://datacatalog.cookcountyil.gov/Finance-Administration/Procurement-Awarded-Contracts-Amendments/qh8j-6k63/data https://datacatalog.cookcountyil.gov/Finance-Administration/Procurement-Awarded-Contracts-Amendments/qh8j-6k63/data https://www.google.com/url?q=https://teams.microsoft.com/l/meetup-join/19%253ameeting_OWFjNzlhNjQtN2M2ZC00NmQ4LWEzZWItYjIwMDMxZGI0NTE3%2540thread.v2/0?context%3D%257b%2522Tid%2522%253a%2522a40e3dcb-ee86-4181-8ede-cc9e1836463d%2522%252c%2522Oid%2522%253a%2522b94d328c-5c7d-47c4-8d81-067ea0661883%2522%257d%26launchAgent%3DGSuiteAddOn%26correlationId%3Dbe001362-6a09-4024-9b5b-29d4f37d7287&sa=D&source=calendar&ust=1757887077905681&usg=AOvVaw3Os-2CD7t0bYVImHYJZ61B

4.7 Uniformity

To provide uniformity and to facilitate comparison of Proposals, all information submitted must clearly refer to the page number, section or other identifying references in this RFP. All information submitted must be noted in the same sequence as its appearance in this RFP. The County reserves the right to waive minor variances or irregularities.

4.8 Proposal Material

The Proposal material submitted in response to the RFP becomes the property of the County upon receipt by the Office of the Chief Procurement Office and will be part of any contract document for the goods or services which are subject to this RFP.

4.9 Addenda

Should any proposer have questions concerning the conditions and specifications, or find discrepancies in or omissions in the specifications, or be in doubt as to their meaning, they should notify the Office of the Chief Procurement Officer no later than September 25,2025, by 12:00 PM Local Time – Chicago to obtain clarification prior to submitting a Proposal.