8-Questionnaire.docx

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Attached to
26P-040 Group Dental Insurance Services for Eligible Employees and Dependents
Solicitation number
26-040
Issued by
Marion County, Florida

About this file

Written by GovTribe AI ·

This is a questionnaire file for Marion County, Florida's Request for Proposals (RFP) 26P-040 seeking qualified insurance carriers to provide comprehensive group dental insurance services for eligible county employees and their dependents. The proposal effective date is October 1, 2026, with a required minimum rate guarantee period of 24 months. Proposers must address all items in the questionnaire, demonstrating their ability to comply with specified requirements including toll-free customer service, monthly invoicing separated by employee divisions, electronic data transfer capabilities, and ACH fund transfer payment acceptance. The selected vendor must provide on-site open enrollment assistance at no cost, maintain a dedicated service representative, obtain Marion County approval for all employee communications, and mail ID cards and member handbooks directly to employees with vendor-paid postage. Additional requirements include COBRA administration, 120-day notice for rate increases, compliance with federal and state statutes, and no exclusions for pre-existing conditions except for late entrants.

The questionnaire requires proposers to provide organizational history, Florida enrollment dates, references from three largest Florida clients by enrollment, information on two terminated clients within 36 months, and current compliance status with Florida Department of Insurance requirements. Proposers must submit member satisfaction survey results, incoming call metrics for 2023-2025, complaint tracking procedures, grievance and appeals processes, and detailed information on provider networks across Marion, Citrus, Lake, and Alachua counties including dentist counts, specialty providers, and GeoAccess summaries showing employee access within 5 and 10-mile radiuses. The proposal must include detailed fee schedules with ADA codes, employee cost-sharing information for specific procedures, provider reimbursement methodologies, website capabilities for provider lookup, claims processing location and turnaround objectives, and credentialing and re-credentialing procedures. Proposers must also disclose any mergers or acquisitions within the past 12 months or planned for the next 12-24 months, confirm the Agent of Record 5% commission inclusion, and provide sample renewal rate determination methodology with experience credibility factors.

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Other files

File Type Posted
4-EXHIBIT B - Current Census.xls XLS spreadsheet
9-RFx - General Terms and Conditions.pdf PDF
6-EXHIBIT D - Top 25 Providers.xlsx XLSX spreadsheet
7-EXHIBIT C - Past Three-Year Claims and Enrollment History.xlsx XLSX spreadsheet
1-Scope of Services.pdf PDF
11-Conflict of Interest Statement Form.pdf PDF
5-EXHIBIT A - Current Plan Certificate.pdf PDF
2-EXHIBIT F - Current Schedule of Benefits.pdf PDF
3-EXHIBIT E - Current Rollover Balance.xlsx XLSX spreadsheet
10-Vendor Information Form.pdf PDF

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Proposers shall clearly describe how they will accomplish each of the items listed in the Scope of Services below. A response to each item is required.

Service Requested
Yes,

Can Comply No, Cannot Comply

1.1
Rate quotation should include a minimum rate guarantee period of 24 months.
1.2
Proposal Effective Date of October 1, 2026.
1.3
Rate quotation is a fully insured funding arrangement.
1.4
Provide toll-free customer service/claim office telephone number for employees.
1.5
Provide monthly Group invoice, separated by divisions identifying Board of County Commissioners and Constitutional Officer employees.
1.6
Accept Marion County monthly premiums paid via ACH fund transfer?
1.7
If you are the selected vendor, you will be required to provide a provider directory file, in the format outlined by Marion County.
1.8
Provide personnel to assist and participate in open enrollment and provide materials for open enrollment at no cost to Marion County.
1.9
Provide on-going access to a dedicated service representative for Marion County to assist Risk and Benefit Services staff with administrative service issues, coverage questions, etc.
1.10
Marion County shall review and approve all communication materials prior to mailing directly to the employee’s home. Postage costs are to be paid by the selected vendor.
1.11
ID Cards and member handbooks are to be mailed in a timely manner directly to the employee’s home, with postage costs to be paid by the vendor. The format and any additions or changes to ID cards shall be approved by Marion County.
1.12
Provide electronic version of plan document to Risk and Benefit Services for employee access via internal benefit websites.
1.13
Supply physical ID Cards?
1.14
You are required to maintain compliance with appropriate Federal and State statutes.
1.15
Variations in actual enrollment shall have no effect on your rate quotation. Your proposal shall be valid regardless of the final enrollment mix.
1.16
There shall be no exclusion provisions for pre-existing conditions, except for late entrants.
1.17
Supply Marion County with standardized monthly reports. These reports will include, but will not be limited to, member-specific information, member enrollment information and/or claim reports.
1.18
Provide COBRA administration for cobra participants. Cost?
1.19
Provide at least 120 days notice on any renewal rate increase or other modification of the policy.

Dental Questionnaire

2.1
Provide a brief (one page or less) history of your organization.
2.2
What date did your organization enroll its first Dental group in Florida?
2.3
Provide references for your three largest clients, by enrollment, for Florida using the following format:

Employer Name

# of Employees Enrolled
Date Services Commenced

Contact Person

Address

Phone Number

2.4
Provide information for your two largest Florida clients who have terminated your plan(s) during the past 36 months using the following format?

Employer Name

# of Employees Enrolled
Date Terminated

Reason

Contact Person

Phone Number

2.5
Is your organization currently in compliance with FL Department of Insurance Statues and requirements? If no, describe why not.
2.6
Provide the location of the office that will manage Marion County’s account and provide the names of the individuals who will be responsible for all aspects of Marion County’s account service.
2.7
Provide a copy of your most recent member satisfaction survey results and indicate the following:

What percentage of survey participants were very satisfied or extremely satisfied with your plan?

Which aspect of your plan’s performance received the lowest average satisfaction score?

2.8
Is member satisfaction information linked to provider compensation? If so, how?
2.9
For incoming calls to your member service department, provide the following:
2023
2024
2025

Average time to answer:

Call abandonment rate:

2.10
Are you able to report the number of complaints (both written and telephonic) received in a calendar year for all plan members (total population) and for Marion County members specifically?

Indicate how you track verbal and written complaints received by your organization.

2.11
How many verbal and written complaints were received per 1,000 members during 2024 and 2025?
2.12
Do you provide physical ID cards? Report the schedule/time frame for ID card distribution. Include an explanation of how providers are instructed to handle members who have not yet been issued member ID cards.
2.13
Will you mail to each member a copy of the benefit plan description detailing the terms and conditions of receiving benefits and documentation of the complaint and appeals process?
2.14
Provide the grievance/appeals procedures for members. Outline the steps and timeframes of the process from initiation to final resolution.
2.15
Are the member grievances/appeals tracked and reported? If yes, are you able to provide Marion County with a report capturing the number and types of grievances/appeals, which are received from Marion County members?
2.16
Can your plan track and report on customer service activity?
2.17
List the specific functions of the members services department (for example, assists members in choosing provider, answers members questions about claims, receive and responds to members’ complaints about providers, etc.).
2.18
What percentage of your member services representatives are bilingual? List the language capabilities available other than English.
2.19
Can you accept electronic data transfers for enrollment, changes, etc.? Do you currently have any clients that use BenTek?
2.20
Marion County Group billing must be separated by divisions identifying the Board of County Commissioners and each Constitutional Officer employees and retirees. Can you comply?
2.21
Are claim forms ever required of patients? If so, in what instances? Include a copy of claim form in your proposal.

Are pre-treatment estimates required? If so, please describe.

2.22
Provide a hard copy of your most up-to-date provider directory for Marion County, Citrus County, Lake County and Alachua County. Also, provide this information on a thumb drive in Excel format.
2.23
Complete the following information on dentist and specialist for the following counties:

County

Total # of Dentists

Total # of Specialists % of Dentists accepting new patients % of Specialty Dentists accepting new patients

Marion

Citrus

Lake

Alachua

County

# of General Dentist

# of Endodontist

# of Periodontist

# of Orthodontist

# of Pedodontist

Marion

Citrus

Lake

Alachua

2.24
Complete the following GeoAccess summary for Marion County employees. The census file is attached. Include a summary report for each of the items listed below with the total number and percentage of employees with access by zip code and by county. Include GeoAccess reports.
a)
Number and percentage of employees with two General Dentists within 5 miles and 10 miles of the employee’s zip code.
b)
Number and percentage of employees with two Specialists within 5 miles and 10 miles of the employee’s zip code.
2.25
Have you changed the size or structure of your network for Marion County during the past twelve months? If so, describe such changes.
2.26
List your top ten dentists/dental group providers (by number of encounters) in Marion County only. Indicate the current contract status and the contract’s expiration date:
Dentists/Dental Group
Contract Status
Expiration Date
2.27
Detail any mergers/acquisitions involving your organization which have occurred in the last 12-month period, and any which are planned for the next 12 to 24 months.
2.28
Do members need to choose and have assigned a specific Dentist? How frequently may members be permitted to change their dentist selection?
2.29
Under what circumstances do members need to obtain a referral to see a specialist?
2.30
Describe, in detail, your out-of-area coverage for traveling members, residing outside established service areas and emergency care after normal working hours both within and outside the U.S. Describe your capabilities for negotiating fees with out-of-area providers.
2.31
Describe, in detail, your out-of-area coverage for dependent students attending school out-of-area. Include your procedures for emergency care, as well as follow-up visits.
2.32
Explain your credentialing process for participating dentists. Do you require periodic re-credentialing of your participating dentists? If so, how often are providers re-credentialed?
2.33
Do you conduct on-site audits of providers in your network? If yes, describe and indicate frequency.
2.34
Describe the specific measures used by your organization to monitor provider access. Provide the most recent corresponding statistics available. (Examples: provider to member ratios, average wait time required for an appointment, etc.)

Average Appointment Wait Times

Type
Weeks

Initial

Hygiene

Routine

2.35
How quickly are members informed when their provider leaves the network? What method of communication is used to notify the member when their provider leaves the network?

______ Before the provider leaves the network.

______ Within two week after leaving the network.

______ More than two weeks after leaving the network?

2.36
Are you willing to aggressively contract with dentists currently used by Marion County employees, both during implementation and on an ongoing basis?
2.37
Do you have a website that provides provider information and directory information? If so, describe your website capabilities and your website address.
2.38
Provide a detailed description of the general reimbursement scheme with Dental providers (Capitated, Discounted Fee-for-Service, Withhold Arrangements, etc.).
2.39
Describe your reimbursement/payment methods for the following types of service:
Service
Capitation
Discount Charges
Full Charges
Other

Restorative

Endodontics

Preventive

Periodontics

Prosthodontics – Removable

Prosthodontics – Fixed

Extractions

Oral Surgery

General Services (office visits after scheduled hours, drug injection, emergency and routine prescriptions, TMJ appliance)

2.40
In the chart below, provide information regarding contracted rates and employee cost sharing for the Marion County Group. Please provide the ADA Code that you are using for each procedure. (Assume zip code 34471)
ADA Code
Description
Allowable
Employee Coinsurance

35.

Periodic Oral Evaluation

36.

Radiographs – 2 films

37.

Radiographs – 4 films

38.

Adult Prophylaxis

39.

Child Prophylaxis

40.

Amalgam – 1 Surface

41.

Amalgam – 2 Surface

42.

Amalgam – 3 Surface

43.

Composite Resin

44.

Porcelain with Gold Crown

45.

46. Porcelain with Nonprecious Metal Crown

47.

48. Porcelain with Semiprecious Metal Crown

49.

Crown Gold Full Case

3 Root Canal Therapy

Osseous Surgery per Quadrant

Periodontal Scaling

Fixed Bridge/Porcelain Gold Crown

Fixed Bridge/Porcelain Semiprecious Crown

Extraction, Complete Bony Impaction

Orthodontic: Global Rate for Normal Adolescent Case

2.41
What controls are in place to prevent unnecessary referrals?
2.42
Provide a complete list of any time frame limitations applicable to procedures. The list must include but is not limited to:
Procedures
Time Frame

Cleaning and Scaling (Prophylaxis)

Fluoride Treatments

Space Maintainers

Routine Examinations

Full Mouth X-Rays

Bitewing X-Rays

Replacement of Existing Appliances

Repair of Existing Dentures

Relining or Rebasing of Existing Dentures

Replacement of Crowns and Gold Fillings

Replacement of Missing and Unreplaced Teeth

Orthodontics

Other(s)

2.43
Where are the dental claims processed? What are the office objectives for claim turnaround and accuracy?
2.44
What percentages of Orthodontists, Maxillofacial Surgeons, Endodontists, and Periodontists have certification in their specialty from an accredited program?
2.45
Does your proposal include a missing tooth clause? If so, how will the missing tooth clause be applied?
2.46
Does your proposal include any type of benefit maximum rollover? If so, please describe how your program works and the dollar thresholds that trigger the benefit. Will you give credit for current accumulated rollover amounts?
2.47
How are the renewal rates and fees determined? Provide sample methodology including experience credibility factors for renewal purposes (e.g., number of years’ experience, number of insured lives, etc.).
2.48
As indicated, the County currently has an Agent of Record in place. Does your proposal include the Agent 5% commission?
2.49
Provide the website URL and instructions on how members will look up in-network providers.
2.50
For out of network services, how are charges determined?

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