8-B-4 - Vision Vendor Response Exhibits.xls

This is a vision vendor response exhibits document and benefits outline for the Saint Louis Public Schools District, detailing requirements for vision plan administration and provider network compliance. The District seeks vision plan coverage for active and retired employees with benefits including eye exams, lenses (single, bifocal, trifocal, lenticular, and progressive), frames, contact lenses, and related optical services. The document specifies benefit frequencies of 12 exams and 24 materials per 24-month period and outlines copay structures differentiating between in-network and out-of-network services. The file includes comprehensive provider network data reflecting claims history from January 1, 2015 through December 31, 2015, listing approximately 150+ vision care providers across Missouri and Illinois with details on total claimants, claim counts, and claim amounts for both base and buy-up plan options.

The pricing structure establishes employee contribution rates of $1.38 for employee-only coverage and $3.72 for employee plus one dependent under the base plan, with corresponding buy-up plan rates of $3.48 and $9.08 respectively. In-network copays are set at $10 for exams and materials, with out-of-network copays at $36 for exams; frame allowances range from $40 (wholesale, approximately $100-$120 retail) in the current plan to $50 (wholesale, approximately $125-$150 retail) in the proposed plan. Contact lens coverage is available at $105 under the current plan and $130 under the proposed plan. The document requires vendor responses to a detailed questionnaire addressing benefit frequency tracking, coverage terms, network administration, claims processing, member services standards, and performance guarantees including answer time, hold time, abandonment rates, claim processing turnaround, and payment accuracy metrics.