8-Attachment A - Dental RFP Submission Form.xlsx
XLSX spreadsheet 2 MB Posted
- Attached to
- Employee Dental and Vision Benefits
- Solicitation number
- 3708-26.02
- Issued by
- Orange County, Texas
About this file
This is a Dental RFP Submission Form for the Amarillo Independent School District in Texas, designed for vendors to submit proposals for Employee Dental and Vision Benefits coverage. The form serves as the standardized submission document for interested bidders to complete and submit by the 2:00 pm deadline on March 20th, 2026. The RFP seeks comprehensive dental and vision benefits packages to cover the district's employee population, with the submission form functioning as the primary mechanism for vendors to present their proposals, qualifications, and pricing structures in response to the district's requirements.
The submission form establishes the framework for vendors to detail their proposed benefit plans, coverage options, rates, and service delivery mechanisms. As a standardized Excel-based form, it ensures all bidders submit information in a consistent format, facilitating comparative evaluation by the district's selection committee. The form likely includes sections for dental plan details, vision plan details, premium rates, network provider information, and other relevant proposal components necessary for the district to assess vendor capabilities and offerings against stated specifications and requirements.
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Text version
Contacts
| Dental Provider RFP | |
| Solution Provider | Response |
| Organization Name | |
| Street Address | |
| City | |
| State | |
| Zip | |
| Telephone # | |
| Fax Phone # | |
| Web Address | |
| Primary RFP Contact | |
| Name | |
| Title | |
| Address | |
| City | |
| State | |
| Zip | |
| Telephone # | |
| Fax Phone # | |
| E-mail Address |
Informational Responses
| Dental Provider Overview | ||
| ID | General Information | Response |
| G1 | Please provide an overview of your organization, including: years in business and a breakdown of the various lines of business your organization serves | |
| G2 | Provide details of your company’s ownership structure, financial interests and stability. Is your organization privately or publicly held? | |
| G3 | Provide details of any third party relationships you would engage to fulfill services being requested. | |
| G4 | Discuss any impending changes in your organization that could impact the delivery of services, such as impending mergers or acquisitions. | |
| G5 | Are there any restrictions by state and/or federal agencies imposed on your organization? If yes, explain. | |
| G6 | Please provide an overview of your service location(s). Please disclose the primary site from which this account will be serviced. | |
| G7 | Please provide a copies of your standard Agreements (Separate Attachment). | |
| G8 | Please provide evidence of all necessary licenses and registrations required by the Texas Department of Insurance to underwrite and administer fully insured dental benefits in the State of Texas. |
Dental
| Dental | ||
| ID | Question | Response |
| D1 | How many clients/members does your organization currently administer the following plan types: | |
| a. Passive PPOs | ||
| b. Active PPOs with differential benefit levels in and out of network | ||
| D2 | Please describe any DHMO offerings that are available in the Amarillo MSA. | |
| D3 | Do you have different provider network arrangements (e.g., “Preferred/PPO/Tier 1" vs “Participating/Premier/Tier 2”)? | |
| D4 | Please describe the nature of your organizations provider network structure: | |
| D5 | Does your organization lease third party dental network(s) access? If yes, please describe the nature of the relationship(s). | |
| D6 | What is the basis to determine reimbursement for non-network claims? | |
| D7 | Please provide a summary of the number of dental professionals within your organizations network specific to the Amarillo MSA. Please include the following categories: General Dentist. |
Pedodontist or Pediatric Dentist.
Orthodontist.
Periodontist or Gum Specialist.
Endodontist or Root Canal Specialist.
Oral Pathologist or Oral Surgeon.
Prosthodontist.
| D8 | What communication materials (e.g., I.D. cards, letters) are provided to the employee/retiree to identify them as a Subscriber? Please provide samples |
| D9 | How are employees notified of the status of their claims? |
| D10 | Please describe how orthodontic claims are processed and managed. |
| D11 | How do you measure/monitor member/patient/family satisfaction and feedback? |
Performance STD
| Performance Statistics | ||||
| ID | Category | Service Performance | Response | Amount at Risk |
| PS1 | Service | Telephone Responsiveness |
Please indicate statistical performance level data surrounding average wait time of calls answered within 30 seconds. (Example 3%) PS2 Service Abandonment Please indicate the average of member service calls placed on hold, which hang up before a representative is available, in comparison to the number of calls received. (Example 3%) PS3 Service Blockage Rate Please indicate the average of all calls that receive a busy signal over the entire workday. (Example 2%) PS4 Service Turnaround Time Please indicate the average of phone/email/website generated claim inquiries resolved within two working days. (Example 95%) PS5 Service Reporting Please indicate if Semi-annual experience reports were delivered electronically to Plan Sponsor and consultant within 30 days and 90 days after the full year accounting.
PS6 Service Financial Accuracy Please indicate the average of claims processed (financially) accurate. (Example 95%) PS7 Service Claim Accuracy Please indicate the average of claims payments processed accurately. (Example 95%) PS8 Service Processing Please indicate the average of application and /or coverage changes processed within five working days of receipt date. (Example 100%) PS9 Service Claims Timeliness Please indicate the average of all claims processed within 14 calendar days. (Example 95%) PS10 Service Account Management Please indicate the average of Plan Sponsor calls returned in 1 business day. (Example 95%) PS11 Service Account Management Please indicate the average of Plan Sponsor emails returned in 1 business day. (Example 95%)
Plan Design Options
| Benefit Options |
| Current: $1,500 Annual Maximum |
| Option 1: $2,000 |
| Option 2: $2,500 |
| Option 3: $3,000 |
Premium Response
| Dental Premiums (Fully Insured) | ||
| Effective | Year 3 | |
| Current Plan Design | July 1, 2026 | Fee Cap |
| Premiums | ||
| Employee Only | $0.00 | $0.00 |
| Employee + Spouse | $0.00 | $0.00 |
| Employee + Children | $0.00 | $0.00 |
| Employee + Family | $0.00 | $0.00 |
| Effective | Year 3 | |
| Option 1 Plan Design | July 1, 2026 | Fee Cap |
| Premiums | ||
| Employee Only | $0.00 | $0.00 |
| Employee + Spouse | $0.00 | $0.00 |
| Employee + Children | $0.00 | $0.00 |
| Employee + Family | $0.00 | $0.00 |
| Effective | Year 3 | |
| Option 2 Plan Design | July 1, 2026 | Fee Cap |
| Premiums | ||
| Employee Only | $0.00 | $0.00 |
| Employee + Spouse | $0.00 | $0.00 |
| Employee + Children | $0.00 | $0.00 |
| Employee + Family | $0.00 | $0.00 |
| Effective | Year 3 | |
| Option 3 Plan Design | July 1, 2026 | Fee Cap |
| Premiums | ||
| Employee Only | $0.00 | $0.00 |
| Employee + Spouse | $0.00 | $0.00 |
| Employee + Children | $0.00 | $0.00 |
| Employee + Family | $0.00 | $0.00 |
| Implementation Credits | ||
| [credits] | $0.00 | $0.00 |
| [credits] | $0.00 | $0.00 |
| It is required that premiums be guaranteed for a minimum of 26 months. |
| Please include any applicable Implementation Credits. |
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