8-RFP 09 Attachment 1 Sections A-E.xlsx
XLSX spreadsheet 846 KB Posted
- Attached to
- Employee Vision Benefits
- Solicitation number
- RFP26-68
- Issued by
- Los Alamos County, New Mexico
About this file
This is a Request for Proposal (RFP) attachment document for Los Alamos County, New Mexico, detailing minimum requirements and technical specifications for fully-insured vision insurance benefits for County employees, with a proposed effective date of January 1, 2027. The RFP requires vendors to provide comprehensive vision coverage including eye exams, lenses, contacts, and frames through a network of retail, chain, and specialty providers. Vendors must maintain or enhance existing plan benefits and agree to continue current coverage on a no-loss/no-gain basis for all covered participants. The proposal document establishes minimum requirements for vendor compliance, including HIPAA privacy and security standards, New Mexico licensure or willingness to obtain licensure, and an established provider network specifically in Los Alamos, Espanola, Santa Fe, Taos, Albuquerque, and Rio Rancho. The RFP requires vendors to complete comprehensive questionnaires and technical sections covering organizational details, insurance policies, customer service capabilities, implementation timelines, and detailed vision care coverage specifics.
Vendors must submit fully-insured rates guaranteed for a minimum of two years from the effective date, with three or more years of guaranteed rates preferred, with renewal rates due 120 days prior to renewal. All proposed rates must be quoted net of commissions, overrides, contingencies, service fees, and premium taxes, as Los Alamos County is exempt from premium tax under New Mexico state statute. The County requires no more than 30-day contract termination notice with no penalties for late notification or termination off-anniversary. Vendors must provide quarterly claims reporting, maintain a designated customer service representative, produce Summary Plan Descriptions within 30 days of the effective date, and submit four sample Evidence of Coverage/Certificate of Coverage documents. Additional requirements include completion of all exhibits and questionnaires in requested formats, submission of a detailed deviation statement from RFP requirements, agreement to audits, and demonstration of provider network accessibility across specified geographic areas in New Mexico.
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A - Minimum Requirements
| Section A - Minimum Requirements |
| Los Alamos County |
| RFP Vision Insurance Benefits for Los Alamos County Employees |
| Proposed Effective Date: January 1, 2027 |
If you are unable to agree to any of the stipulations noted below, you must provide an explanation for your inability to comply. Your inability to meet a minimum requirement, may or may not lead to a deduction in point value attributed to your proposal or a disqualification of your bid.
Benefits
Continuation of the existing plan benefits, or better, and incorporating a network of retail, chain and specialty providers. Enhancements to the existing plan design must be fully illustrated and any cost impact indicated.
Funding
| Quote on a fully insured basis . Illustrate your rates in the Cost Proposal Worksheet. | |||
| Agree | Disagree | ||
| 1 | The effective date of 1/1/2027 for coverage is acknowledged and accepted. | ||
| 2 | Fully insured rates must be guaranteed for a minimum of two (2) years from the effective date with 3 or more years of guaranteed rates preferred. If you are offering a guarantee or rate cap for subsequent years, indicate this on the mandatory Cost Proposal Response Form. | ||
| 3 | The rates / fees shall not include commissions, overrides, contingencies or service fees. | ||
| 4 | Renewal rates must be submitted 120 days prior to the renewal date. | ||
| 5 | Plan summaries of quoted plans must be provided. | ||
| 6 | The vendor will be responsible for producing the Plan Document / Summary Plan Description. Consultant and Employer reserve the right to review / revise the SPD prior to final printing. | ||
| 7 | Vendor agrees to provide an Summary Plan Description/document draft within 30 days of the effective date. | ||
| 8 | You must provide a designated customer service representative for this group | ||
| 9 | Insured coverage must be provided on a no-loss / no-gain basis for all covered participants so the current group does not suffer a loss of benefit solely due to the transfer of coverages to your firm. | ||
| 10 | You must agree to waive the “actively at work” provision for the currently enrolled. The master contract will reflect the elimination of the actively at work restriction or deferred effective date for all initially enrolled active or inactive employees and dependents. This will include only initial eligibles (those eligible on the effective date of the contract) including COBRA continuees. | ||
| 11 | You are in compliance with all HIPAA Privacy and Electronic Data Interface (EDI) requirements. | ||
| 12 | You are in compliance with all HIPAA Security Regulations. | ||
| 13 | You have reviewed and accept the Plan’s eligibility provisions outlined in the RFP. | ||
| 14 | Your contract must require no more than a 30-day notice of termination by the County. Your contract cannot prohibit the group from terminating coverage at any time. There must be no penalties for late notification or for termination off anniversary. | ||
| 15 | Claims reporting is requested on a quarterly basis. | ||
| · If you are unable to provide claims experience on a quarterly basis, please describe frequency and format of claims reports. If you are unable to provide any reporting, please explain the reason. | |||
| 17 | You must be licensed in New Mexico, or willing to obtain a license in New Mexico. | ||
| 18 | You currently have a provider network in New Mexico but specifically Los Alamos, Espanola, Santa Fe, Taos, Albuquerque, or Rio Rancho | ||
| 19 | Vendors may be required to attend Open Enrollment meetings. | ||
| 20 | Vendor has specifically listed all deviations from the RFP and coverage requirements on the Submission of County’s Standard Sample Service Agreement with Deviations or Exceptions Noted or Statement of No Deviations or Exceptions. NOTE: Deviations MUST be listed; you cannot simply make a “general” reference to section(s) of the proposal. | ||
| 21 | You completed all questionnaires and exhibits in full and in the format requested (e.g., Word or Excel – not PDF). | ||
| 22 | By New Mexico State statute(s), insurance premium tax does not apply to public entity employers including, but not limited to, cities, counties, school districts, etc. Confirm your understanding that the County is NOT subject to premium tax or commissions, and that your financial rates are proposed NET of any premium tax and commissions. | ||
| 23 | Vendor agrees to audits conducted by the County or their chosen auditor. Vendor agrees to make available all provider records to the County or its representatives (e.g. County auditiors, actuary, etc.) |
B - General Questionnaire
| Section B - GENERAL QUESTIONNAIRE |
| Los Alamos County |
| RFP Vision Insurance Benefits for Los Alamos County Employees |
| Proposed Effective Date: January 1, 2027 |
VENDORS MUST COMPLETE AND PROVIDE RESPONSES IN THE COLUMN AT THE RIGHT. IF NOT APPLICABLE, INDICATE "N/A"
| 1 | Provide a brief description of your organization, to include, at a minimum: parent company and location; quoting organization and location, if different; and subcontractors/partners, if any. | ||
| For each organization noted, provide: | |||
| Date formed | |||
| Where is your corporate headquarters located? | |||
| Number of employees | |||
| How many New Mexico employers with greater than 500 employees are administered by your organization? | |||
| Have you recently been acquired or been involved with any merger/acquisition? If yes, describe. | |||
| Provide company’s organization chart, including client service team and locations of service team. | |||
| 2. | Do you carry an Errors & Omissions policy? | ||
| What are the policy limits and deductible? | |||
| 3. | Do you carry a comprehensive general liability policy? | ||
| What are the policy limits and deductible? | |||
| 4. | Does your company carry a fidelity bond? | ||
| What are the policy limits and deductible? | |||
| What are the combined aggregate funds held for all clients? | |||
| 5. | What is the average size of New Mexico employers that you cover? | ||
| 6. | What customer service office will be responsible for this account? Provide the following: | ||
| Location of office | |||
| Size of office | |||
| Days and hours of operation | |||
| Will you provide a toll-free number? | |||
| 7. | What is the normal lead-time required to implement a group? | ||
| 8. | Please outline details regarding your transition/implementation process. | ||
| 9. | Do you require a deposit? | ||
| If so, how much do you require? | |||
| Can the deposit requirement be waived? | |||
| What are the requirements for waiving the deposit? | |||
| 10. | What mediums do you accept for plan enrollment? | ||
| 11. | When are premiums due under your policy? | ||
| What is the grace period? | |||
| If premium is paid after the grace period, is a penalty and/or interest charge assessed? | |||
| If yes, explain in detail. | |||
| Are there any options available with respect to the grace period? | |||
| If so, explain the option(s) and any charge that is made for them. | |||
| 12 | Describe all Support/Educational tools that are availble for the County HR department as well as employees (add extra lines as needed) | ||
| 13 | Which of the following tasks can members and plan sponsor representatives perform online? (check all that apply) | Members | Plan Sponsors |
| Billing (Plan Administrators only) | N/A | ||
| • ID Card request | |||
| • Claim inquiry | |||
| • Other | |||
| • Other |
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C - Technical Questions
| Section C - Technical Questions |
| Los Alamos County |
| RFP Vision Insurance Benefits for Los Alamos County Employees |
| Proposed Effective Date: January 1, 2027 |
A. VISION CARE
| 1. | Deviations from the specifications: | ||
| · Will your organization underwrite and administer the benefit program exactly as shown in this material? | Yes | No | |
| · Will your organization require any additional information or impose restrictions on benefit selections? | Yes | No | |
| · What occurrences would require your organization to change its proposed rates and fees for the proposed effective date? | |||
| · Please list any other items that can be considered deviations from the specifications. | |||
| 2. | Which services are covered in a comprehensive eye exam? Complete the following chart. | Indicate “Yes” if service is included in the exam | Indicate “No” if service is not included in the exam |
| Exam Includes: | |||
| · Case history | Yes | No | |
| · Recording corrected and uncorrected visual acuity | Yes | No | |
| · Internal exam | Yes | No | |
| · External Exam | Yes | No | |
| · Pupillary reflexes | Yes | No | |
| · Binocular Vision | Yes | No | |
| · Objective refraction | Yes | No | |
| · Subjective refraction | Yes | No | |
| · Test for glaucoma | Yes | No | |
| · Slit lamp exam (biomicroscopy) | Yes | No | |
| · Dilation (as indicated and permitted) | Yes | No | |
| · Color vision | Yes | No | |
| · Corneal Topography | Yes | No | |
| · Depth perception | Yes | No | |
| · Other | Yes | No | |
| 3. | How often are benefits payable for the following: | ||
| · Eye exam | |||
| · Lenses | |||
| · Contacts | |||
| · Frames | |||
| 4. | What type of coverage do you offer for contact lenses? | ||
| · Does your contact lens coverage include disposables? | Yes | No | |
| 5. | Do you offer a mail service contact lens program? | Yes | No |
| 6. | What types of frames are available under your plan? | ||
| · Are patients limited to a certain selection? | Yes | No | |
| 7. | Describe any restrictions on members in accessing providers for materials. |
B. VISION CLAIMS ADMINISTRATION
| 8. | During each of the last two years, what percentage of claims processed by your organization was for services provided by a network provider? | ||
| 9. | Are any authorization forms or ID cards issued and/or required? | Yes | No |
| 10. | Do members pay up front and submit claims for reimbursement, or are members responsible only for plan copays? |
C. VISION NETWORK
| 11. | With regard to network directories, please respond to the following items. (NOTE: Do NOT include a provider directory with your proposal.) | ||||
| · Are your directories available on the internet or a website? | Yes | No | |||
| · If your provider directories are not available online, how frequently are they updated and distributed? | |||||
| · How are members, plan sponsors and providers notified of changes? | |||||
| 12. | Do you own your provider network, or do you subcontract? | Own | Subcontract | ||
| · If you subcontract, please identify network. | |||||
| 13. | Do you contract with chain stores or retail stores? | Yes | No | ||
| Chain Stores | Yes | No | |||
| Retail Stores | Yes | No | |||
| Neither | Yes | No | |||
| 14. | Are members required to follow a pre-authorization process? | Yes | No | ||
| 15. | What level of in-network utilization do you project for your vision plan? |
D - Network Accessibility
| Section D - Network Accessibility |
| Los Alamos County |
| RFP Vision Insurance Benefits for Los Alamos County Employees |
| Vision Network Analysis |
| Network Accessibility - Please complete the following tables regarding your provider network. | |
| Standard Network Counts | Number |
| All points of access (all doctors at all offices) | |
| All doctors, counted once | |
| All office, counted once |
| Metropolitan Area | # of Ophthalmologists | # of Optometrists | # of Optical Outlets | |
| Total | ||||
| Bernalillo County (871) | ||||
| Los Alamos County (875) | ||||
| Rio Arriba County (875) | ||||
| Sandoval County (871) | ||||
| Santa Fe County (875) | ||||
| Taos County (875) |
List all chains in your network
E - Additional Info Request
| Attachment 1 - Section E - ADDITIONAL INFORMATION REQUEST |
| Los Alamos County |
| RFP Vision Insurance Benefits for Los Alamos County Employees |
| Proposed Effective Date: January 1, 2027 |
Section I. Benefits Plan Booklet
Vendor is required to include four (4) sample Evidence of Coverage / Certificate of Coverage documents.
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